Which sign corresponds to left shoulder pain due to splenic injury?

• A. Grey-Turner Sign
• B. Cullen Sign
• C. Kehr Sign
• D. Venous Bleeding

Answer: (C)

Kehr sign is left shoulder pain caused by diaphragmatic irritation from blood in the peritoneal cavity, as happens with splenic injury. When the spleen ruptures, blood irritates the left hemidiaphragm, and the phrenic nerve (C3–5) transmits that irritation as referred pain to the left shoulder. This makes the left shoulder pain a key clue pointing to intra-abdominal bleeding from the spleen.

Grey-Turner sign and Cullen sign are how the body shows ecchymoses—Grey-Turner on the flanks and Cullen around the umbilicus—associated with intra-abdominal or retroperitoneal bleeding, but they describe external bruising rather than referred shoulder pain. Venous bleeding isn’t a specific clinical sign for this presentation.