What does the Markle sign indicate in an examination of suspected appendicitis?

The Markle sign, also known as the heel jar test, specifically indicates the presence of right lower quadrant pain in a patient when they drop from tiptoe to heels. This sign is significant in the context of suspected appendicitis because it can elicit pain due to the impact of the heel striking the ground, which puts pressure on the inflamed appendix. The mechanism behind this is that the sudden jarring motion can cause tension in the abdominal muscles and irritation of the peritoneum, both of which can heighten discomfort in the presence of appendicitis.

Other options may suggest various signs of abdominal issues, but they do not specifically correlate with the Markle sign's purpose or definition. For instance, rebound tenderness indicates a different type of peritoneal irritation and is more associated with acute abdomen in general, while guarding refers to an involuntary contraction of the abdominal muscles in response to pain. Palpable tenderness in the left lower quadrant is not directly related to appendicitis, as this typically refers to left-sided conditions. Understanding the specific implications of the Markle sign helps reinforce the clinical assessment of appendicitis in patients.