a positive care sign is indicative of a splenic rupture we're going to be looking in the left upper quadrant right below the costal margin and that's approximately where the spleen is so let's say that my patient had an acute traumatic injury to the spleen or the left upper quadrant a positive care sign would be a pain traveling up to the left shoulder so if a patient comes in with complaints of a left upper quadrant pain or a recent history of trauma and they're having complaints of left shoulder pain that would be indicative of car sign meaning a splenic rupture