From the Research
Kehr sign is a clinical symptom characterized by pain in the left shoulder that occurs due to irritation of the diaphragm, typically associated with internal bleeding in the abdominal cavity, particularly from a ruptured spleen. This referred pain happens because the phrenic nerve, which supplies the diaphragm, shares cervical nerve roots (C3-C5) with nerves that supply the shoulder. When blood from a splenic rupture irritates the diaphragm, pain signals are transmitted along the phrenic nerve and perceived in the shoulder area.
Key Points
- Kehr sign is an important diagnostic indicator in trauma cases, especially after abdominal injuries or in cases of spontaneous splenic rupture, as noted in a case report and literature review 1.
- The presence of this sign should prompt immediate medical evaluation, as it may indicate significant internal bleeding requiring urgent intervention.
- The pain typically worsens when the patient is lying flat and may improve when sitting upright, as this position reduces diaphragmatic irritation.
- Physicians often test for Kehr sign by having the patient lie flat with their legs elevated, which can increase diaphragmatic irritation if blood is present in the upper abdomen.
Clinical Considerations
- A recent study from 2023 highlights the importance of prompt diagnosis and treatment in cases of spontaneous splenic rupture, which can present with Kehr's sign among other symptoms 1.
- The exact origin of Kehr's sign is still a topic of discussion, with some questioning its attribution to Hans Kehr 2, but its clinical significance remains undisputed.
- Kehr's sign has been traditionally described in the context of splenic abscess or rupture, as seen in a case report from 2012 3, but its presence should always prompt a thorough investigation for potential internal bleeding or other serious conditions.