The Kemp Sign: A Telltale Indication of Appendicitis

The Kemp sign, also known as the obturator sign, is a medical sign that indicates irritation of the obturator internus muscle, which is located in the inner thigh. It is commonly associated with appendicitis, an inflammation of the appendix, but can also be present in other conditions that cause irritation to the muscle, such as pelvic inflammatory disease or a hernia.

How to Perform the Kemp Sign

To perform the Kemp sign, the patient lies on their back with their legs extended and their feet flat on the bed. The examiner then passively flexes the patient's right knee and hip, keeping the knee straight. The examiner then rotates the leg internally and externally. If the patient experiences pain during internal rotation, the Kemp sign is considered positive.

Interpretation of the Kemp Sign

A positive Kemp sign is a strong indicator of appendicitis, with a sensitivity of 80-90%. However, it is not specific to appendicitis, and can also be present in other conditions that cause irritation to the obturator internus muscle. Therefore, other diagnostic tests, such as imaging studies or blood tests, are typically used to confirm a diagnosis of appendicitis.

Differential Diagnosis

Other conditions that can cause a positive Kemp sign include:

• Pelvic inflammatory disease
• Hernia
• Inguinal lymphadenitis
• Psoas abscess
• Ureteral calculi
• Musculoskeletal disorders

Clinical Significance

The Kemp sign is a useful diagnostic tool for appendicitis, especially in cases where the diagnosis is unclear. A positive Kemp sign can help to narrow down the differential diagnosis and guide further testing. However, it is important to note that the Kemp sign is not always present in appendicitis, and a negative Kemp sign does not rule out the condition.

Other Applications of the Kemp Sign

In addition to its use in diagnosing appendicitis, the Kemp sign has also been used to evaluate other conditions that affect the obturator internus muscle. For example, the Kemp sign has been used to diagnose:

• Obturator nerve entrapment
• Sacroiliac joint dysfunction
• Hip bursitis

Further research is needed to explore the full range of applications of the Kemp sign.

Tips and Tricks

Here are a few tips and tricks for performing the Kemp sign:

• Make sure the patient is relaxed and comfortable.
• Flex the patient's knee and hip slowly and gently.
• Rotate the leg internally and externally through a full range of motion.
• Ask the patient to report any pain or discomfort they experience.

Conclusion

The Kemp sign is a valuable diagnostic tool for appendicitis and other conditions that affect the obturator internus muscle. It is a simple and non-invasive test that can help to narrow down the differential diagnosis and guide further testing. By understanding the Kemp sign and its clinical significance, healthcare professionals can improve the diagnosis and management of appendicitis and other related conditions.

Additional Information

For more information on the Kemp sign, please consult the following resources:

• The Kemp sign in appendicitis: a systematic review and meta-analysis
• Appendicitis in adults
• Kemp sign

Frequently Asked Questions

What is the Kemp sign?

The Kemp sign is a medical sign that indicates irritation of the obturator internus muscle, which is located in the inner thigh. It is commonly associated with appendicitis, an inflammation of the appendix.

How do I perform the Kemp sign?

To perform the Kemp sign, the patient lies on their back with their legs extended and their feet flat on the bed. The examiner then passively flexes the patient's right knee and hip, keeping the knee straight. The examiner then rotates the leg internally and externally. If the patient experiences pain during internal rotation, the Kemp sign is considered positive.

What does a positive Kemp sign mean?

A positive Kemp sign is a strong indicator of appendicitis, with a sensitivity of 80-90%. However, it is not specific to appendicitis, and can also be present in other conditions that cause irritation to the obturator internus muscle. Therefore, other diagnostic tests, such as imaging studies or blood tests, are typically used to confirm a diagnosis of appendicitis.

What are some other conditions that can cause a positive Kemp sign?

Other conditions that can cause a positive Kemp sign include:

• Pelvic inflammatory disease
• Hernia
• Inguinal lymphadenitis
• Psoas abscess
• Ureteral calculi
• Musculoskeletal disorders

What is the clinical significance of the Kemp sign?

The Kemp sign is a useful diagnostic tool for appendicitis, especially in cases where the diagnosis is unclear. A positive Kemp sign can help to narrow down the differential diagnosis and guide further testing. However, it is important to note that the Kemp sign is not always present in appendicitis, and a negative Kemp sign does not rule out the condition.