Kehr’s Sign

Original Editor - Oyemi Sillo
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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.[1] It was first described by Hans Kehr - a German surgeon.[2] 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.[2] This is due to the phrenic and supraclavicular nerves having shared cervical origins - C3, C4.[1] While Kehr's sign (left shoulder pain) is commonly a symptom of splenic rupture, right shoulder pain typically signals liver or gallbladder irritation.[3]

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.[1]

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Evidence[edit | edit source]

The sensitivity and specificity of Kehr's sign are unknown, as no studies have reported on that.[1] However, a study showed that 90% of patients with splenic ruptures presented with Kehr's sign.[5] Kehr's sign has also been observed in other conditions that involve the presence of blood or other irritants in the peritoneal cavity.[1]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 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.
  2. 2.0 2.1 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.
  3. Mcevoy M, Rabrich JS, Murphy M. Critical Care Transport. Burlington:Jones & Bartlett Learning, 2017.
  4. Med School Made Easy. Kehr Sign - Spleen Exam. Available from: http://www.youtube.com/watch?v=UkXghZn2WJ8
  5. 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.