Rebound tenderness is a clinical finding made by the physician while examining the abdomen. It is referred as pain experienced by the patient upon removing pressure from the abdomen. This sign is normally elicited when the parietal layer of peritoneum is irritated. The cause of irritation can be inflammation of peritoneum due to infection or trauma or collection of blood in the abdominal organs and some organs of pelvis.
The basic pathophysiology underlying rebound tenderness is pain produced by overstretching of the peritoneum or movement of the internal organ that is affected.Let us know the medical conditions that may be lead to rebound tenderness.
What Are The Causes Of Rebound Tenderness?
Rebound tenderness is also referred as Blumberg’s sign. It basically occurs due to removal of pressure from the abdomen and not pain produced by putting pressure on abdomen. German surgeon Jacob Blumberg was the first person to describe this technique that helps in diagnosing abdominal diseases causing acute abdomen. Rebound tenderness is caused when the peritoneum is irritated and inflamed.
Peritoneum is a membrane that lines the abdominal cavity. It also covers abdominal organs.Its function is to support the abdominal organs and facilitate pathway for the blood vessels and lymph fluid in the abdominal region. Peritoneum has two layers, parietal and visceral. Parietal peritoneum lines the internal side of abdominal and pelvic wall. The nerve supply to parietal peritoneum and abdominal wall is same. Hence pain from parietal peritoneum is associated with pressure on the abdominal wall.
Following are some of the conditions that may cause rebound tenderness:
- Peritonitis is inflammation of peritoneum. It can occur due to infection or trauma and bleeding from the abdominal organs.
- Rebound tenderness is one of the characteristic features of acute appendicitis. Once the appendix is inflamed it irritates the peritoneal lining locally. However, if the appendix penetrates and ruptures the peritoneum, the entire peritoneum is affected. This may lead to rebound tenderness all over the abdomen.
- Diverticula are protrusion of small pouches within the wall of large intestine. When the diverticula are inflamed the condition is called diverticulitis. This condition can cause rebound tenderness of abdomen.
- Pancreatitis is another serious condition that may lead to rebound tenderness. Pancreas is a gland that secretes important enzymes and hormones. Inflammation of pancreas can irritate the parietal peritoneum leading to pain and rebound tenderness while examination.
- Sickle cell crisis is a medical condition in which there is enormous destruction of red blood cells. The rate at which the red blood cells are destroyed is much faster than the rate of red blood cell production. Rebound tenderness of abdomen is one of its symptoms besides jaundice, pallor, chest pain, etc.
- Inflammation of fallopian tube in the pelvic area cause rebound tenderness, especially in case of ruptured ectopic pregnancy.
Diagnosis And Treatment Of Rebound Tenderness
Rebound tenderness is easily identified when the physician palpates patient’s abdomen. He puts gentle pressure on the abdomen for a minute and then suddenly removes his hand. Patient during this period experiences severe pain while the physician lifts his hand. To confirm something is wrong in the abdomen, several diagnostic tests are needed. This may include blood tests, sonogram of abdomen and pelvis, X-ray abdomen, MRI etc.
Rebound tenderness is a sign of an underlying disease. Hence the aim of treatment is to treat the underlying condition in order to alleviate pain in abdomen. Most patients having rebound tenderness require hospitalization. In some cases conservative medical treatment may solve the condition.
Antibiotics, intravenous fluids for maintaining electrolyte balance are few medications that may be needed. Sometimes surgical intervention may be needed as in case of appendicitis.