McBurney’s Point

What are McBurney’s point and McBurney’s sign?

McBurney’s point is found two-thirds of the distance from the umbilicus (belly button) to the right anterior superior iliac spine. McBurney’s sign is focal tenderness at that point. This tenderness represents parietal peritoneal irritation from an inflamed appendix. Acute appendicitis has a lifetime risk of about 7% to 8% and is a common indication for urgent abdominal surgery in adolescents and young adults.

What causes McBurney’s sign?

In acute appendicitis, inflammation of the appendix can irritate the adjacent parietal peritoneum, producing McBurney’s point tenderness. Because appendicitis signs during physical exam depend on the inflamed serosa around the appendix, tenderness may be less pronounced or somewhat displaced in patients with retrocecal or pelvic appendices.

The psoas and obturator sign may support suspicion for appendicitis in the appropriate clinical context, but neither sign reliably distinguishes appendicitis from other right lower quadrant or pelvic pathology. A positive psoas sign suggests irritation of the iliopsoas region and can also occur in other adjacent inflammatory processes, including psoas abscess. Right-sided ileitis, adnexal pathology, and ureteral stones can also cause tenderness at McBurney’s point.

What are the signs and symptoms associated with McBurney’s sign?

Anorexia, nausea, and abdominal pain that begins near the umbilicus and later localizes to the right lower quadrant commonly precede focal tenderness at McBurney’s point in acute appendicitis. Low-grade fever and leukocytosis support an inflammatory process. Patients often describe McBurney’s point pain as sharp, localized right lower quadrant pain that worsens with coughing or walking. The obturator sign is elicited when internal rotation of the flexed hip causes pain, suggesting irritation near the obturator internus region.

Abdominal guarding is involuntary tightening of the muscles of the abdominal wall in response to peritoneal irritation. Both obturator sign and psoas sign are supportive but nonspecific findings and may also occur in other lower abdominal or pelvic inflammatory processes.

How is the cause of a positive McBurney’s sign diagnosed?

During the abdominal examination, the patient lies supine while the clinician palpates McBurney’s point for focal tenderness and may assess for guarding or rebound tenderness. Additional maneuvers such as Rovsing sign, the psoas sign, and the obturator sign can support suspicion for appendicitis, but none is independently diagnostic. Laboratory testing and imaging, often ultrasound or CT depending on the clinical setting, help confirm appendicitis and evaluate for alternative causes of right lower quadrant pain.

How is McBurney’s sign treated?

When appendicitis is suspected, initial management includes intravenous fluids, analgesia, and antibiotics when indicated while definitive evaluation and treatment are arranged. Appendectomy is standard treatment for many cases of acute appendicitis. A persistent positive Psoas sign, persistent fever, or worsening abdominal pain after treatment should raise concern for postoperative abscess or another complication.

What are the most important facts to know about McBurney’s point?

• McBurney’s point is found two-thirds of the distance from the umbilicus (belly button) to the right anterior superior iliac spine, and McBurney’s sign is focal tenderness at that point.
• Acute appendicitis is the most common cause of McBurney’s point tenderness, but right-sided ileitis, adnexal pathology, and ureteral stones can produce similar right lower quadrant pain and tenderness.
• Associated features include anorexia, nausea, vomiting, fever, abdominal guarding, obturator sign, and psoas sign.
• Physical examination, together with laboratory testing and imaging, helps confirm suspected appendicitis and guide treatment, usually involving an appendectomy.
• Persistent positive psoas sign, persistent fever, or worsening abdominal pain after treatment should prompt evaluation for complications such as an abscess.