Can you make the diagnosis?

Jeremy checks into the Emergency Department for left shoulder pain.  He tells the triage nurse that his shoulder started hurting that morning.  He had been riding his bike to work and hit a pothole.  He thinks his stomach hit the handlebars before he hit the ground.

What should the triage nurse do?

  1.  Tell Jeremy that the E.R. is really busy, it will be a couple hour wait to be seen.
  2.  Triage Jeremy as a high priority, he may have a signficant intra-abdominal injury



If you guessed 2. Triage Jeremy as a high priority, you are right!

When a patient has a history of a trauma or injury to the abdomen, and then complains of left shoulder pain, it can be from  “referred pain”, due to the innervation of the abdominal organs.  The referred nerve pain causes the left shoulder to hurt even though the shoulder is not injured.

In this case, Jeremy has a ruptured spleen.  It is common from patients with a ruptured spleen from trauma to complain of left shoulder pain due to referred pain.  Most patients will also have abdominal pain when examined.

When a spleen ruptures, it is an emergency.  While some patients can be managed non-surgically, there are also cases that result in significant bleeding and must be treated with a surgery.

Ruptured spleen that has been removed at surgery:



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