title: Collins' sign: validation of a clinical sign in cholelithiasis.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To evaluate accuracy of Collins' sign as indicator of cholelithiasis.
  
  
  METHODS
  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.
  
  
  RESULTS
  Collins' sign was positive in 51.5% of gallstone patients and 7.5% of control group (P < 0.001).
  
  
  CONCLUSIONS
  Collins' sign was positive in over half of all patients with cholelithiasis and was useful discriminator in diagnosis of gallstones.
authors.affiliation: Bon Secours Hospital, Glasnevin, Dublin, Ireland. drnadiagilani7@hotmail.com
authors.forename: S N S
authors.initials: SN
authors.lastname: Gilani
authors.forename: G
authors.initials: G
authors.lastname: Bass
authors.forename: F
authors.initials: F
authors.lastname: Leader
authors.forename: T N
authors.initials: TN
authors.lastname: Walsh
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D016022:Case-Control Studies; D002769:Cholelithiasis / Q000175:diagnosis*; D005260:Female; D042882:Gallstones / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053591:Referred Pain / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012540:Scapula
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