Homans sign explained

Differential:	deep vein thrombosis

In medicine, Homans' sign (sometimes spelled as Homans sign or called dorsiflexion sign) is considered by some physicians to be a sign of deep vein thrombosis (DVT). It was defined by John Homans in 1941 as discomfort behind the knee upon forced dorsiflexion of the foot.^[1] After many examples of false-positive Homans' signs were reported, Homans redefined it in 1944, stating that "discomfort need have no part in the reaction", and that increased resistance, involuntary flexure of the knee or pain in the calf upon forced dorsiflexion should be considered positive responses.^{[2] [3]}

It is estimated to have a sensitivity of 10-54% and a specificity of 39-89%, 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. 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] An elevated D-dimer in the elderly population has no predictive value for deep venous thrombosis. 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

• Baker, W.F. Jr . 1998 . Diagnosis of deep venous thrombosis and pulmonary embolism . Med. Clin. North Am. . 82 . 3, May . 459–476 . 9646774 . 10.1016/s0025-7125(05)70005-5 .
• Urbano, Frank L. . 2001 . Review of Clinical Signs: Homans' Sign in the Diagnosis of Deep Venous Thrombosis . Hospital Physician . March 22 . 22–24 . 12 January 2016 . https://web.archive.org/web/20180920164442/http://www.turner-white.com/pdf/hp_mar01_homan.pdf . 20 September 2018 . dead .

Notes and References

1. Book: McGee, Steven. Evidence-Based Physical Diagnosis. Saunders. 2012. 978-1-4377-2207-9. Philadelphia, USA. 472–473.
2. Book: Hume, Michael. Venous Thrombosis and Pulmonary Embolism. Harvard University Press. 1970. 9780674933200. Cambridge. 149.
3. Shafer N. & Duboff S. (1971). "Physical signs in the early diagnosis of thrombophlebitis," Angiology 22:18–30.
4. Homans' Sign in the Diagnosis of Deep Venous Thrombosis. Urbano. Frank. March 2001. Hospital Physician. 2016-02-05. https://web.archive.org/web/20180920164442/http://www.turner-white.com/pdf/hp_mar01_homan.pdf. 2018-09-20. dead.
5. Diagnosis and treatment of deep-vein thrombosis. Canadian Medical Association Journal. 2006-10-24. 1488-2329. 1609160. 17060659. 1087–1092. 175. 9. 10.1503/cmaj.060366. Dimitrios. Scarvelis. Philip S.. Wells.
6. Web site: Diagnosis of suspected deep vein thrombosis of the lower extremity. 2016-02-02. 2016-02-05. UpToDate. Grant. Brydon.
7. Book: Oxford Handbook of Clinical Surgery. Oxford University Press. 2013. 9780199699476. Oxford, UK. 668.