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Kehr's sign is a classic example of referred pain: irritation of the diaphragm is signaled by the phrenic nerve as pain in the area above the collarbone. This is because the supraclavicular nerves have the same cervical nerves origin as the phrenic nerve, C3, C4, and C5.
The major symptom and signs include an acute onset of RUQ abdominal pain aggravated by breathing, coughing or laughing, which may also present with referred pain to the right shoulder. There is usually also tenderness on palpation of the right upper abdomen and tenderness to percussion of the lower ribs which protect the liver.
Shoulder pain may be localized or may be referred to areas around the shoulder or down the arm. Other regions within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that the brain may interpret as arising from the shoulder. [1]
Referred pain, also called reflective pain, [1] is pain perceived at a location other than the site of the painful stimulus.An example is the case of angina pectoris brought on by a myocardial infarction (heart attack), where pain is often felt in the left side of neck, left shoulder, and back rather than in the thorax (chest), the site of the injury.
Pain arising from structures supplied by the phrenic nerve is often "referred" to other somatic regions served by spinal nerves C3-C5. For example, a subphrenic abscess beneath the right diaphragm might cause a patient to feel pain in the right shoulder. Irritation of the phrenic nerve (or the tissues it supplies) leads to the hiccup reflex.
Dr. Carrie Jose explains how you can naturally get rid of shoulder impingement for the long term. Health and Wellness: Shoulder impingement syndrome, treating the cause over symptoms Skip to main ...
Kehr's sign which is referred pain to left shoulder due to ruptured spleen or blood or irritant in peritoneal cavity. Murphy's sign which is tested for during an abdominal examination; it is performed by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (the ...
Other symptoms may include fever, as well as referred pain between the shoulder blades or below the right shoulder. If one or more gallstones block the bile ducts and cause bilirubin to leak into the bloodstream and surrounding tissue, jaundice and itching may also occur. In this case, liver enzyme levels are likely to be raised. [16]