Collins' sign: validation of a clinical sign in cholelithiasis

Cholelithiasis typically presents with right upper quadrant pain, as can pain from other right upper quadrant organs. Pain of cholelithiasis is often referred to tip of scapula. Professor Paddy Collins drew attention to fact that patients with gallstone pain would attempt to demonstrate this by placing their hand behind the back and thumb pointing upwards. This became known amongst his students as Collins' sign.

To evaluate accuracy of Collins' sign as indicator of cholelithiasis.

Case-control study performed on 202 patients with symptomatic cholelithiasis and 200 control patients (with oesophagitis, gastritis or duodenal ulcer). Questionnaire examined pain pattern in both groups. The results analysed using t test and χ(2) test.

Collins' sign was positive in 51.5% of gallstone patients and 7.5% of control group (P < 0.001).

Collins' sign was positive in over half of all patients with cholelithiasis and was useful discriminator in diagnosis of gallstones.