• Located 1.5-2 inches from the anterior superior spinous process of the ilium on a straight line drawn from that process to the umbilicus.

• Tenderness localized over the McBurney 'spoint is a classic sign concerning for appendicitis when properly put into the context of the rest of the clinical presentation.

• Patient presents with pain in the right lower quadrant
• Diagnosis of appendicitis is suspected

1. Start by having the patient lie supine on the exam table
2. Ask the patient to cough or perform the Valsalva maneuver and point to where the pain occurs
   
3. Palpate the abdomen for an area of local tenderness

• Likelihood ratios (McGee S.; 2001)
• Positive: 3.4 (95% CI 1.6, 7.2)
  
• Negative: 0.4 (95% CI 0.2, 0.7)

• If the appendix is rupture or located in an abnormal position and/or generalized peritonitis is present, tenderness will not be in the expected location.
• Pregnancy can also displace the appendix closer to the umbilicus or higher up in the right upper quadrant of the abdomen.  The gestational age of the baby will influence the change in location (Erkek A et al., 2015).

1. McBurney C. Experience with early operative interference in cases of disease of the vermiform appendix. N Y Med J 1889;50:676-684.
2. Bickley LS et al. Bates' Guide to Physical Examination and History Taking. 11^th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2013;467-8.
3. McGee S. Evidence-Based Physical Diagnosis. Philadelphia, PA: W.B. Saunders; 2001.
4. Orient, JM. Sapira's Art and Science of Bedside Diagnosis. 4^th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2010;422-3.
   
5. Erkek A et al. Location of the appendix at the third trimester of pregnancy: a new approach to an old delimma.  J Obstet Gynaecol 2015;Feb 18:1-3. PubMed
   

Editors:

• Anthony J. Busti, MD, PharmD, FNLA, FAHA
  

Last Reviewed: July 2015