Positive psoas and obturator signs are highly suggestive of which condition?

• A. Pelvic inflammatory disease
• B. Ovarian torsion
• C. Acute appendicitis
• D. Pancreatitis

Answer: (C)

Irritation of the iliopsoas and obturator muscles signals inflammation in the right lower quadrant, which is most commonly due to appendicitis. The psoas sign comes from irritation of the iliopsoas when the hip is extended or the thigh is resisted during flexion; it reproduces pain because the inflamed appendix (often retrocecal) presses on the psoas muscle. The obturator sign occurs when the hip is flexed and internally rotated, which stretches the obturator internus; pain here indicates irritation in the pelvis from an inflamed or nearby appendix. When both signs are present, acute appendicitis is the most likely diagnosis, especially if the appendix is in a retrocecal or pelvic position.

Other conditions can cause abdominal pain, but these specific maneuvers are most characteristic of appendiceal irritation and are less typical for pelvic inflammatory disease, ovarian torsion, or pancreatitis.