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