Which sign involves pain with internal rotation of the flexed right thigh, indicating appendicitis?

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Pain on internal rotation of a flexed right thigh signals irritation of the obturator nerve from pelvic involvement of appendicitis. When the hip is flexed and rotated internally, the obturator internus muscle is stretched; if the appendix lies in the pelvis and inflames nearby tissues, it can irritate the obturator nerve, producing pain in the right lower quadrant. This obturator sign is most notable when the appendix is in a pelvic position or when a pelvic abscess affects the area.

This differs from other signs that point to different mechanisms: the psoas sign involves pain with hip extension or resisted hip flexion, reflecting irritation of the psoas muscle and typically retrocecal appendicitis; Rovsing’s sign is RLQ pain elicited by palpation in the LLQ, indicating general peritoneal irritation; Murphy’s sign is inspiratory arrest during palpation of the right upper quadrant, suggestive of cholecystitis. Thus, the described maneuver specifically corresponds to the obturator sign.