An elderly emaciated woman presents with recurrent episodes of medial thigh and knee pain radiating from the groin, worsened by hip extension and adduction. Examination reveals no inguinal or femoral lump. Pelvic MRI demonstrates a small pelvic side-wall hernia. Which sign was elicited in her history?

• A Fothergill sign
• B Maigne sign
• C Howship-Romberg sign ✓
• D Sister Mary Joseph sign

Explanation

The obturator hernia compresses the obturator nerve against the obturator canal margins, producing referred pain down the medial thigh to the knee, exacerbated by extension, adduction, or internal rotation of the hip. This is the Howship-Romberg sign. Obturator hernias are commonest in elderly thin women, are rarely palpable externally, and have a high rate of strangulation, so the diagnosis depends on recognising this referred pattern plus imaging.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.