Murphy’s Punch/Sign is a thoracic spine examination procedure that tests for kidney inflammation, infection and obstruction in the kidneys. Jabbing thrusts are made over the 12th rib to evoke pain or tenderness.


Patient should be awake and cooperative during a Murphy’s Punch/Sign test.

  1. Patient should be seated while the procedure is being done.
  2. The examiner locates the 12th vertebrae; this is the area directly over the kidneys.
  3. The examiner closes his fists and uses it to make jabbing thrusts over the area.
  4. The examiner checks for any pain or tenderness.

Examiner forcefully taps the lower back with a closed fist.


Positive Murphy’s Punch/Sign

A positive Murphy’s Punch/Sign is when there is tenderness or pain. This indicates possible pyelonephritis or infection or hydronephritis or obstruction along the networks and tubules of the kidneys. Possible kidney inflammation may also be suspected.

Clinical Notes

After a positive Murphy’s Punch/Sign, the examiner should follow up with bimanual palpation of the kidneys and urinalysis.