Kehr’s Sign |causes |how to assess

Last updated on December 28th, 2023

Kehr’s Sign

Kehr’s sign is a clinical sign suggestive of irritants in the peritoneal cavity, especially due to spleen rupture. 

Kehr’s sign is defined as pain in the supraclavicular area due to peritoneal irritants such as blood. 

It is an excellent example of typical referred pain. Patients positive for Kehr’s sign feel acute pain in the left shoulder due to irritation of the diaphragm signaled via the phrenic nerve. Its because phrenic nerves and supraclavicular nerves have the same cervical nerves (C3 and C4) root origins.

Kehr’s sign is named after a German gall bladder surgeon Dr.Hans Kehr (1862-1916). However, a study on the origins of Kehr’s sign concludes that there is no adequate evidence to support the term [Kehr’s sign] pertaining to his own original work.

Causes for positive Kehr’s sign

Positive Kehr’s sign seen in patients with:

  • Splenic rupture
  • Blunt trauma to the abdomen
  • Ruptured ectopic pregnancy
  • Phrenic artery rupture
  • Splenic abscess
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How to assess for Kehr’s sign

To assess for Kehr’s sign,

  • Position patient in supine position with both legs slightly bent from the knees.
  • Gently palpate the left upper quadrant of the abdomen. If it induces or increases pain in the left shoulder is indicative of positive Kehr’s sign.
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