PAIN AND TENDERNESS OF THE ABDOMINAL WALL

Pain and tenderness occur far more frequently in the abdominal wall than in the abdominal viscera. Palpation over relaxed abdominal muscles fails completely to differentiate parietal from visceral tenderness. Parietal tenderness and, inferentially, pain are demonstrated best by making firm palpation while the patient balloons out the abdomen and holds the abdominal muscles as tense as possible.1Any tenderness thereby disclosed is necessarily parietal in location, because the tense muscles prevent the examiner's fingers coming in contact with the viscera. This is a simple bedside test, requiring no special instruments; it can be carried out in less than two minutes and will give invaluable diagnostic information if it is employed, as it should be, on every patient having abdominal pain or tenderness. Hypersensitiveness, either on pricking or stroking the abdominal skin with a pin, or on pinching a liberal fold of skin and fat, indicates parietal tenderness, but both