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KEHR’S SIGN
Kehr’s sign is pain that occurs in the tip of the shoulder when there is blood or other irritants in the peritoneal cavity associated with the spleen. It is irritation of the diaphragm and is felt via the phrenic nerve to above the clavicle. It is considered a classic symptom of a ruptured or abscessed spleen. Ruptured spleens can occur with mononucleosis. The sign is a pain in the upper left quadrant with palpable tenderness at the site and under the left rib cage. Signs of shock due to internal bleeding may occur. Important for Therapists who deal with sports injuries as it is the most common cause of death due to abdominal trauma in sports injuries.
Splenic abscess presents with fever and left upper abdominal pain. This test in conjunction with CT imaging has a diagnostic rate of 86.7%
MURPHY’S PERCUSSION
Murphy’s percussion is a test for kidney involvement with infection or inflammation. The test is performed by placing the hand over the costovertebral angle of the rib cage and thumping this hand with the other fist. If it reproduces the signs of flank or back pain it is a positive for kidney involvement although there are no specific studies to determine its reliability. This symptom may coincide with fevers and chills.
Kidney Location: By OpenStax College [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons
1. Soyuncu, S et al. Traditional Kehr’s sign: Left shoulder pain related to splenic abscess. Ulus Travma Acil Cerrahi Derg. 2012 Jan 18(1): 87-8.
2. Hansen, N. Peterson, R. Ruptured Spleen. Physio-pedia.com. n.d. web. Jan 12 2016.
3. Lake, C, Templin, K. Thoracic Examination. Physio-pedia.com n.d. web. Jan 12 2016.
4. Goodman, C, Kelly Snyder, T. Differential Diagnosis for Physical Therapists.St. Louis: Elsevier
