Case Report

Pinch-an-inch Test for Appendicitis

Authors: LTC, Bruce D. Adams, MD, FACEP CAPT, Devin Rickett, MD CAPT, Philip A. Albaneze, MD CAPT, Michael D. Jones, MD MAJ, Gerald York, II, MD

Abstract

Rebound tenderness is a widely used examination technique for patients with suspected appendicitis, but it can be quite uncomfortable. An alternative test for peritonitis is termed the “pinch-an-inch” test. This report describes two patients who presented with mild abdominal pain who subsequently were found to have appendicitis. In both patients, classic peritoneal signs were absent, but the pinch-an-inch test was positive. The experienced physician's bedside clinical examination remains the most critical component for rapidly identifying peritonitis. Although rebound tenderness is a widely used examination, it is uncomfortable and may be inaccurate. To perform the pinch-an-inch test, a fold of abdominal skin over McBurney's point is grasped and elevated away from the peritoneum. The skin is allowed to recoil back briskly against the peritoneum. If the patient has increased pain when the skin fold strikes the peritoneum, the test is positive and peritonitis probably is present.


Key Points


* The experienced physician's bedside clinical examination remains the most critical component for rapidly identifying appendicitis.


* Rebound tenderness is a widely used examination, but it is uncomfortable and may be inaccurate.


* Through two case reports, a new examination technique termed “pinch-an-inch” is introduced.


* A fold of abdominal skin over McBurney's point is grasped and elevated away from the peritoneum. The skin is then allowed to recoil back briskly against the peritoneum. If the patient has increased pain when the skin fold strikes the peritoneum, the test is positive and peritonitis is presumably present.

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