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Murphy’s sign

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A common abdominal examination manoeuvre, but a common understanding is elusive

Most of us think that Murphy’s sign consists of the abrupt interruption of deep inspiration when palpating in the right upper quadrant of the abdomen. Its relevance would seem to be its presence in a non-tender abdomen, but is that so? Canvass your colleagues and you will find that a common understanding is as elusive as the Scarlet Pimpernel. The radiological community’s development of a “sonographic” Murphy’s sign has only added to the confusion.

John B Murphy (1857–1916) was a Chicago surgeon practising at the turn of the 20th century. Diagnostic investigations were limited, and the task of differentiating between different abdominal emergencies was difficult. Murphy described several clinical tests to aid in differential diagnosis, but the sign he is best remembered for was first described in 19031 and was further expounded on many occasions in his journal Surgical Clinics of John B. Murphy (a forerunner to Surgical Clinics of North America).

Murphy described two signs for cholecystitis. The one that bears his name he called “deep-grip palpation”; the other, which he considered to be an even better test, was referred to as “hammer-stroke percussion”.2,