What is a Positive Homans Sign
A positive Homans sign is pain in the calf when the foot is passively dorsiflexed with the leg extended, traditionally used to screen for deep vein thrombosis (DVT), but it has very poor predictive value for the presence or absence of DVT and should not be relied upon for diagnosis. 1
Definition and Technique
- Homans sign is elicited by passive dorsiflexion of the foot while the patient's leg is in extension, with pain in the calf indicating a positive result 2, 1
- The test primarily stretches the posterior tibial venous system rather than evaluating the entire deep venous network of the leg 2
- It was historically used as a bedside test to help identify potential deep vein thrombosis 3
Clinical Value and Limitations
- Despite its widespread use, Homans sign has very poor predictive value for diagnosing DVT 1
- Multiple studies have demonstrated that Homans sign occurs with approximately equal frequency in limbs with and without deep venous thrombosis 4
- While the sign is relatively specific for DVT, it lacks sensitivity, making it unreliable as a screening tool 5
- In one study, classic symptoms including muscle pain, muscle tenderness, swelling, and a positive Homans sign were found with similar frequency in patients with and without DVT 4
Alternative Clinical Assessments
- Neuhof's sign (feeling of tender fullness of the calf) is considered more reliable than Homans' sign by some clinicians 2
- Sigg's sign (pain in the popliteal fossa on passive extension of the knee) is another clinical test, though its value remains controversial 2
- Modern clinical practice relies on more objective diagnostic tools such as D-dimer testing, compression ultrasonography, and other imaging modalities rather than physical examination signs alone 3, 1
Clinical Implications
- Due to its poor predictive value, a positive Homans sign should not be used in isolation to diagnose DVT 1, 4
- The presence of a positive Homans sign should prompt further diagnostic evaluation with more reliable methods such as duplex ultrasonography 3
- When evaluating patients with suspected DVT, clinicians should use validated clinical prediction rules (such as the Wells score) in combination with objective testing 3
- Relying solely on clinical signs like Homans sign may lead to missed diagnoses or unnecessary treatment 4, 5
Common Pitfalls
- Overreliance on Homans sign may lead to both false positive and false negative assessments 1, 4
- Pain during the maneuver could be caused by other conditions such as muscle strain, Baker's cyst, or other musculoskeletal issues 2
- A negative Homans sign does not rule out DVT, as many patients with confirmed DVT do not exhibit this sign 4, 5
- Clinical assessment for DVT should always include multiple factors and not rely on any single physical examination finding 3, 1