What is the Murphy sign of the wrist joint?

Murphy Sign of the Wrist Joint

The Murphy sign of the wrist joint is not a recognized clinical test in orthopedic or hand surgery literature. The term "Murphy sign" is primarily associated with gallbladder disease examination, not wrist pathology.

Murphy Sign in Gallbladder Disease

Murphy sign is a well-established physical examination finding used in the evaluation of gallbladder disease, particularly acute cholecystitis:

• It is defined as focal tenderness corresponding to a sonographically localized gallbladder, which helps differentiate acute cholecystitis from gallstones alone 1
• The sign is elicited when a patient experiences increased pain and stops breathing during deep palpation of the right upper quadrant of the abdomen during inspiration 1
• It is considered a useful feature in the clinical examination for suspected acute cholecystitis, alongside fever, right upper quadrant pain/tenderness, vomiting, and food intolerance 1

Diagnostic Value in Gallbladder Disease

• The World Journal of Emergency Surgery reports a positive likelihood ratio of 2.8 (95% CI 0.8-8.6) for acute cholecystitis, though confidence intervals include 1.0 1
• When used alone, Murphy sign has relatively low specificity for acute cholecystitis 1
• Administration of pain medications prior to examination invalidates the reliability of a negative Murphy sign 1
• In one study of 497 patients with suspected acute cholecystitis, the positive predictive value of stones combined with a positive sonographic Murphy sign was 92.2% for acute cholecystitis 2

Sonographic Murphy Sign

• The sonographic Murphy sign is tenderness reproducing the patient's abdominal pain elicited by probe compression directly on the gallbladder, combined with the absence of similar tenderness when it is compressed elsewhere 3
• Emergency physicians have demonstrated good accuracy in detecting the sonographic Murphy sign, with one study showing it had a sensitivity of 75% compared to the formal ultrasound sensitivity of 45% for acute cholecystitis 4

Clinical Pitfalls and Caveats

• Murphy sign may be absent in elderly, diabetic, or immunocompromised patients despite severe gallbladder disease 1
• No single clinical or laboratory finding has sufficient diagnostic power to establish or exclude acute cholecystitis 1
• Complicated cholecystitis may present with similar clinical findings as uncomplicated disease, requiring additional imaging studies beyond ultrasound 1

Wrist Examination

For wrist joint examination, there is no established "Murphy sign." Instead, standard wrist examination techniques should be used:

• The American College of Radiology recommends specific imaging approaches for acute hand and wrist trauma based on clinical findings 3
• MRI is ideal for evaluating tendon injuries and helping with surgical planning in hand and wrist injuries 3
• Ultrasound allows for diagnosis of specific wrist and hand pathologies such as pulley system injuries 3

Conclusion

The Murphy sign is specifically associated with gallbladder examination and has no established counterpart in wrist examination. When evaluating wrist pathology, clinicians should use standard wrist examination techniques and appropriate imaging as indicated by clinical findings.