Murphys Sign

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Murphy's sign is a physical examination technique used to diagnose acute cholecystitis, which is inflammation of the gallbladder and it was first described an American physician John Benjamin Murphy (1857–1916) in the 1880s.[1] One of the most common and recognizable signs of gallbladder hypersensitivity is the inability of the patient to take a complete, deep breath while the physician's fingers are placed deep beneath the right costal arch, below the hepatic margin. The diaphragm pushes the liver down until the sensitive gallbladder meets the fingers during examination, at which point the patient's ability to inhale suddenly stops as though it has been cut off.[2]

Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area(right upper quadrant) of the abdomen.[3]Murphy described two signs for cholecystitis. He called the first one that bears his name 'deep-grip palpation' patient upright in a seated position on deep inspiration and the second one 'hammer-stroke percussion', which he considered even better.

In 1914, Murphy sets instructions to test for a distended gallbladder. Hook your fingers under the costal arch and ask the patient to take a deep breath. Strike the flexed fingers at the height of inspiration. If the patient experiences pain, it is a positive indication of a distended gallbladder. A more reliable test is the perpendicular finger percussion test. Place your middle finger at the tip of the ninth costal cartilage. Ask the patient to take a deep breath and strike a sharp blow on the finger. If the gallbladder is distended or inflamed, the patient will experience severe pain. Unfortunately, over time, the percussion test has become forgotten, and Murphy's sign now refers to deep-grip palpation.[2]

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Murphy’s sign is performed by palpating the subcostal region during inspiration. If pain is elicited and the patient suddenly stops their inspiratory effort. If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.

Evidence[edit | edit source]

Several studies have shown that the presence of Murphy's sign is highly sensitive (97.2%) and predictive (93.3%) of a positive diagnosis of acute cholecystitis in most patients. However, this sign may not be as reliable in elderly patients as found by Adedeji and McAdam in their retrospective investigation. They discovered that the diagnostic accuracy for acute cholecystitis dropped to 34% when Murphy's sign was negative in patients over 70 years old, compared to 80% when it was present. The test's positive predictive value in the same patients was 58%, with a sensitivity of 48% and a specificity of 79%.[1] In elderly patients, a positive Murphy's sign is useful, but a negative sign is not exclusive and other diagnostic tests should be performed promptly.[6]

Resources[edit | edit source]

Murphy's sign of cholecystitis

The sonographic diagnosis of acute gangrenous cholecystitis: importance of the Murphy sign

References[edit | edit source]

  1. 1.0 1.1 Musana K, Yale SH. John Benjamin Murphy (1857 - 1916). Clinical Medicine & Research. 2005 May 1;3(2):110–2. ‌
  2. 2.0 2.1 Jeans PL. Murphy’s sign. Medical Journal of Australia. 2017 Feb;206(3):115–6.
  3. Musana KA, Yale SH. Murphy’s Sign. Clinical Medicine & Research. 2005 Aug 1;3(3):132–2.
  4. Doctor O'Donovan. Murphys sign. Available from: [last accessed 1/2/2024]
  5. Surgical Teaching. Murphy's sign | What is this Classic Examination Finding?. Available from: [last accessed 1/2/2024]
  6. Adedeji OA, McAdam WA. Murphy's sign, acute cholecystitis and elderly people. J R Coll Surg Edinb. 1996;41(2):88-89.