Traditional Signs in Surgery: Friends or Foes?
- PDF / 129,637 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 22 Downloads / 207 Views
LETTER TO EDITOR
Traditional Signs in Surgery: Friends or Foes? Aman Jawwad 1 Received: 7 September 2020 / Accepted: 29 September 2020 # Association of Surgeons of India 2020
Sir, With great interest, readers learned from the article by Chintamani [1] in which the author re-explored the reliability of clinical signs superseded by upcoming imaging modalities. The author related to his personal experience while elucidating some of the clinical tests that must be re-visited in order to rationalize our methodology. Those tests are not only cruel to the patient but have also lost their scientific credibility. Compassion to see the patient as a unique person cannot be learned from a textbook. The following are certain clinical signs that add to the strength of the above argument: 1. Psoas sign: Hyperextension of the right hip joint may induce abdominal pain in the presence of retrocecal appendicitis. Seldom has a clinician been seen eliciting this sign because with a likelihood ratio of just 3.2, it causes additional discomfort to the patient [2]. 2. Homan’s sign: Demonstrated in medical colleges due to easy technique, it involves eliciting pain on dorsiflexion of the ankle in a limb suspected with Deep Venous Thrombosis (DVT). Doppler Ultrasonogram of the limb is anyway necessary to confirm DVT, and the Homan’s sign has been proved to be unreliable. It no longer holds any importance other than the historical one [3]. 3. Zieman’s test involves placing index finger over the deep ring, the middle one over the superficial ring, and the ring finger over the femoral ring. The patient is then asked to cough. This is expected to differentiate between hernias from the respective sites. But medical students and residents are often struggling to position their fingers,
let alone differentiate impulses from three different sites simultaneously. 4. Prehn’s sign: On raising the testis, relief of pain in the scrotum and groin region signifies positive Prehn’s test, suggesting an alternative diagnosis like Epididymoorchitis. While the persistence of pain indicates testicular torsion requiring immediate exploration, Doppler Ultrasonogram is a much better modality to assess the vascular supply. Manipulation of scrotum only adds to the discomfort of the patient. However, Doppler Ultrasound may not be available during odd hours or at peripheral facilities. In such situations, Prehn’s sign serves as a useful guide due to its high predictive value. 5. Wright’s hyperabduction test: The diagnosis of neurogenic Thoracic Outlet Syndrome is controversial and needs investigations, like Electrophysiology, Computed Tomography, and Magnetic Resonance Imaging. This requires multiple visits to the medical practitioner before a diagnosis is made. In Wright’s provocative test, an examiner locates the radial pulse of the patient, followed by the hyper-abduction of the same arm with external rotation. A positive test is indicated by the disappearance of the pulse. The author witnessed a patient wincing in pain every time this test was elicited, while it
Data Loading...
