Homan's Sign Test

Original Editor - Temi Olagunju

Lead Editors  

Purpose

Homan’s sign test also called dorsiflexon sign is a physical examination procedure that is used to test for Deep Vein Thrombosis (DVT). It is a quick indicator of Deep Vein Thrombosis. Positive Homan’s sign in the presence of other clinical signs may be an 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.

Technique

1.      In performing this test the patient will need to actively extend his knee.

2.      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.

3.      Deep calf pain and tenderness may indicate presence of DVT.

Evidence

Passive, abrupt and forced ankle dorsiflexion in concert 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.

Precaution

Vigorous dorsiflexion of the foot is used by surgeons to expel clot from the veins and so this test may have its dangers.

Common Errors

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.