What might indicate CVA tenderness when a physician pounds on the back?

CVA tenderness, or costovertebral angle tenderness, is assessed by gently tapping or pounding on the back near the kidneys. The presence of CVA tenderness typically indicates inflammation or irritation of the structures in the area, particularly the kidneys.

When a physician performs this maneuver, a positive response—signified by pain upon percussion—suggests that there may be problems related to the kidneys, such as pyelonephritis (kidney infection), kidney stones, or other renal issues. If the kidneys are inflamed or irritated, the underlying tissues become sensitive, leading to discomfort when pressure is applied.

In contrast, constitutional issues like fever or malaise may not directly cause CVA tenderness but could indicate an underlying systemic infection, including kidney involvement. Muscle strains could lead to back pain, but they would typically not cause tenderness specific to the costovertebral angle. Additionally, spinal alignment issues may cause back pain as well, yet they would not directly relate to CVA tenderness, which is specifically associated with kidney pathology.

Thus, the presence of CVA tenderness upon percussion effectively points towards kidney problems, making it the most relevant answer in this context.