Murphy exam

Indications

  • A patient presenting with upper right quadrant pain/tenderness
  • Concern for cholecystitis


Technique

  • Have the patient lie supine on the exam table
  • Place your left hand, fingers pointing toward the midline, on the patient's lowermost right anterior rib cage so that your index finger is resting on the most inferior rib
  • Extend your left thumb and push it into the patient's belly and hold. Note:  Do not lean on the patient's rib cage
  • Ask the patient to take a deep breath.  Note: You should feel the rib cage move toward you during inspiration
  • Note the patient's breathing and the degree of tenderness
  • Repeat the test with a placebo maneuver by putting your hand in the same position but do not push in with your thumb.  Note if thepatient can complete a full inspiration


Results

  • Positive:
    • The patient experiences pain/tenderness sufficient to cause an abrupt halt in inspiration (normally occurs toward the end of inspiration) and acute cholecystitis is suspected.
  • Negative:
    • The patient is able to complete a full inspiration without significant pain/tenderness.


Diagnostic Accuracy

  • Sensitivity: 44% – 97%
  • Specificity: 48% – 96%
  • Likelihood ratios:
    • Positive test: 2.0
    • Negative test: nonsignificant
  • In older patients
    • Sensitivity: 48%
    • Specificity: 79%
    • Positive predictive value: 0.58