Physical examination maneuver
Physical Exam
Costovertebral Angle Percussion
also known as Murphy punch sign; Pasternatsky sign; Goldflam sign
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How to Perform
With the patient seated, place the palm of one hand flat over the costovertebral angle between the 12th rib and the spine, and gently strike the back of that hand with the ulnar surface of the other fist. Repeat on the opposite side for comparison. The test is positive when percussion elicits pain over the costovertebral angle.
How to Interpret
Showing 2 of 5 findings
Cystitis
Costovertebral angle tenderness
Rule in
Minimally helpful
Rule out
Not helpful
Evidence:Limited
Nephrolithiasis
Costovertebral angle tenderness
Rule in
Not helpfulDerived CI
Rule out
InconclusiveWide CI
Evidence:Limited