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What Is Costovertebral Angle Tenderness?

By Clara Kedrek
Updated Mar 03, 2024
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Costovertebral angle tenderness is a term used to describe having pain and tenderness in a region of the lower back adjacent to the spine. Often, medical professionals check for the presence of tenderness in this area by tapping patients on their backs. Having pain in this area could signify the presence of diseases such as pyelonephritis, perinephric abscesses, or kidney stones.

In order to fully understand what having costovertebral angle tenderness represents, it helps to understand some of the basic anatomy underlying this area of the body. The ribs, which wrap around the chest, protecting important structures such as the heart and lungs, originate in the spinal column and end in the sternum at the front of the body. The area where the vertebral column intersects the lower ribs is known as the costovertebral angle. It is an important area because it marks the spot where the kidneys are typically found.

Healthcare professionals often check 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 it is sometimes referred to as the "kidney punch." If the maneuver elicits pain, positive costovertebral angle tenderness is said to be present. Typically, a medical professional would check for tenderness both on the right and left sides of the body.

Tenderness is most closely associated with the presence of pyelonephritis, an infection of the kidneys. Renal stones, a condition also known as pyelonephritis, can also cause this type of pain. Having an infection or abscess in the area surrounding the kidney could also cause soreness in this region. Other causes of could include a rib fracture, rashes in the skin overlying the region, or bruising in the area secondary to previous trauma.

One of the most important reasons to check for tenderness at the costovertebral angle 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 up the urinary tract through the bladder into the kidneys. As a result, a simple urinary tract infection affecting the bladder could eventually cause pyelonephritis if it not treated. Whereas having a urinary tract infection does not cause costovertebral angle tenderness, pyelonephritis does. The presence of tenderness therefore helps identify sicker patients who have developed more advanced infections and might require more aggressive treatment.

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Discussion Comments
By seag47 — On Oct 05, 2012

My friend had intense pain in her back when she had kidney stones. She had also lost the ability to urinate, so she went to the emergency room.

They could tell she was in a lot of pain, because she was crying and even screaming from time to time. It wasn't long before she got in a room, and when the doctor touched her back, she nearly fainted!

She had extreme costovertebral angle tenderness. The stones had to be broken up with a laser, and she had to wear a catheter to pass them. It took a couple of weeks and many painkillers for her to fully recover. She said that her back was sore for awhile.

By Perdido — On Oct 04, 2012

@wavy58 – No, it wouldn't work to treat a kidney infection. If a urinary tract infection has progressed into the kidneys, then it has become very dangerous and needs to be treated with antibiotics right away.

I let my UTI go for too long, and it went into my kidneys. When the doctor tapped on the region of my kidneys, I winced in pain. I had also been vomiting and experiencing constant soreness in my lower back and sides.

He said I had a kidney infection and gave me some strong antibiotics. Cranberry juice may work to prevent a UTI, but once you have a kidney infection or a UTI that has lingered for a few days, it won't cure it.

By wavy58 — On Oct 04, 2012

I wondered why my doctor tapped on my back when I went in for a urinary tract infection! I wanted to tell him that my pain was down in my bladder, not in my back.

I'm glad that I didn't have a kidney infection. I had no pain when he tapped my back. That seemed to satisfy him, and he gave me a prescription for antibiotics.

He told me that I could drink cranberry juice every day to treat a mild urinary tract infection and to prevent further ones. I wonder if a person with a kidney infection could do this?

By shell4life — On Oct 03, 2012

I have polycystic kidney disease, so I often have pain in the area of my lower back. Every time I go in for a checkup, my doctor will feel around this area, as well as the front of my abdomen.

I have multiple cysts on my kidneys, and when they rupture, they cause extreme pain. My kidneys are enlarged, and sometimes, they just become sore, even if a cyst hasn't ruptured.

My doctor checks for costovertebral angle tenderness out of curiosity, I think. There really isn't anything that can be done for this condition, so I'm not sure why he checks to see how sore I am.

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