please help:tenderness and rebound tenderness

[anhtran]

hi everyone
i wonder if a patient with appendicitis for example,in physical examination he has tenderness at LRQ,how can we do the rebound tenderness in that region because when we press on that place the patient already feel pain,and i read somewhere the appendix can be ruptured too if we press on that,i am a medical student and when i practice medicine in hospital,some doctors do the rebound tenderness after they elicit tenderness,this make the patients very uncomfortable and i never dare to do that.and in an article i read they said that rebound tenderness is usually a required test.please help me,how to do right?
english is not my mother tounge so sorry if i don't explain it clearly,hope you understand what i want to say ...

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[TooMuchResearch]

hi everyone
i wonder if a patient with appendicitis for example,in physical examination he has tenderness at LRQ,how can we do the rebound tenderness in that region because when we press on that place the patient already feel pain,and i read somewhere the appendix can be ruptured too if we press on that,i am a medical student and when i practice medicine in hospital,some doctors do the rebound tenderness after they elicit tenderness,this make the patients very uncomfortable and i never dare to do that.and in an article i read they said that rebound tenderness is usually a required test.please help me,how to do right?
english is not my mother tounge so sorry if i don't explain it clearly,hope you understand what i want to say ...

If you push and it hurts, it is tenderness. If you push then let go and it hurts when you let go, it is rebound tenderness.

If you push and it ruptures the appendix, it was probably going to rupture anyway.

 

[BoardingDoc]

Hey Anhtran,
The point of checking for rebound when they already have point tenderness is to check for peritoneal involvement. Example: If your ascending colon is really distended with bowel gas and I push on it, it's going to hurt. If I check for rebound tenderness, you aren't going to have it. On the other hand, if you have an inflammatory process going on which involves the peritoneum (like appendicitis) you will get rebound tenderness.

My point is this: you can have point tenderness in the RLQ and have it be a million things other than appendicitis which is why you do further checking.

As for rupturing the appendix, all I can say is don't push crazy hard, and don't worry about it.

 

[gman33]

Why are you touching patients? Yuck

 

[anhtran]

@BoardingDoc thank you very much,your answer is exactly what i need 😀
@gman33 i know some countries like America don't admit that but in my country touching patients is acceptable for medical students 🙂 however i also do not want to touch the patients,they are in pain already and every medical students in there want to do the thing...