Physical Therapist Screening for Cholelithiasis: A Case Series

BACKGROUND: Cholelithiasis is a common condition accounting for 1.1 million outpatient visits in the United States each year. Symptom locations include the right upper quadrant of the abdomen, the right flank, the right caudal border of the scapula, and the right shoulder. Due to the location of symptoms, these patients may present to physical therapy. CASE PRESENTATION: This case series describes three patients presenting to physical therapy with pain in the right flank or right scapula. OUTCOME & FOLLOW-UP: In each case, the physical therapists appropriately referred the patient for additional medical examination resulting confirmation of cholelithiasis and subsequent surgical intervention. DISCUSSION: Physical therapists need to be aware of risk factors (i.e. female gender, obesity, advanced age) and physical examination procedures to screen for cholelithiasis especially among patients presenting with right shoulder, scapular, or flank-region pain. LEARNING POINTS: Collins’ Sign and Murphy’s Sign are clinical considerations in the differential diagnosis of patients with suspected cholelithiasis.