Kehr sign refers to referred pain in which location?

• A. Tip of the shoulder
• B. Lower back
• C. Chest wall
• D. Groin

Answer: (A)

Kehr sign is due to diaphragmatic irritation causing referred pain to the shoulder through the phrenic nerve (C3–5). When blood or irritating fluid enters the peritoneal cavity (often from splenic injury), the irritated diaphragm transmits pain to the shoulder area, typically felt at the tip of the shoulder (often on the left). This pattern—diaphragmatic irritation producing shoulder tip pain—makes the shoulder tip the correct location. The other areas (lower back, chest wall, groin) don’t align with the diaphragmatic referral path.