Costovertebral Angle Tenderness
Other Names
- CVA Tenderness
- Costovertebral Tenderness
- Murphy Punch Sign
- Kidney Punch Tenderness
- Renal Angle Tenderness
Purpose
- Evaluate for irritation or inflammation involving the kidney or surrounding retroperitoneal structures
Description
- The examiner identifies the costovertebral angle between the 12th rib and vertebral column
- The examiner places one hand over the costovertebral angle
- The dorsum of the placed hand is gently struck using the ulnar aspect of the opposite fist
- The maneuver is typically performed bilaterally for comparison
- Positive test
- Reproduces pain or marked tenderness over the affected costovertebral angle
Pathology
- Pyelonephritis
- Nephrolithiasis
- Renal trauma
- Obstructive uropathy
- Perinephric infection
Evidence
Pyelonephritis
- Fukaguchi et al in febrile patients[2]
- Sensitivity: 48%
- Specificity: 90%
Obstructive Urinary Diseases[2]
- Fukaguchi et al
- Sensitivity: 65%
- Specificity: 82%
Suspected Ureteral Stone
- Higauchi et al[3]
- Sensitivity: 65%
- Specificity: 50%
See Also
References
- ↑ Manav, Alper Nesip, and Ahmet Güzel. "The effect of narrow costovertebral angle on percutaneous nephrolithotomy outcomes." Urolithiasis 54.1 (2025): 13.
- ↑ 2.0 2.1 Fukaguchi, K., et al. "377 the diagnostic accuracy of costovertebral angle tenderness in the emergency department." Annals of Emergency Medicine 78.4 (2021): S151.
- ↑ Higuchi, Hiroyasu, Taku Harada, and Juichi Hiroshige. "Evaluation of the usefulness of costovertebral angle tenderness in patients with suspected ureteral stone." Journal of General and Family Medicine 24.1 (2023): 56-58.
Created by:
John Kiel on 28 May 2026 10:54:42
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Last edited:
28 May 2026 11:51:17
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