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In medicine, Homans' sign (sometimes spelled as Homans sign) or the dorsiflexion sign is considered a sign of deep vein thrombosis (DVT). It was defined by John Homans in 1941 as discomfort behind the knee on forced dorsiflexion of the foot.[1] After surgeons discovered many examples of a false-positive Homans' sign, Homans redefined it in 1944, stating that "discomfort need have no part in the reaction", including increased resistance, involuntary flexure of the knee or pain in the calf to forced dorsiflexion as positive responses.[1][2][3][needs update]
It is estimated to have a sensitivity of 10-54% and a specificity of 39-89%,[1] 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.[1] 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] 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. PMID 9646774.
Urbano, Frank L. (2001). "Review of Clinical Signs: Homans' Sign in the Diagnosis of Deep Venous Thrombosis" (PDF). Hospital Physician (March 22): 22–24. Retrieved 12 January 2016.
References
^ abcdMcGee, Steven (2012). Evidence-Based Physical Diagnosis. Philadelphia, USA: Saunders. pp. 472–473. ISBN 978-1-4377-2207-9.
^Hume, Michael (1970). Venous Thrombosis and Pulmonary Embolism. Cambridge: Harvard University Press. p. 149. ISBN 9780674933200.
^Shafer N. & Duboff S. (1971). "Physical signs in the early diagnosis of thrombophlebitis," Angiology22:18–30.
^Urbano, Frank (March 2001). "Homans' Sign in the Diagnosis of Deep Venous Thrombosis" (PDF). Hospital Physician. Retrieved 2016-02-05.
^Scarvelis, Dimitrios; Wells, Philip S. (2006-10-24). "Diagnosis and treatment of deep-vein thrombosis". Canadian Medical Association Journal. 175 (9): 1087–1092. doi:10.1503/cmaj.060366. ISSN 1488-2329. PMC 1609160. PMID 17060659.
^Grant, Brydon (2016-02-02). "Diagnosis of suspected deep vein thrombosis of the lower extremity". UpToDate. Retrieved 2016-02-05.
^Oxford Handbook of Clinical Surgery. Oxford, UK: Oxford University Press. 2013. p. 668. ISBN 9780199699476.
…meta-analysis reported that patients with a difference in calf diameter were twice as likely to have DVT . Homans sign (calf pain on passive dorsiflexion of the foot) is unreliable for the presence of DVT. An evaluation…
…erythema. A larger calf circumference in the affected leg is the most useful finding, whereas Homans sign (calf pain upon passive dorsiflexion of the foot) is not a reliable sign of DVT. The findings of…
…enlarging into the calf (a dissecting cyst) can result in erythema, distal edema, and a positive Homans sign, similar to findings in deep vein thrombosis (DVT) of the lower extremity . Enlargement of the …
…Larger calf diameter in the affected leg compared with the contralateral leg may also be noted. Homans sign (calf pain on passive dorsiflexion of the foot) is unreliable for the presence of DVT in children…
Survey of methods used to determine if a patient has a deep vein thrombosis: An exploratory research report.
Heick JD, Farris JW.
Physiotherapy theory and practice. 2017 Sep;33(9)733-742.
The use of evidence-based practice (EBP) is encouraged in the physical therapy profession, but integrating evidence into practice can be difficult for clinicians because of lack of time and other constraints. To survey physical therapy clinical instructors and determine the methods they use for scre
Intermittent Pneumatic Compression for the Prevention of Venous Thromboembolism after Total Hip Arthroplasty.
Kwak HS, Cho JH, Kim JT, Yoo JJ, Kim HJ.
Clinics in orthopedic surgery. 2017 Mar;9(1)37-42.
Venous thromboembolism (VTE) is a relatively common and potentially life threatening complication after major hip surgery. There are two main types of prophylaxis: chemical and mechanical. Chemical prophylaxis is very effective but causes bleeding complications in surgical wounds and remote organs.
An analysis of deep vein thrombosis in burn patients (Part 1): Comparison of D-dimer and Doppler ultrasound as screening tools.
Ahuja RB, Bansal P, Pradhan GS, Subberwal M.
Burns : journal of the International Society for Burn Injuries. 2016 Dec;42(8)1686-1692.
The high prevalence of deep vein thrombosis (DVT) reported in prospective studies and the unreliability of clinical diagnosis mandates prospective screening for DVT in burn patients. Our study seeks to compare D-dimer and Doppler ultrasound (DUS) in search for a practical, inexpensive and a reliable
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