Homan's Sign Test
Original Editor - Temi Olagunju
Lead Contributor Temi Olagunju
Purpose
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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) [1][2].
Technique
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- 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.
Evidence[edit | edit source]
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 [4] [5].
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 [6].
Accuracy[edit | edit source]
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[7].
Precaution[edit | edit source]
Vigorous dorsiflexion of the foot is used by surgeons to expel clot from the veins and so this test may have its dangers[8].
Common Errors[edit | edit source]
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.
Differential Diagnosis[edit | edit source]
The following are the conditions that can be associated with a positive Homan's sign:[9]
- Intervertebral disc herniation
- Ruptured Baker's cyst
- Neurogenic claudication
- Gastrocnemius spasm, and cellulitis.
Relevance to Physiotherapists[edit | edit source]
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.
References[edit | edit source]
- ↑ Wheeler HB. Diagnosis of deep vein thrombosis. Review of clinical evaluation and impedance plethysmography. American journal of surgery. 1985 Oct;150(4A):7-13.
- ↑ Patel K, Chun LJ, Deep Venous Thrombosis. Medscape 2017 https://emedicine.medscape.com/article/1911303-workup (Accessed on 3rd July, 2018).
- ↑ bigesor. Homan's Sign. Available from https://youtu.be/2cp2DikKRwg [last Accessed on 3 May 2022]
- ↑ Shafer N, Duboff S. Physical signs in the early diagnosis of thrombophlebitis. Angiology. 1971 Jan;22(1):18-30.
- ↑ Mathewson M. A Homan's sign is an effective method of diagnosing thrombophlebitis in bedridden patients. Critical care nurse. 1983 Jul 1;3(4):64-5
- ↑ Hirsh J, Hull RD, Raskob GE. Clinical features and diagnosis of venous thrombosis. Journal of the American College of Cardiology. 1986 Dec 1;8(6 Supplement 2):114B-27B.
- ↑ Ambesh P, Obiagwu C, Shetty V. Homan’s sign for deep vein thrombosis: A grain of salt?. Indian Heart Journal. 2017 May;69(3):418.
- ↑ Homans J. Thrombosis of the deep veins of the lower leg, causing pulmonary embolism. New England Journal of Medicine. 1934 Nov 29;211(22):993-7
- ↑ Ambesh, P., Obiagwu, C., & Shetty, V. (2017). Homan’s sign for deep vein thrombosis: A grain of salt? Indian Heart Journal, 69(3), 418-419.
