Homan's Sign Test

Original Editor - Temi Olagunju

Lead Contributor   Temi Olagunju

Purpose

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

  1. In performing this test the patient will need to actively extend his knee.
  1. 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.
  1. Deep calf pain and tenderness may indicate presence of DVT.


[3]

Evidence

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

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

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

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.

Relevance to Physiotherapists

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

  1. Wheeler HB. Diagnosis of deep vein thrombosis. Review of clinical evaluation and impedance plethysmography. American journal of surgery. 1985 Oct;150(4A):7-13.
  2. Patel K, Chun LJ, Deep Venous Thrombosis. Medscape 2017 https://emedicine.medscape.com/article/1911303-workup (Accessed on 3rd July, 2018).
  3. Steph Magee. Homan's Sign. Available from https://www.youtube.com/watch?v=R5cevg5Y0Zg [last Accessed on 1/7/2018]
  4. Shafer N, Duboff S. Physical signs in the early diagnosis of thrombophlebitis. Angiology. 1971 Jan;22(1):18-30.
  5. 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
  6. 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.
  7. 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.
  8. 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