medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...

, Homans' sign (sometimes spelled as Homans sign or called dorsiflexion sign) is considered by some physicians to be a

sign A sign is an object, quality, event, or entity whose presence or occurrence indicates the probable presence or occurrence of something else. A natural sign bears a causal relation to its object—for instance, thunder is a sign of storm, or me ...

deep vein thrombosis Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enla ...

(DVT). It was defined by

John Homans John Homans (1877–1954) was an American surgeon who described Homans' sign and Homans' operation. He was born in Boston, Massachusetts, and was educated at Harvard University and Harvard Medical School. His residency was undertaken at Massach ...

in 1941 as discomfort behind the knee upon forced

dorsiflexion Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...

of the foot. 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. 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 Doppler ultrasonography is medical ultrasonography that employs the Doppler effect to perform imaging of the movement of tissues and body fluids (usually blood), and their relative velocity to the probe. By calculating the frequency shift of ...

), as well the ease of eliciting it. 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 A clinical prediction rule or clinical probability assessment specifies how to use medical signs, symptoms, and other findings to estimate the probability of a specific disease or clinical outcome. Physicians have difficulty in estimated risks of ...

such as the Wells score). There may exist some concern that eliciting this sign may be dangerous and that it should not be elicited.

References

Further reading