The costovertebral angle (CVA) is the angle formed by the lateral and downward curve of the twelfth rib and the vertebral column. This HealthHearty write-up provides information on the possible causes of CVA tenderness.
|Murphy’s punch sign test, which is conducted for testing costovertebral angle tenderness, was first described by an American surgeon named John Benjamin Murphy.|
The human rib cage comprises twelve pairs of ribs, twelve thoracic vertebrae, sternum, and costal cartilages. Only the first seven pairs (true ribs) attach directly to the sternum through the costal cartilage. The next three pairs (false ribs) are connected to the cartilage of the seventh pair. The last two pairs (floating ribs) are only attached to the vertebrae. Each of the twelve pairs is connected to the thoracic vertebra in the spine.
The term ‘costovertebral angle’ refers to the acute angle that is formed by the vertebral column and the twelfth rib on either side of the back. Murphy’s kidney punch, which is also referred to as Murphy’s punch sign, is a test involving percussion of the twelfth rib. This test is conducted to test for costovertebral angle tenderness (CVAT). If the patient experiences pain and/or tenderness, other diagnostic tests might be conducted to rule out certain medical conditions.
|Contributing Factors for Costovertebral Angle Tenderness
More often than not, Murphy’s kidney punch test is conducted to rule out renal involvement. Often associated with renal disease, CVA tenderness is mostly unilateral, and is felt around the affected kidney. However, it could be bilateral in some cases. The area in question overlies the kidneys. If one of the kidneys is affected by an infection, the percussion of this area is likely to disturb the inflamed renal tissue, thereby causing pain. In such cases, the likelihood of renal involvement is high, especially if the patient is also experiencing urinary symptoms. CVA tenderness is most likely to be experienced by individuals affected by the following conditions:
Kidney Stones/Urinary Stones
If an individual has been experiencing such symptoms along with CVA tenderness, diagnostic tests such as renal ultrasonography or computed tomography might be conducted to check for kidney stones.
A perinephric abscess refers to a pocket of pus in the perinephric space, which is a part of the retroperitoneal space that contains the kidney, renal vessels, adrenal glands, fat, and proximal ureter. The formation of an abscess in this area is mostly associated with a urinary tract or bladder infection that spreads to the kidney or the area around it. In majority of cases, kidney stones and urinary tract obstruction are the contributing factors. Structural defects in the urinary tract, diabetes, or trauma are some of the other risk factors. The symptoms of this condition include:
Acute Renal Arterial Occlusion
Blockage of the artery that supplies blood to the kidney could also have an adverse effect on the kidney function. This could occur due to the formation of a blood clot in the artery. Problems are more likely to arise if the other kidney is not functioning properly. At times, the affected individual may not experience pain. However, if pain is experienced, there’s a sudden onset. This condition might cause the following symptoms:
How is Murphy’s Punch Sign Conducted
Each of the kidneys is located anterior to the costovertebral angle in the retroperitoneal space. CVA tenderness can be checked by tapping on the CVA angle. To perform this test, the physician would follow the steps given below:
The physician must not use excessive force. He/she should use just enough force to give the palm a percussive thump. The patient should only feel a gentle thud. The test is negative if the patient experiences just a thud without any pain.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.