Adams et al describe a "pinch-an-inch" test for evaluating a patient with abdominal pain and possible appendicitis. This can serve as an alternative to the elicitation of rebound tenderness as a sign of peritoneal tenderness. The authors are from Brooke Army Medical Center in San Antonio.


Site location: McBurney's point



(1) Gently grip and lift a 2-3 inch fold of skin until some recoil is felt.

(2) Release the fold rapidly.


If the pain during step 2 is greater than in step 1, then the test is positive.

If the pain in step 1 is greater than in step 2, then the test is negative.

If both are equivalent, then the test is indeterminate.



• A positive test is suggestive of peritonitis.

• Significant pain during step 1 may indicate a low tolerance for pain.


Implementation points:

• A maximal pain that is minimal would make interpretation difficult.

• The test may not be beneficial if there is severe or extreme pain, since this would indicate significant disease.

• Reporting significant pain during step 1 may also be a sign of malingering.


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