The Markle test, also known as the heel-drop jarring test, is a specific clinical maneuver utilized by healthcare professionals to assess for inflammation within the abdominal cavity, particularly the peritoneum. It is a valuable diagnostic tool, commonly employed when evaluating patients presenting with abdominal pain, especially when conditions like appendicitis are suspected.
Purpose and Application
The primary purpose of the Markle test is to identify signs of peritonitis, which is the inflammation of the peritoneum—the membrane lining the abdominal wall and covering abdominal organs. A positive result strongly suggests the presence of such inflammation. This test is frequently used in emergency settings and clinical examinations to help pinpoint the cause of acute abdominal discomfort and guide further diagnostic steps or treatment.
How the Test is Performed
The test relies on creating a jarring motion that subtly shifts the abdominal contents, thereby irritating an inflamed peritoneum and eliciting pain. There are a few common ways to administer the Markle test:
- Standing Method: The patient is instructed to stand upright, rise onto the balls of their feet (toes), and then forcefully drop down onto their heels. The sudden impact generates the necessary jarring sensation.
- Alternative Method (for bedridden or severe pain): If a patient is unable to stand due to pain or other reasons, similar jarring can be achieved by asking them to cough forcefully while lying supine, or by gently shaking the examination bed if appropriate.
A positive Markle test is indicated when the patient reports a sudden, sharp increase in abdominal pain upon the jarring motion.
Clinical Significance
The Markle test was introduced in 1973 and quickly became recognized as a simple, effective bedside test for detecting conditions causing intraperitoneal inflammation. Its straightforward nature and ease of performance make it a practical component of a physical examination. In clinical practice, it has been noted for its efficacy and, for detecting peritoneal irritation, has even been considered superior to the more widely known rebound tenderness test (Blumberg's sign). Its ability to reliably elicit pain related to peritoneal irritation makes it a helpful sign for clinicians in diagnosing acute abdominal conditions.
