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
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.
Conclusion
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.
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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.
FAQs
Costovertebral angle (CVA) tenderness is pain that results from touching the region inside of the costovertebral angle. The CVA is formed by the 12th rib and the spine. Assessing for CVA tenderness is part of the abdominal exam, and CVA tenderness often indicates kidney pathology.
What is Costovertebral angle tenderness diagnosis? ›
Costovertebral angle (CVA) tenderness is pain that results from touching the region inside of the costovertebral angle. The CVA is formed by the 12th rib and the spine. Assessing for CVA tenderness is part of the abdominal exam, and CVA tenderness often indicates kidney pathology.
How do you assess for costovertebral angle CVA tenderness? ›
Costo-Vertebral Angle Tenderness
- Patient in sitting position.
- Gently press the costovertebral angle.
- Percuss the costovertebral angles.
- Feel the paravertebral muscles to assess the tone.
- Assess tenderness of ribs, paraspinal muscle and spine.
- Auscultate the costovertebral angle for bruit.
Clinical Significance
Costotransverse disorders are disorders affecting or involving the costotransverse and costovertebral joints and ligaments. Important considerations: Often overlooked yet it can be responsible for pain in the thoracic region or functional impairments of the thoracic spine.
What is the significance of CVA tenderness? ›
Costovertebral angle tenderness (CVAT) is a widely used physical examination maneuver to differentiate renal pathology, such as pyelonephritis and ureteral stones. However, limited studies have reported its diagnostic accuracy despite the common use of CVAT particularly in the emergency department (ED) setting.
What is the medical meaning of costovertebral angle? ›
The costovertebral angle (Latin: arcus costovertebralis) is the acute angle formed on either side of the human back between the twelfth rib and the vertebral column.
What is Costovertebral angle tenderness also known as? ›
Costovertebral angle tenderness (CVAT), also known as CVA tenderness, Murphy's punch sign, Pasternacki's sign, or Goldflam's sign (Latin: succusio renalis), is a medical test in which pain is elicited by percussion of the area of the back overlying the kidney (the costovertebral angle, an angle made by the vertebral ...
What is positive Costovertebral angle tenderness? ›
To test for CVA tenderness, the examiner placed one hand over the region inside the CVA and tapped that hand gently with the closed first of the other hand. Tapping intensity was at the discretion of each physician. Positive CVA tenderness was defined as an exacerbation of pain and a left–right difference.
What does costovertebral pain feel like? ›
Costovertebral joint disorders cause a dull ache in the upper back that is made worse by deep breathing, coughing or rotation movements of the trunk and rib cage. The aching is often felt between the shoulder blades and to one side of the spine. Other symptoms may include: reduced range of movement.
Is costovertebral angle tenderness the same as flank pain? ›
If the patient experiences CVA tenderness, it's often a clinical sign that the patient has kidney stones. Since the area of the CVA corresponds with a patient's flank, you should consider CVA tenderness and flank pain to be interchangeable terms.
: of or relating to a rib and its adjoining vertebra.
Which objective assessment technique is utilized to assess Costovertebral angle tenderness? ›
Percussion. You may observe advanced practice nurses and other health care providers percussing the abdomen to obtain additional data. Percussing can be used to assess the liver and spleen or to determine if costovertebral angle (CVA) tenderness is present, which is related to inflammation of the kidney.
In which area would the nurse assess for Costovertebral angle tenderness? ›
The nurse would assess for costovertebral angle tenderness in the posterior chest area. The anterior chest does not contain the costovertebral angle. Neither the lower nor the upper extremities have the costovertebral angle.
Which steps should a nurse take to evaluate for costovertebral angle CVA tenderness? ›
Place palm of one hand over the costovertebral angle (CVA) of one side. Use fist of other hand to strike the back of the flat hand with the ulnar aspect of the fist. Repeat with the patient's other side. Pain upon this maneuver is considered positive for CVA tenderness.
What is CVA and write causes signs and symptoms of CVA? ›
Cerebrovascular accident (CVA) is the medical term for a stroke. A stroke is when blood flow to a part of your brain is stopped either by a blockage or the rupture of a blood vessel. There are important signs of a stroke that you should be aware of and watch out for.
What is the most important risk factor for CVA? ›
Risk factors for stroke
- High blood pressure. ...
- Heart disease. ...
- Diabetes. ...
- Smoking. ...
- Birth control pills (oral contraceptives)
- History of TIAs (transient ischemic attacks). ...
- High red blood cell count. ...
- High blood cholesterol and lipids.
To diagnose the problem, your health care provider may use the following tests:
- A medical history. ...
- Physical exam. ...
- Urinalysis. ...
- Urine culture. ...
- Blood cultures. ...
- Computed tomography (CT scan). ...
- Kidney ultrasound.
Treatment can include:
- Deep tissue massage.
- Joint mobilisation.
- Joint manipulation.
- Muscle energy techniques.
- Home exercise program.
- Dry needling.
- Postural strengthening program.
- Stretches.
Physiotherapy is an excellent treatment for costovertebral joint disorders.
- Above: Progressive strengthening exercises isolating the upper back muscles.
- Above: Percussion massage applied to the mid thoracic spine.
- Above: mobilisations of the mid thoracic spine.
- Above: Muscle balance and scapula setting examination.
