Homan's Sign Test
Homan’s sign test also called dorsiflexon sign test is a physical examination procedure that is used to test for Deep Vein Thrombosis (DVT). A positive Homan’s sign in the presence of other clinical signs may be a quick indicator of DVT. Clinical evaluation alone cannot be relied on for patient management, but when carefully performed, it remains useful in determining the need for additional testing (like D-dimer test, ultrasonography, multidetector helical computed axial tomography (CT), and pulmonary angiography) .
- In performing this test the patient will need to actively extend his knee.
- Once the knee is extended the examiner raises the patient’s straight leg to 10 degrees, then passively and abruptly dorsiflexes the foot and squeezes the calf with the other hand.
- Deep calf pain and tenderness may indicate presence of DVT.
Passive, abrupt and forced ankle dorsiflexion with slight knee flexion causes mechanical traction on the posterior tibial vein. This traction stimulates the pain sensitive structures in the lower limb  .
Differential diagnosis of conditions that demonstrate a positive Homan’s sign include intervertebral disc herniation, ruptured Baker’s cyst, neurogenic claudication, gastrocnemius spasm, and cellulitis .
Homan’s sign has low sensitivity and specificity in diagnosing DVT; it can be of value if used in addition to more accurate diagnostic procedures like ultrasonography and venography.
Vigorous dorsiflexion of the foot is used by surgeons to expel clot from the veins and so this test may have its dangers.
A common error that may occur is the examiner not dorsiflexing the patient’s foot enough to get a correct interpretation. The knee of the patient must also be in full extension.
Relevance to Physiotherapists
Homan’s sign test may serve as a quick and easy way to determine if a patient might be having a DVT and subsequently exercise caution when carrying out certain movements involving the lower limb especially in bedridden and unconscious patients.
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