The patient lies on a couch. The examiner gently stretches the right spermatic cord using the thumb and index finger right about the testis in the right scrotum. For a patient with appendicitis, this causes pain in the right iliac fossa.[2] The traction of spermatic cord is thought to cause right iliac fossa pain due to the apposition of the gonadal vessels against an inflamed appendix.[2] The sensitivity and specificity of the Ten Horn's sign is unknown.