Homan’s Sign is a historical physical examination technique once used to help detect deep vein thrombosis (DVT) in a patient’s leg. First described by American surgeon John Homans in the 1930s, the maneuver was an early attempt at a bedside diagnostic tool. Its purpose was to mechanically stress the deep veins of the calf to elicit a painful response, suggesting the presence of a blood clot. Today, the sign is rarely used because it is highly unreliable, but it remains a notable part of medical history.
Performing the Test
The Homan’s Sign maneuver is performed while the patient is lying on their back, often with the knee slightly bent. The healthcare provider gently bends the patient’s foot upward toward the shin, a movement known as passive dorsiflexion. This action stretches the calf muscles and the associated deep veins. A “positive” Homan’s Sign is indicated if this forced dorsiflexion causes sudden pain in the calf or the space behind the knee. The theory was that a blood clot (thrombus) within the deep veins would cause irritation or obstruction, leading to pain when the vein was stretched.
The Condition It Was Meant to Detect
Homan’s Sign was intended to help diagnose Deep Vein Thrombosis (DVT), which involves the formation of a blood clot in one of the deep veins, most commonly in the lower leg or thigh. This clot (thrombus) can partially or completely block blood flow back to the heart. DVT is serious because the clot can break free, becoming an embolus, and travel to the lungs, causing a pulmonary embolism (PE). PE is a blockage in the lung’s arteries that can be life-threatening.
Common symptoms of DVT include swelling, usually in only one leg, and a feeling of warmth, redness, or tenderness in the affected area. The pain is often described as cramping or soreness starting in the calf. However, up to 30% of people with DVT experience no noticeable symptoms, which is why clinical signs alone are insufficient for diagnosis. Because of the potential for complications like PE, rapid and accurate diagnosis is necessary when DVT is suspected.
Why Clinical Practice Has Changed
Homan’s Sign has largely been abandoned because it is highly unreliable for diagnosing DVT. Studies show the sign has low sensitivity, meaning it fails to detect DVT in many people who have the condition; approximately 50% of confirmed DVT cases have a negative Homan’s Sign. Conversely, it also has low specificity, meaning a positive result can occur in people without DVT, such as those with a ruptured Baker’s cyst, muscle strain, or cellulitis. This lack of accuracy means neither a positive nor a negative result can reliably confirm or rule out a deep vein clot.
Beyond its poor diagnostic value, performing the Homan’s Sign test carries a distinct risk. The forceful manipulation of the leg could potentially dislodge the clot it is meant to detect, causing a pulmonary embolism. Because of this risk and the sign’s unreliability, clinicians have transitioned to evidence-based, non-invasive diagnostic procedures.
The current standard approach for evaluating suspected DVT begins with clinical prediction scores, most notably the Wells Criteria. This system assigns points for risk factors and symptoms, such as active cancer, recent surgery, or calf swelling, to categorize a patient’s probability of DVT as “likely” or “unlikely.” Low-risk patients may then receive a D-dimer blood test, which is highly sensitive and can effectively rule out DVT if the result is negative.
For patients with high clinical suspicion or a positive D-dimer result, the definitive diagnostic tool is Duplex Ultrasound. This non-invasive imaging technique uses sound waves to visualize the veins and assess blood flow. The primary sign of DVT on ultrasound is the inability to fully compress the vein with the probe, indicating a clot obstructing the vessel. These modern methods provide the accuracy necessary for diagnosing a condition with serious potential complications, leading to Homan’s Sign’s relegation to medical history.