Homans sign

In medicine, Homans' sign (sometimes spelled as Homans sign) or the dorsiflexion sign is considered a sign of deep vein thrombosis (DVT). It was defined by John Homans in 1941 as discomfort behind the knee on forced dorsiflexion of the foot.[1] After surgeons discovered many examples of a false-positive Homans' sign, Homans redefined it in 1944, stating that "discomfort need have no part in the reaction", including increased resistance, involuntary flexure of the knee or pain in the calf to forced dorsiflexion as positive responses.[1][2][3]

It is estimated to have a sensitivity of 10-54% and a specificity of 39-89%,[1] and is thus considered to have no diagnostic value, since a positive sign does not indicate DVT and a negative sign does not rule it out.[1] Still, it is widely used in clinical practice, probably because of its historical role prior to the availability of more reliable diagnostic studies (such as a D-dimer titration or a Doppler ultrasound), as well the ease of eliciting it.[4] Signs and symptoms of DVT in general are not sufficiently sensitive or specific to make a diagnosis, being helpful only to help determine the likelihood of a DVT (with the use of a clinical prediction rule such as the Wells score).[5]

There may exist some concern that eliciting this sign may be dangerous and that it should not be elicited.[6][7]

Further reading

References

  1. 1 2 3 4 McGee, Steven (2012). Evidence-Based Physical Diagnosis. Philadelphia, USA: Saunders. pp. 472–473. ISBN 978-1-4377-2207-9.
  2. ↑ Hume, Michael (1970). Venous Thrombosis and Pulmonary Embolism. Cambridge: Harvard University Press. p. 149. ISBN 9780674933200.
  3. ↑ Shafer N. & Duboff S. (1971). "Physical signs in the early diagnosis of thrombophlebitis," Angiology 22:18–30.
  4. ↑ Urbano, Frank (March 2001). "Homans’ Sign in the Diagnosis of Deep Venous Thrombosis" (PDF). Hospital Physician. Retrieved 2016-02-05.
  5. ↑ Scarvelis, Dimitrios; Wells, Philip S. (2006-10-24). "Diagnosis and treatment of deep-vein thrombosis". Canadian Medical Association Journal. 175 (9): 1087–1092. ISSN 1488-2329. PMC 1609160 Freely accessible. PMID 17060659. doi:10.1503/cmaj.060366.
  6. ↑ Grant, Brydon (2016-02-02). "Diagnosis of suspected deep vein thrombosis of the lower extremity". UpToDate. Retrieved 2016-02-05.
  7. ↑ Oxford Handbook of Clinical Surgery. Oxford, UK: Oxford University Press. 2013. p. 668. ISBN 9780199699476.
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