What is Homan’s Sign | Physiotherapy

Homan's Sign

Overview of homan’s sign

Homan’s sign is an indicator of deep vein thrombosis. The sign is present where the pain in the calf is caused by passive dorsiflexion of the foot. However, clinical signs and symptoms have been found to be of little help in the diagnosis of venous thrombosis of the legs because they lack sensitivity.

Homan’s sign, swelling, and erythema have understandings of 60-88% and specificities of 30-72% in elegant studies for the diagnosis of deep vein thrombosis (using venography as the reference standard). Studies of the Homan sign suggest that it is positive in between 8 and 56% of people with proven deep vein thrombosis (DVT), but it is also positive in more than 50% of symptomatic people without DVT.

Homan’s sign can be positive for both calf DVT and ruptured Baker’s cyst. The test has fallen out of favor due to a lack of sensitivity and specificity for a diagnosis of deep vein thrombosis.

Purpose

The Homan’s sign test, also called the dorsiflexon sign test, is a physical exam procedure used to evaluate deep vein thrombosis (DVT). A positive Homan’s sign in the presence of other clinical signs can be a rapid indicator of DVT. The clinical evaluation alone cannot be relied upon for patient management, but when done carefully, it is still helpful in determining the need for additional tests (such as D-dimer test, ultrasound, computed tomography (CT) helical multidetector, and pulmonary angiography).

Procedure

Client supine/sitting, affected knee extended; therapist to passively dorsiflex the client’s ankle

Findings

Deep pain in the calf. You may also find local warmth/tenderness to deep vein thrombosis (DVT). The dorsalis pedis pulse may also be decreased and the affected leg swollen/pale.

Meaning of the Homan sign

In a study involving control subjects and patients with lower limb thrombosis, phlebography was used to evaluate certain clinical parameters, one of which was the Homan sign. The results showed that all the clinical signs were inconsistent. Homan’s sign was observed in only 1/3 of patients with true thrombosis. On the other hand, it was also observed in 21% of the subjects without thrombosis.

Interestingly, a study showed that in patients with clinical suspicion of DVT, the Homan’s sign was more common in patients with a negative venogram than in patients with a positive result.

Therefore, after numerous studies, researchers and clinicians have reasonably concluded that Homan’s sign is neither sensitive nor specific for the diagnosis of DVT.

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