Title: Understanding Costovertebral Angle (CVA) Tenderness: Causes and Diagnostic Insights (2024)

The costovertebral angle (CVA) is a crucial anatomical landmark formed by the lateral and downward curve of the twelfth rib and the vertebral column. Understanding the possible causes of CVA tenderness is essential for accurate diagnosis and effective management of associated conditions.

Anatomy of the Costovertebral Angle

The CVA is an acute angle formed by the vertebral column and the twelfth rib on either side of the back. It plays a significant role in diagnosing potential health issues related to the kidneys and surrounding structures.

Murphy’s Punch Sign Test

The Murphy’s punch sign test, also known as Murphy’s kidney punch, is a diagnostic test involving percussion of the twelfth rib to assess for costovertebral angle tenderness (CVAT). This test, first described by American surgeon John Benjamin Murphy, is a crucial step in identifying potential renal involvement and associated conditions.

Contributing Factors for CVA Tenderness

CVA tenderness is commonly associated with various medical conditions, including kidney stones/urinary stones, pyelonephritis, perinephric abscess, and acute renal arterial occlusion. Understanding the symptoms and diagnostic insights for each condition is vital for accurate diagnosis and timely intervention.

Kidney Stones/Urinary Stones

The formation of stone-like deposits in the kidneys or urinary tract can lead to severe flank pain, nausea, vomiting, and urinary symptoms. Diagnostic tests such as renal ultrasonography or computed tomography are crucial in confirming the presence of kidney stones and determining the appropriate management approach.


Pyelonephritis, a type of kidney infection, can cause fever, flank pain, and painful urination. Understanding the underlying causes, such as bacterial infections or urinary tract obstructions, is essential for targeted treatment and preventing potential complications.

Perinephric Abscess

A perinephric abscess, characterized by a pocket of pus in the perinephric space, is often associated with urinary tract infections and structural defects. Recognizing the symptoms, including fever, flank pain, and abdominal discomfort, is crucial for prompt medical intervention and management.

Acute Renal Arterial Occlusion

Blockage of the artery that supplies blood to the kidney can lead to decreased urine output, flank pain, and abdominal discomfort. Timely recognition of symptoms and diagnostic tests are vital for evaluating kidney function and determining the appropriate course of action.

Conducting Murphy’s Punch Sign

Physicians conduct the Murphy’s punch sign test by gently tapping on the CVA angle to assess for tenderness. Careful evaluation and subsequent diagnostic procedures, such as palpation of the kidneys, auscultation, renal ultrasound, and blood tests, are essential for confirming the diagnosis and identifying the underlying cause of CVA tenderness.


Understanding the possible causes and diagnostic insights for costovertebral angle (CVA) tenderness is crucial for healthcare professionals and individuals experiencing related symptoms. Timely recognition, accurate diagnosis, and targeted management strategies are essential for addressing underlying medical conditions and promoting optimal health and well-being.

Sign up to receive the latest articles and insights to stay informed about health-related topics.

This comprehensive article aims to provide valuable information on CVA tenderness, including its anatomical significance, diagnostic tests, and associated conditions, to help individuals and healthcare professionals better understand and address potential health concerns related to the costovertebral angle.

Title: Understanding Costovertebral Angle (CVA) Tenderness: Causes and Diagnostic Insights (2024)
Top Articles
Latest Posts
Article information

Author: Edwin Metz

Last Updated:

Views: 6409

Rating: 4.8 / 5 (58 voted)

Reviews: 89% of readers found this page helpful

Author information

Name: Edwin Metz

Birthday: 1997-04-16

Address: 51593 Leanne Light, Kuphalmouth, DE 50012-5183

Phone: +639107620957

Job: Corporate Banking Technician

Hobby: Reading, scrapbook, role-playing games, Fishing, Fishing, Scuba diving, Beekeeping

Introduction: My name is Edwin Metz, I am a fair, energetic, helpful, brave, outstanding, nice, helpful person who loves writing and wants to share my knowledge and understanding with you.