Physical examination maneuver
Physical Exam
Costovertebral Angle Percussion
also known as Murphy's 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 strike the back of that hand a single firm blow with the ulnar surface of the other fist. A positive test is sharp pain (tenderness) over the angle.
How to Interpret
Showing 2 of 5 findings
Cystitis
Costovertebral angle tenderness positive
Rule in
Minimally helpful
Rule out
—
Evidence:Strong
Nephrolithiasis
Costovertebral angle tenderness
Rule in
—
Rule out
Minimally helpful
Evidence:Limited