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Purpose[edit | edit source]
Kehr's Sign refers to left shoulder pain that is caused by the irritation of the inferior surface of the diaphragm due to bleeding from a splenic rupture. It was first described by Hans Kehr - a German surgeon. It is an example of referred pain; the irritation to the diaphragm is transmitted as pain signals along the phrenic nerve to the supraclavicular region. This is due to the phrenic and supraclavicular nerves having shared cervical origins - C3, C4. While Kehr's sign (left shoulder pain) is commonly a symptom of splenic rupture, right shoulder pain typically signals liver or gallbladder irritation.
Technique[edit | edit source]
Position the patient in supine lying with the lower extremity elevated (trendelenburg position). A gentle palpation of the left upper quadrant of the abdomen will elicit pain in the left shoulder.
Evidence[edit | edit source]
The sensitivity and specificity of Kehr's sign are unknown, as no studies have reported on that. However, a study showed that 90% of patients with splenic ruptures presented with Kehr's sign. Kehr's sign has also been observed in other conditions that involve the presence of blood or other irritants in the peritoneal cavity.
References[edit | edit source]
- Rastogi V, Singh D, Tekiner H, Ye F, Mazza JJ, Yale SH. Abdominal Physical Signs of Inspection and Medical Eponyms. Clin Med Res. 2019 Dec;17(3-4):115-126. doi: 10.3121/cmr.2019.1420. Epub 2019 Jul 15. PMID: 31308022; PMCID: PMC6886890.
- Söyüncü S, Bektaş F, Cete Y. Traditional Kehr's sign: Left shoulder pain related to splenic abscess. Ulus Travma Acil Cerrahi Derg. 2012 Jan;18(1):87-8. doi: 10.5505/tjtes.2011.04874. PMID: 22290058.
- Mcevoy M, Rabrich JS, Murphy M. Critical Care Transport. Burlington:Jones & Bartlett Learning, 2017.
- Med School Made Easy. Kehr Sign - Spleen Exam. Available from: http://www.youtube.com/watch?v=UkXghZn2WJ8
- Lowenfels AB. Kehr's sign--a neglected aid in rupture of the spleen. N Engl J Med. 1966 May 5;274(18):1019. doi: 10.1056/NEJM196605052741810. PMID: 5909736.