From the Research
Kehr's sign is the classic sign of splenic rupture, characterized by pain in the left shoulder. This referred pain occurs because blood from the ruptured spleen irritates the diaphragm, which shares nerve innervation (specifically the phrenic nerve) with the shoulder area. When a patient experiences left shoulder pain after abdominal trauma, especially when lying flat or in Trendelenburg position, Kehr's sign should raise suspicion for splenic injury. The spleen is the most commonly injured abdominal organ in blunt trauma, and early recognition of splenic rupture is crucial as it can lead to life-threatening internal bleeding, as seen in a case report from 1.
The phenomenon demonstrates how pain can be referred to distant areas through shared nerve pathways, making it an important clinical indicator in emergency medicine. A study from 2 highlights the importance of Kehr's sign in diagnosing splenic abscess, and another study from 3 emphasizes the need for prompt identification and hemorrhage control in splenic trauma. Although the origin of Kehr's sign is unclear, as discussed in 4, its significance in clinical practice remains unchanged.
Key points to consider:
- Kehr's sign is a referred pain in the left shoulder due to splenic rupture
- The spleen is the most commonly injured abdominal organ in blunt trauma
- Early recognition of splenic rupture is crucial to prevent life-threatening internal bleeding
- Kehr's sign is an important clinical indicator in emergency medicine, as seen in cases reported in 5 and 1