Murphy’s Sign – Physical Exam

Murphy’s sign is a maneuver that is done during a physical examination as part of the abdominal examination. It is useful for differentiating pain in the right upper quadrant (RUQ). Typically, Murphy’s sign is positive in acute cholecystitis, but negative in choledocholithiasis, pyelonephritis and ascending cholangitis.

Classically Murphy’s sign is tested for during an abdominal examination; it is performed by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (the approximate location of the gallbladder). The patient is then instructed to inspire (breathe in). Normally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down (and lungs expand). If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner’s fingers) and winces with a ‘catch’ in breath, the test is considered positive. In order for the test to be considered positive, the same maneuver must not elicit pain when performed on the left side.