To the Editor.
—In their review of the bedside approach to a patient with suspected acute appendicitis, Dr Wagner and colleagues1 note the usefulness of several helpful physical examination findings, including guarding, rigidity, and rebound tenderness. I would like to describe another rarely used and seldom appreciated sign that is helpful in the diagnosis of infection or inflammation in the right lower guadrant.In 1973, Markle2 published his experience with the "heel-drop jarring test" in 54 patients with suspected acute appendicitis and reported that this sign was more sensitive than rebound tenderness. In the heel-drop jarring test, the patient stands, goes up on his or her toes for 15 seconds, and then comes down with full weight on his or her heels.
Babb RR. Does This Patient Have Appendicitis?. JAMA. 1997;277(8):625–626. doi:10.1001/jama.1997.03540320027018