OnExam

Murphy’s Sign is used to elicit support for a diagnosis of cholecystitis.

Performing the Test

  1. Apply pressure superiorly under the costal margin at the right midclavicular line. Can utilize the hooking method described for liver palpation.
  2. Have the patient take a deep breath.
  3. Concurrently, press your fingers upwards reaching beneath the costal margin.
  4. If the patient stops inspiration suddenly, the sign is positive.

Interpretation

  • The sudden cessation of inspiration is thought to be from a pang of pain as the tender, inflamed gallbladder moves inferiorly with inspiration and strikes the clinician's fingertips.
  • Studies show Murphy's Sign to be moderately sensitive and specific. Its positive and negative likelihood ratios for cholecystitis are cited as 1.9 and 0.6 respectively.

References

  1. Insall, RL, Davies RJ, Prout WG. Significance of Buerger’s test in the assessment of lower limb ischaemia. J R Soc Med. 1989; 82:729-731
  2. McGee S. Evidence Based Physical Diagnosis, Second Edition. St. Louis, MO: Saunders Elsevier; 2007.