Homans Sign Overview

Homans Sign is used to check for deep vein thrombosis (DVT) which causes calf pain. It’s sometimes called dorsiflexion sign. This sign was first described by John Homans in 1941 who was an American surgeon.

How do you assess the Homan’s sign?

The Homans Sign test is performed with the patient in supine position. The examiner lifts the affected leg and rapidly dorsiflexes the patient’s foot with the knee extended. This maneuver is repeated with the patient’s knee flexed while the examiner simultaneously palpates the calf.

See Also: Thomas Test

Positive Homans Sign

Homans Sign (DVT) is positive “if pain is occurring upon dorsiflexion of the foot with the knee extended and flexed indicating deep vein thrombosis (DVT)”.

The explanation of the Homans sign is that the passive, abrupt and forced dorsiflexion of the ankle with knee flexion causes mechanical traction on the posterior tibial vein. This traction stimulates the pain sensitive structures in the lower limb.

See Also: Deep Venous Thrombosis (DVT)

Pain may also be elicited on palpation of the calf in conjunction with the passive stretch.

A positive finding indicates a life-threatening condition that should be addressed by appropriate medical personnel immediately

Accuracy & Releability

The sensitivity of homans sign for DVT has been questioned because deep vein thrombosis may not always produce an abnormal Homans test.

Homans sign test sensitivity and specificity is considered low as a DVT Test; but it can be of value if used in addition to more accurate diagnostic procedures like ultrasonography and venography ².

• Sensitivity: 10-54%
• Specificity: 39-89%

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

Homans sign though unreliable holds great historical importance. Thus it continues to be practiced in medical colleges and private physician clinics across the world because of its easy technique and simple demonstrability.

See Also: DVT Tests

Notes:

Calf pain with the knee extended can also be caused by intervertebral disk disease (radicular symptoms) or muscle contractures.

Obviously, injury to the gastrocsoleus complex may also be aggravated by Homans test.

Another case that is seen in women who after chronically wearing high heels start wearing flat shoes. In these women, sometimes due to mechanical traction in the lower limb, a positive Homans sign test can be demonstrated.

The performance of the Homans sign test may increase the risk of producing a pulmonary embolism (PE).

More accurate diagnostic DVT Tests other than Homans sign include:

1. Contrast venography,
2. Doppler and B-mode ultrasound,
3. Venous duplex imaging,
4. Impedance plethysmography,
5. I-125 fibrinogen uptake.

Reference

1. McGee, Steven (2012). Evidence-Based Physical Diagnosis. Philadelphia, USA: Saunders. pp. 472–473.
2. Ambesh P, Obiagwu C, Shetty V. Homans sign for deep vein thrombosis: A grain of salt? Indian Heart J. 2017 May-Jun;69(3):418-419. doi: 10.1016/j.ihj.2017.01.013. Epub 2017 Jan 23. PMID: 28648447.
3. Shafer N, Duboff S. Physical signs in the early diagnosis of thrombophlebitis. Angiology. 1971 Jan;22(1):18-30. doi: 10.1177/000331977102200105. PMID: 4925428.
4. Mathewson M. A Homan’s sign is an effective method of diagnosing thrombophlebitis in bedridden patients. Crit Care Nurse. 1983 Jul-Aug;3(4):64-5. PMID: 6554175.
5. Levi M, Hart W, Büller HR. Fysische diagnostiek–het teken van Homans [Physical examination–the significance of Homan’s sign]. Ned Tijdschr Geneeskd. 1999 Sep 11;143(37):1861-3. Dutch. PMID: 10526599.
6. Pini M, Ria L, Pattacini C, Tagliaferri A, Poti R. Il segno di Homans rivisitato: è attendibile la diagnosi clinica di trombosi venosa profonda? [Homan’s sign revisited: is the clinical diagnosis of deep venous thrombosis reliable?]. Recenti Prog Med. 1984 Jul-Aug;75(7-8):650-7. Italian. PMID: 6505364.
7. Urbano, FL: Homans’ sign in the diagnosis of deep vein thrombosis. Hosp Physician, March:22, 2001.
8. Homans J. Thrombophlebitis in the legs. New Engl J Med. 1938;218:594–599.
9. Homans J. Diseases of the veins. New Engl J Med. 1944;231:51–60.
10. McGee, Steven (2012). Evidence-Based Physical Diagnosis. Philadelphia, USA: Saunders. pp. 472–473.
11. Clinical Tests for the Musculoskeletal System 3rd Edition.
12. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
13. Sarvdeep S. Dhatt, Sharad Prabhakar – Handbook of Clinical Examination in Orthopedics.