Homans sign

In medicine, Homans' sign or the Homans sign was used as a sign of deep vein thrombosis (DVT).

It has fallen out of favor because a positive sign does not indicate DVT (Likelihood ratio positive = 1) and a negative sign does not rule it out (Likelihood ratio negative = 1)[1] [2] It is estimated to have a sensitivity of 60-88% and a specificity of 30-72%.[3]

A positive sign is present when there is pain in the calf on forceful and abrupt dorsiflexion of the patient's foot at the ankle while the knee is extended.[4]

It is named for the American physician John Homans.[5]

This is not a commonly used test. The other test for a DVT is to have a blood test done (D-dimer, which is sensitive for DVT but not specific and can be elevated for many other reasons) and an ultrasound of the leg, which are both a better choice to rule out blood clots than the Homans' sign.

There is a mistaken belief that eliciting Homan's sign is dangerous; this concern is based upon a single case of pulmonary thromboembolism following calf pressure during a Doppler examination. However, modern medical texts such as the Oxford Handbook of Clinical Medicine (8th Edition) state that this sign should not be elicited as the risk of dislodging the thrombus is significant, leading to the potential development of a pulmonary embolism.

References

  1. ↑ S McGee. Evidence Based Physical Diagnosis. Elsevier, 2012. Chapter 54
  2. ↑ Marx et al., Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th Ed. Elsevier, 2010. Chapter 86
  3. ↑ Homan's sign in gpnotebook. In turn citing: Joshua AM et al. Beauty is in the eye of the examiner: reaching agreement about physical signs and their value. Internal Medicine Journal 2005; 35(3):178-187.
  4. ↑ Shafer N, Duboff S. Physical signs in the early diagnosis of thrombophlebitis. Angiology 1980;22:18–30.
  5. ↑ Homans' sign at Who Named It?