Kehr Sign indicates left shoulder pain related to which injury?

• A. Right shoulder pain from liver injury
• B. Lower back pain from kidney injury
• C. Abdominal pain relieved by bending forward
• D. Left shoulder pain from splenic injury

Answer: (D)

Kehr sign is the referred pain felt in the left shoulder caused by irritation of the left hemidiaphragm from intra-abdominal bleeding. When the diaphragm is irritated, sensory signals travel with the phrenic nerve (C3–C5) and are perceived in the shoulder region, most commonly on the left side if the spleen is involved. In the trauma setting, splenic injury can lead to hemoperitoneum, which irritates the diaphragmatic pleura and peritoneum, producing the characteristic left shoulder pain. That’s why the scenario points to splenic injury as the cause.

The other possibilities don’t fit this pattern: right shoulder pain would not be the classic sign of diaphragmatic irritation from splenic bleed, while kidney-related back pain and general abdominal pain relieved by bending forward describe different patterns of pain or relief that don’t involve this diaphragmatic referral phenomenon.