Kehr sign

Kehr sign is a referred pain to 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. Kehr sign is a rare finding and should increase the suspicion of the peritoneal process and is considered a classical symptom of a ruptured spleen ². Kehr’s sign may result from diaphragmatic or peridiaphragmatic lesions, renal calculi, splenic injury or ectopic pregnancy.

Kehr’s sign was originally described by the German surgeon Hans Kehr (1862-1916). It is a classical example of referred pain: irritation of the diaphragm is signaled by the phrenic nerve as pain in the area above the clavicle ³.

References

1. 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
2. Akoury T, Whetstone DR. Splenic Rupture. [Updated 2019 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525951
3. Klimpel V (2004). “Does Kehr’s sign derive from Hans Kehr? A critical commentary on its documentation?”. Chirurg. 75 (1): 80–3. doi:10.1007/s00104-003-0796-2