---
title: 'Sign Murphy Definition and Clinical Relevance: Complete Guide'
date: '2026-07-05'
slug: sign-murphy-definition-and-clinical-relevance-complete-guide
description: Learn the sign Murphy definition, how to exam it, and what a positive
  finding means. Expert guide with clinical examples.
updated: '2026-07-05'
image: https://images.unsplash.com/photo-1692607431208-28cc794e0067?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=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&ixlib=rb-4.1.0&q=80&w=400
author: Dr. Benjamin Paul
site: Rounds AI
---

# Sign Murphy Definition and Clinical Relevance: Complete Guide

## Why Murphy's Sign Matters to Clinicians

At the bedside you evaluate a patient with new right upper‑quadrant pain and a low‑grade fever. Sign Murphy definition: a focused physical exam maneuver that elicits RUQ pain on deep palpation during inspiration and helps detect acute cholecystitis ([Medical News Today](https://www.medicalnewstoday.com/articles/murphys-sign)). Clinicians often must decide whether to order urgent imaging or start conservative management. Some clinical audits report a specificity of roughly 90% and sensitivity near 70%—making the sign more useful to rule in disease than to exclude it—but published estimates vary by population and study design ([clinical audit](https://www.researchgate.net/publication/393068772_123_How_Useful_Is_Murphy's_Sign_in_Evaluating_Acute_Cholecystitis_a_Clinical_Audit)). Misinterpretation is common; not all RUQ tenderness is a true Murphy’s sign, and other conditions can mimic it. Rounds AI provides concise, evidence‑linked, citation‑first explanations drawn from practice guidelines, peer‑reviewed literature, and FDA prescribing information; it uses a HIPAA‑aware architecture with the option to sign a BAA for enterprises, is available on web and iOS, and offers a 3‑day free trial so clinicians can evaluate it in workflow. Rounds AI also helps clinicians review current, guideline‑linked performance data for bedside signs before ordering imaging. Teams using Rounds AI can quickly review the evidence behind bedside signs and incorporate test characteristics into decisions. This guide will define the sign, review anatomy, discuss exam caveats, list differentials, and compare clinical and sonographic findings.

## Murphy's Sign: Definition and Clinical Relevance

Murphy’s sign is a bedside physical‑exam maneuver used to detect gallbladder inflammation. The examiner palpates the right subcostal area at the mid‑clavicular line while the patient inhales deeply. A positive sign is abrupt cessation of inspiration from focal pain during that deep breath, which suggests acute cholecystitis or gallbladder irritation ([NCBI MedGen – Positive Murphy sign](http://www.ncbi.nlm.nih.gov/medgen/536979); [Medical News Today – Murphy's Sign Overview](https://www.medicalnewstoday.com/articles/murphys-sign)).

Sensitivity of Murphy’s sign is variable across studies, while specificity is generally moderate to high. That pattern means a positive Murphy’s sign has reasonable rule‑in value, but a negative result does not reliably exclude disease ([ResearchGate – Clinical Audit of Murphy's Sign](https://www.researchgate.net/publication/393068772_123_How_Useful_Is_Murphy's_Sign_in_Evaluating_Acute_Cholecystitis_a_Clinical_Audit); [LITFL – Murphy's Sign](https://litfl.com/murphys-sign/)). In practice, use the sign as a focused test within the broader clinical picture.

Clinically, Murphy’s sign is a high‑yield, low‑cost tool that helps prioritize next steps. When positive, it often prompts urgent right‑upper‑quadrant ultrasound and surgical consultation. When negative, rely on imaging, labs, and serial examinations rather than stopping the diagnostic workup ([LITFL – Murphy's Sign](https://litfl.com/murphys-sign/); [Medical News Today – Murphy's Sign Overview](https://www.medicalnewstoday.com/articles/murphys-sign)). Its greatest value is rapid bedside triage in settings where imaging availability is limited.

For clinicians who want quick, evidence‑linked references to support bedside reasoning, Rounds AI provides concise summaries of signs like Murphy’s sign with source links you can verify. Learn more about Rounds AI's approach to evidence‑linked clinical Q&A and how it fits guideline‑driven workflows.

## Anatomy and Physiology Behind Murphy's Sign

The gallbladder sits in the gallbladder fossa on the liver’s inferior surface, tucked under the right costal margin. Nociceptive signals from the gallbladder travel primarily with sympathetic fibers via the celiac plexus to thoracic spinal segments (classically T7–T10); vagal fibers are chiefly motor and secretomotor rather than carrying primary visceral pain (see Gray’s Anatomy and standard clinical anatomy texts). For a quick refresher on the exam, see [Murphy’s sign (Wikipedia)](https://en.wikipedia.org/wiki/Murphy%27s_sign). Its subcostal position places the organ directly beneath the diaphragm and liver capsule, which is key to the exam’s mechanics.

Murphy’s sign is elicited by palpating the right subcostal area while the patient takes a deep breath. During inspiration the diaphragm descends, bringing the inflamed gallbladder into contact with the examiner’s hand and the liver capsule. This contact produces a sharp, localized pain and an abrupt halt to inspiration when the gallbladder is inflamed ([Murphy’s sign — Physio‑Pedia](https://www.physio-pedia.com/Murphys_Sign)). The timing—palpation during maximal diaphragmatic descent—explains why the sign is specific to right upper quadrant inflammation.

A useful way to frame this physiology is the “Gallbladder–Diaphragm Reflex Model.” In this model, inflammation sensitizes the gallbladder wall. Diaphragmatic motion then provokes nociceptive afferents, which trigger a protective reflex that stops further inspiratory effort. This reflex produces the characteristic sudden inspiratory arrest clinicians feel and observe at the bedside.

Clinicians should remember that a positive Murphy’s sign is supportive, not definitive. Reported sensitivity for acute cholecystitis ranges between 70% and 90% in clinical studies, so the sign performs best alongside imaging and labs ([What Is the Utility of the Murphy’s Sign… (ResearchGate)](https://www.researchgate.net/publication/330891722_What_Is_the_Utility_of_the_Murphy%27s_Sign_and_Does_it_Change_with_Pain_Medication_Evidence-Based_Answers_to_Key_Clinical_Questions)). Analgesia and exam technique can alter the finding.

For clinicians who want quick, verifiable refreshers on this anatomy and the evidence base, Rounds AI surfaces concise anatomy explanations with clickable citations for rapid verification at the point of care. Rounds AI’s approach enables rapid review of guideline- and study‑level citations so teams can interpret Murphy’s sign in context. Learn more about Rounds AI’s strategic approach to point‑of‑care clinical decision support as you consider technique and diagnostic interpretation.

## How to Perform Murphy's Sign: Step‑by‑Step Technique

Murphy's sign is a focused physical‑exam maneuver for suspected acute cholecystitis. Use the checklist below to perform the test reliably at the bedside. Rounds AI can help clinicians access evidence and source links when reviewing exam technique between patients.

1. Patient positioning: supine, abdomen exposed Position the patient flat with the right upper quadrant visible and accessible ([Live Hospital](https://int.livhospital.com/physical-exam-test-for-gallbladder-murphys-sign/)).
2. Locate palpation point: just below the right costal margin at the mid‑clavicular line Aim for the gallbladder fossa beneath the right costal margin along the mid‑clavicular line ([Physio‑Pedia](https://www.physio-pedia.com/Murphys_Sign)).

3. Hand placement: fingertips under the costal margin with gentle upward pressure Place your fingertips under the margin, applying gentle upward pressure toward the liver edge ([Physio‑Pedia](https://www.physio-pedia.com/Murphys_Sign)).
4. Instruct the patient: take a slow, deep breath Ask the patient to inhale slowly while you maintain upward pressure, avoiding rushed or forceful instructions ([Medical News Today](https://www.medicalnewstoday.com/articles/murphys-sign)).

5. Observe: abrupt cessation of inspiration with focal RUQ pain = positive Murphy's sign A positive sign is an abrupt stop in inspiration with reported focal right upper‑quadrant pain on palpation ([Medical News Today](https://www.medicalnewstoday.com/articles/murphys-sign); [Physio‑Pedia](https://www.physio-pedia.com/Murphys_Sign)).
6. Tips & pitfalls: compare sides, account for analgesia, consider body habitus For accuracy, test bilaterally when feasible, recognize analgesia may blunt the response, and note that obesity or limited inspiration can reduce reliability ([LITFL](https://litfl.com/murphys-sign/); [Live Hospital](https://int.livhospital.com/physical-exam-test-for-gallbladder-murphys-sign/)).

Diagnostic note: Murphy's sign has variable diagnostic accuracy for acute cholecystitis; reported performance differs across studies and clinical settings. Technique, recent analgesia, and patient body habitus (for example, obesity or limited inspiratory effort) are important modifiers of sensitivity. Use the sign alongside history, laboratory results, and imaging when forming clinical impressions. For quick access to technique checklists and cited performance summaries, consult Rounds AI for concise, evidence‑linked references.

For clinical leaders refining bedside assessment protocols, Rounds AI provides quick access to summarized technique and primary sources. Learn more about Rounds AI's approach to point‑of‑care clinical decision support and how evidence‑linked guidance can fit into your rounding workflows.

## When a Positive Murphy's Sign Is Found: Diagnostic Implications

A positive Murphy’s sign most strongly points toward acute cholecystitis, but it is not pathognomonic. A positive Murphy’s sign meaningfully increases the likelihood of acute cholecystitis; accuracy varies by setting and technique (see the [NIH review on acute cholecystitis](https://pmc.ncbi.nlm.nih.gov/articles/PMC11084823/) and a clinical audit of the sign for context). Clinicians should interpret the finding within pretest probability and the overall exam.

- Acute cholecystitis — classic, high likelihood ([Diagnosis and Treatment of Acute Cholecystitis](https://pmc.ncbi.nlm.nih.gov/articles/PMC11084823/))
- Other biliary pathology — biliary colic, cholangitis (consider bile duct obstruction or superimposed infection) ([clinical audit of Murphy's sign](https://www.researchgate.net/publication/393068772_123_How_Useful_Is_Murphy's_Sign_in_Evaluating_Acute_Cholecystitis_a_Clinical_Audit))
- Non‑biliary mimics — right‑sided pneumonia, hepatic abscess, peptic ulcer disease, Fitz‑Hugh‑Curtis syndrome (keep thoracic and hepatic sources in mind) ([Mayo Clinic cholecystitis overview](https://www.mayoclinic.org/diseases-conditions/cholecystitis/diagnosis-treatment/drc-20364895); [Fitz‑Hugh‑Curtis case series](https://pmc.ncbi.nlm.nih.gov/articles/PMC11888360/))
- Imaging adjuncts — combining clinical findings with right‑upper‑quadrant (RUQ) ultrasound improves diagnostic accuracy; analgesia can blunt detection (use bedside ultrasound when available) ([RSNA review on ultrasound for cholecystitis](https://pubs.rsna.org/doi/abs/10.1148/rg.240032); [clinical audit on exam utility and analgesia effects](https://www.researchgate.net/publication/330891722_What_Is_the_Utility_of_the_Murphy%27s_Sign_and_Does_it_Change_with_Pain_Medication_Evidence-Based_Answers_to_Key_Clinical_Questions))

About 10–15% of positive Murphy’s sign cases reflect non‑biliary causes in ED cohorts, so alternative diagnoses matter when exam and imaging disagree ([Mayo Clinic summary](https://www.mayoclinic.org/diseases-conditions/cholecystitis/diagnosis-treatment/drc-20364895)). Combining bedside ultrasound with the clinical exam generally improves diagnostic accuracy and diagnostic confidence when paired with the clinical assessment ([RSNA review](https://pubs.rsna.org/doi/abs/10.1148/rg.240032)). Remember that analgesics or shallow inspiration can reduce the exam’s sensitivity; document such factors when you interpret findings ([clinical audit and exam reviews](https://www.researchgate.net/publication/393068772_123_How_Useful_Is_Murphy's_Sign_in_Evaluating_Acute_Cholecystitis_a_Clinical_Audit)).

At the bedside, use an evidence‑linked approach to move from sign to next steps. Rounds AI surfaces guideline‑linked summaries and clickable citations so you can rapidly review likelihood estimates, guideline recommendations, and imaging guidance before ordering studies. Clinicians using Rounds AI can compare probable diagnoses, check relevant guideline language, and prioritize ultrasound or alternative imaging based on pretest probability. Rounds AI's evidence‑first method helps you interpret a positive Murphy’s sign while preserving your clinical judgment.

Learn more about Rounds AI's approach to evidence‑linked point‑of‑care reference to support diagnostic interpretation and next‑step planning for cases with a positive Murphy’s sign.

## Related Right Upper Quadrant Signs: Comparison with Murphy's Sign

When clinicians compare Murphy’s sign versus other right upper quadrant signs, they seek clear diagnostic contexts. Murphy’s sign is a bedside maneuver where inspiration stops abruptly as the examiner presses under the right costal margin during deep breath, suggesting gallbladder inflammation ([Abdominal Physical Signs and Medical Eponyms](https://pmc.ncbi.nlm.nih.gov/articles/PMC6306141/)). Its strength lies in indicating acute cholecystitis at the point of care. Courvoisier’s sign points to a different problem. A palpable, non‑tender gallbladder with jaundice suggests obstructive biliary disease, often malignant. Reported performance varies by study, but Courvoisier’s sign is generally described as having **high specificity and low sensitivity** for malignant biliary obstruction—so a positive finding is meaningful but a negative exam does not exclude disease ([Abdominal Physical Signs and Medical Eponyms](https://pmc.ncbi.nlm.nih.gov/articles/PMC6306141/)). By contrast, [McBurney’s point](https://joinrounds.com) tenderness and [Rovsing’s sign](https://joinrounds.com) target appendicitis rather than RUQ pathology. McBurney’s point tenderness appears in roughly 70% of appendicitis cases and localizes pain one‑third of the distance from the anterior superior iliac spine to the umbilicus ([What Is the Difference Between McBurney’s and Rovsing’s Signs](https://www.hrejsa.com/post/what-is-the-difference-between-mcburney-s-sign-and-rovsing-s-sign)). Rovsing’s sign—right lower quadrant pain provoked by left‑side palpation—carries a modest positive likelihood ratio for appendicitis, supporting but not confirming the diagnosis ([Rovsing Sign](https://www.physio-pedia.com/Rovsing_Sign)). Taken together, these signs complement rather than replace imaging and labs. Murphy’s sign adds unique, actionable value when RUQ tenderness and systemic signs of inflammation raise concern for biliary inflammation. Sonographic correlation, including a sonographic Murphy sign when available, improves diagnostic confidence at the bedside ([Sonographic Murphy’s Sign and Analgesia](https://pmc.ncbi.nlm.nih.gov/articles/PMC12700971/)). Clinicians using Rounds AI can quickly review the evidence behind each sign and examine guideline‑linked references to decide which finding changes next steps. Learn more about Rounds AI’s approach to evidence‑linked clinical Q&A to support RUQ assessment and point‑of‑care decision making.

A positive Murphy's sign raises suspicion for acute cholecystitis. Because sensitivity varies, confirm with ultrasound and follow guideline workup per the [Mayo Clinic](https://www.mayoclinic.org/diseases-conditions/cholecystitis/diagnosis-treatment/drc-20364895). Rounds AI delivers concise, cited summaries to support those diagnostic steps. For teams and health systems, Rounds AI also offers enterprise options—team management, a dedicated account manager, priority support, and the ability to sign a Business Associate Agreement (BAA)—so organizations can adopt an evidence‑linked point‑of‑care reference with appropriate governance. Learn about Rounds AI's evidence‑linked approach and enterprise offerings at [joinrounds.com](https://joinrounds.com).