Rebound tenderness is a clinical sign where palpation of a patient’s abdomen followed by a quick release causes an increase in pain levels. This can indicate that the peritoneum, the material that lines the abdomen, may be inflamed. Physicians may also refer to this as Blumberg’s sign; this is an example of a non-specific clinical sign. Some practitioners do not recommend it, believing other tests can provide more accurate results, sometimes with less stress for the patient.
Patients complaining of abdominal symptoms like pain, diarrhea, and tenderness often need a physical examination to check for possible causes. One thing the practitioner will look for is abdominal tenderness, where touching the abdomen causes pain for the patient. Patients may also tense their muscles in a phenomenon known as abdominal guarding, a reflex to protect themselves from palpating hands. In rebound tenderness, the physician looks specifically for an increase of pain when pressure is released, rather than when it is applied.
Abdominal palpation may be quite deep to allow the care provider to feel as much as possible. This also stretches the peritoneum. If this structure is inflamed, it cannot readily snap back when the pressure is released, and may cause rebound tenderness. This can occur in cases of peritonitis, inflammation of the peritoneum, caused by appendicitis, bowel infections, and other intestinal conditions. Tenderness may be more pronounced in some quadrants of the abdomen than others.
One issue with this test is the variation of patient pain thresholds. Some people may be quite tolerant of pain, and may not experience undue distress upon palpation even when something is seriously wrong. Others are very sensitive and tender, and may report extreme pain on palpation. Because there is no absolute scale for pain, it can be hard to assess the intensity of the symptom. Another issue is that in patients with painful abdomens, the pain may be so persistent that the patient has trouble differentiating between basic and rebound tenderness.
If a physician notices rebound tenderness on an examination, there are several options for the patient. The doctor may ask to take a blood sample to check for signs of inflammation like a high white blood cell count. Medical imaging studies can provide some information about what is going on inside the abdomen. An examination might reveal other symptoms that point the way to a diagnosis, in which case it may be possible to start providing treatment immediately.
