Homan’s Sign
What is Homan’s Sign?
Homan’s sign is a clinical test for deep vein thrombosis (DVT). It is positive if dorsiflexion of the foot causes pain in the calf, suggesting possible thrombosis. However, it is not highly specific or reliable for diagnosing DVT.
This method was believed to cause calf pain, which was a sign of a blood clot in the leg’s deep veins.Homan’s sign is not a valid test for DVT, though. Because of its lack of sensitivity and specificity, a positive test does not always indicate that a patient has DVT, and a negative test does not rule it out either.
Purpose
The dorsiflexon sign test, often referred to as the Homan’s sign test, is a physical examination used to detect deep vein thrombosis (DVT).Homan’s sign is meant to indicate calf pain, which was formerly believed to be a symptom of a blood clot in the leg’s deep veins.
Other, more accurate diagnostics, such the D-dimer blood test and Doppler ultrasonography, can be used to diagnose DVT.
Technique
The patient should lie on their back with a bent knee. Keeping the knee bent, carefully raise the patient’s leg off the bed. Support the patient’s heel with one hand. Hold the patient’s heel ball with your other hand.
Pull the patient’s toes up towards their shin with a swift, powerful motion. This is dorsiflexion.
Keep an eye out for any indications of calf pain.
A positive When the examiner firmly dorsiflexes the patient’s foot (bends it upward toward the shin), the patient feels discomfort in the calf, which is known as Homan’s sign.
Deep vein thrombosis, a blood clot in the leg’s deep veins, is considered to be the origin of this pain.
Homan’s Sign (for DVT) Video
What does a positive Homan sign actually mean?
Although deep vein thrombosis (DVT) is frequently linked to a positive Homan’s sign, it’s crucial to keep in mind that this test is not particularly accurate. People without DVT may benefit from it because of a number of other problems. Here are a few of them:
Conditions of the Musculoskeletal System:
Muscle strain: Homan’s sign-like soreness may be caused by a strained muscle in the calf.
Arthritis: Pain during dorsiflexion may also result from inflammation in the leg’s joints, particularly the knee or ankle.
Intervertebral disc herniation: Similar to DVT, a lower back herniated disc can occasionally induce referred pain in the leg.
A ruptured Baker’s cyst is a sac behind the knee that is filled with fluid. It might cause calf discomfort and edema if it bursts.
Narrowing of the spinal canal causes neurogenic claudication, a disorder that can cause leg discomfort during exercising.
Gastrocnemius spasm: DVT-like discomfort can also be caused by a calf muscle spasm.
Cellulitis is a bacterial skin illness that can make a leg red, swollen, and painful.
Short Achilles tendon: People who have a short Achilles tendon may occasionally feel discomfort when they dorsiflex, particularly if they abruptly go from wearing high heels to flat shoes.
Given that Homan’s sign is not specific to DVT, it is important to rule out other potential reasons of leg discomfort and, if DVT is suspected, to do more accurate testing such a D-dimer blood test or Doppler ultrasonography.
Evidence
Although Homan’s sign has been used historically for testing for DVT, its diagnostic utility is limited because of its low sensitivity and specificity: low sensitivity means that patients who do not have DVT may test positive, and low specificity means that patients who do have DVT may test positive.
This is due to the fact that the test is frequently negative in individuals with DVT and positive in those without. Even if a patient does not have DVT, they may still feel pain throughout the exam.
Because the test is subjective, the examiner may have a different interpretation of the patient’s reaction. Patients suffering from cellulitis, arthritis, or muscular injuries may have good test results.
Precautions
When doing the Homan’s sign exam, keep the following in mind:
Gentle technique: If a clot is present, the examiner should perform the test with gentle pressure to prevent it from being released.
Comfort of the patient: Throughout the exam, the patient should feel at ease. The examination needs to stop right away if they feel any pain.
Other tests:
The examiner should think about other tests if the patient has any conditions that limit the Homan’s sign test, such as a history of DVT or pulmonary embolism.Further assessment: DVT cannot be diagnosed with a positive Homan’s sign; further testing is required to confirm the diagnosis.
Contraindications
Known DVT: Because the test may dislodge a clot and result in a pulmonary embolism, it should not be administered to individuals who have a known history of deep vein thrombosis (DVT).
Pulmonary embolism: Patients who have a history of pulmonary embolism should not undergo the test since it may dislodge a clot and result in further problems.
Patients with active thrombophlebitis should not undergo the test since it could worsen their inflammation.
Patients who are in severe pain should not undergo the test.
Limitations
Due to its low sensitivity, Homan’s sign may overlook several DVT cases. According to studies, only around 50% of DVT patients have it.
Low specificity: Homan’s sign might be positive in individuals without DVT since it is likewise not particularly specific. False-positive findings and needless further testing may come from this.
Subjectivity: Depending on the examiner, Homan’s sign might be interpreted differently. Comparing findings from multiple examiners may become challenging as a result.
FAQs
What is the significance of Homan’s sign?
frequently used to diagnose leg deep vein thrombosis.
What is another name for the Homans sign?
One physical examination technique for identifying Deep Vein Thrombosis (DVT) is the Homan’s sign test, sometimes referred to as the dorsiflexon sign test.
What is a positive Homans sign?
The diagnosis of deep vein thrombosis in the leg is commonly made using Homans’ sign. The presence of thrombosis may be indicated by a positive Homans’ sign, which is calf pain with foot dorsiflexion.
How to do a homans test on yourself?
Step 1: In the leg you wish to examine, actively extend the knee.
Step 2: You’ll need assistance raising your leg to 10 degrees when your knee is in the proper position.
Step 3: As you flex your foot with one hand, have them suddenly and passively squeeze your calf with the other.
What is the Homans sign postpartum?
Pain in the calf muscle, which indicates a thrombus, is a positive marker of dorsiflexion of the foot when the knee is flexed. Because of the elevated clotting factors after delivery and by laying in bed, the mother is susceptible to getting a DVT.
References
- Wikipedia contributors. (2022, May 24). Homans sign. Wikipedia. https://en.wikipedia.org/wiki/Homans_sign
- Homans’ sign. (n.d.). In Merriam-Webster Dictionary. https://www.merriam-webster.com/medical/Homans%27%20sign
- Homans Sign Test & Example | Free PDF download. (n.d.-b). https://www.carepatron.com/templates/homans-sign-tests
- Restoration, C. F. V. (2024, December 9). Homan’s sign test explained: Detecting deep vein thrombosis. Center for Vein Restoration. https://www.centerforvein.com/blog/homans-sign-test-explained-detecting-deep-vein-thrombosis
- Homan’s sign. (2018, January 1). https://gpnotebook.com/pages/cardiovascular-medicine/homans-sign
