Kehr’s Sign: Difference between revisions
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== Purpose == | == Purpose == | ||
Kehr's Sign refers to | Kehr's Sign refers to the occurrence of acute pain in the tip of the left [[shoulder]] due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated.<ref name=":0">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.</ref> It was first described by Hans Kehr - a German surgeon(1862-1916).<ref name=":1">Söyüncü S, Bektaş F, Cete Y. [https://tjtes.org/jvi.aspx?un=UTD-04874 Traditional Kehr's sign: Left shoulder pain related to splenic abscess.] Ulus Travma Acil Cerrahi Derg. 2012 Jan;18(1):87-8. </ref> It is an example of [[Referred Pain|referred pain]]; the irritation to the [[Diaphragm Anatomy and Differential Diagnosis|diaphragm]] is transmitted as pain signals along the phrenic nerve to the supraclavicular region.<ref name=":1" /> This is due to the phrenic and supraclavicular nerves having shared cervical origins - C3, and C4.<ref name=":0" /> While Kehr's sign (left [[shoulder]] pain) is commonly a symptom of splenic rupture, right [[shoulder]] pain typically signals liver or gallbladder irritation.<ref>Mcevoy M, Rabrich JS, Murphy M. Critical Care Transport. Burlington:Jones & Bartlett Learning, 2017.</ref> <br> | ||
== Technique == | == Technique == | ||
Position the patient in supine lying with the lower extremity elevated ( | Position the patient in a supine lying with the lower extremity elevated ([[Trendelenburg Position|Trendelenburg position]]). A gentle palpation of the left upper quadrant of the abdomen will elicit pain in the left [[shoulder]].<ref name=":0" /> | ||
{{#ev:youtube|UkXghZn2WJ8|300}}<ref>Med School Made Easy. Kehr Sign - Spleen Exam. Available from: http://www.youtube.com/watch?v=UkXghZn2WJ8</ref> | {{#ev:youtube|UkXghZn2WJ8|300}}<ref>Med School Made Easy. Kehr Sign - Spleen Exam. Available from: http://www.youtube.com/watch?v=UkXghZn2WJ8</ref> | ||
Revision as of 22:54, 25 June 2024
Purpose[edit | edit source]
Kehr's Sign refers to the occurrence of acute pain in the tip of the left shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated.[1] It was first described by Hans Kehr - a German surgeon(1862-1916).[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, and 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 a 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]
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]
- ↑ 1.0 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.
- ↑ 2.0 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.
- ↑ 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.
