Costovertebral angle tenderness is pain and tenderness in the lower back near the spine, often checked by patting patients on the back. It can indicate diseases such as pyelonephritis, kidney stones, or perinephric abscesses. It is important to distinguish between pyelonephritis and urinary tract infections as the former requires more aggressive treatment.
Costovertebral angle tenderness is a term used to describe pain and tenderness in a region of the lower back adjacent to the spine. Often, medical professionals check for tenderness in this area by patting patients on the back. Having pain in this area could mean the presence of diseases such as pyelonephritis, perinephric abscesses or kidney stones.
To fully understand what costovertebral angle tenderness represents, it is helpful to understand some of the basic anatomy underpinning this area of the body. Ribs, which wrap around the chest, protecting important structures such as the heart and lungs, originate in the spine and end at the sternum at the front of the body. The area where the spine intersects the lower ribs is known as the costovertebral angle. It is an important area because it marks where the kidneys are typically located.
Healthcare professionals often test for tenderness in this area by tapping their fists on this region of the body. This maneuver was originated by John Benjamin Murphy, an American physician, and is sometimes called a “kidney punch.” If the maneuver causes pain, positive costovertebral angle tenderness is said to be present. Typically, a doctor will check for tenderness on both the right and left sides of the body.
The tenderness is most closely associated with the presence of pyelonephritis, an infection of the kidneys. Kidney stones, a condition also known as pyelonephritis, can also cause this type of pain. Having an infection or abscess around the kidney could also cause pain in this region. Other causes could include a rib fracture, a rash in the skin overlying the region, or bruising in the area secondary to previous trauma.
One of the most important reasons to check for costovertebral angle tenderness is to distinguish between pyelonephritis and urinary tract infections. Pyelonephritis, which involves inflammation and infection of the kidney itself, is often caused by the spread of bacteria from outside the body along the urinary tract through the bladder to the kidneys. As a result, a simple urinary tract infection affecting the bladder could eventually cause pyelonephritis if left untreated. While having a urinary tract infection doesn’t cause costovertebral angle tenderness, pyelonephritis does. The presence of tenderness therefore helps identify sicker patients who have developed more advanced infections and may require more aggressive treatment.
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