Homans' sign
Homans’ sign is positive when deep calf pain results from strong and abrupt dorsiflexion of the ankle. This pain results from venous thrombosis or inflammation of the calf muscles. However, because a positive Homans’sign appears in only 35% of patients with these conditions, it’s an unreliable indicator. (See Eliciting Homans’ sign.) Even when accurate, a positive Homans’ sign doesn’t indicate the extent of the venous disorder.
This elicited sign may be confused with continuous calf pain, which can result from strains, contusions, cellulitis, or arterial occlusion or with pain in the posterior ankle or Achilles tendon (for example, in a woman with Achilles tendons shortened from wearing high heels).
History and physical examination
When you detect a positive Homans’ sign, focus the patient history on signs and symptoms that can accompany deep vein thrombosis (DVT) or thrombophlebitis. These include throbbing, aching, heavy, or tight sensations in the calf and leg pain during or after exercise or routine activity. Also, ask about shortness of breath or chest pain, which may indicate pulmonary embolism. Make sure to ask about predisposing events, such as a leg injury, recent surgery, childbirth, use of hormonal contraceptives, associated diseases (cancer, nephrosis, hypercoagulable states), and prolonged inactivity or bed rest.
Next, inspect and palpate the patient’s calf for warmth, tenderness, redness, swelling, and the presence of a palpable vein. If you strongly suspect DVT, elicit Homans’sign very carefully to avoid dislodging the clot, which could cause pulmonary embolism, a life-threatening condition.
In addition, measure the circumferences of both the patient’s calves. The calf with the positive Homans’ sign may be larger because of edema and swelling.
Medical causes
Deep vein thrombophlebitis
A positive Homans’ sign and calf tenderness may be the only clinical features of deep vein thrombophlebitis However, the patient may also have severe pain, heaviness, warmth, and swelling of the affected leg; visible, engorged superficial veins or palpable, cordlike veins; and a fever, chills, and malaise.
DVT
DVT causes a positive Homans’ sign along with tenderness over the deep calf veins, slight edema of the calves and thighs, a low-grade fever, and tachycardia If DVT affects the femoral and iliac veins, you’ll notice marked local swelling and tenderness
If DVT causes venous obstruction, you’ll notice cyanosis and possibly cool skin in the affected leg.
Popliteal cyst (ruptured)
Rupture of this synovial cyst may produce a positive Homans’ sign as well as a sudden onset of calf tenderness, swelling, and redness.
Cellulitis (superficial)
Superficial cellulitis typically affects the legs, but can also affect the arms, producing pain, redness, tenderness, and edema Some patients also experience a fever, chills, tachycardia, a headache, and hypotension.
Special considerations
Be sure to place the patient on bed rest, with the affected leg elevated above heart level
Apply warm, moist compresses to the affected area, and administer mild oral analgesics. In addition, prepare the patient for further diagnostic tests, such as Doppler studies and venograms.
When the patient is ambulatory, advise him to wear elastic support stockings after his discomfort decreases (usually in 5 to 10 days) and to continue wearing them for at least 3 months. In addition, instruct the patient to keep the affected leg elevated while sitting and to avoid crossing his legs at the knees to prevent impairing circulation to the popliteal area. (Crossing at the ankles is acceptable.)
Pediatric pointers
Homans’ sign is seldom assessed in children, who rarely have DVT or thrombophlebitis.
Pictures
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Deep vein thrombosis
Read excerpts from these other book chapters related to Deep vein thrombosis:
Medical Books Excerpts
- Homans' sign
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Homans' sign
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Deep vein thrombosis
» Next page: Intermittent claudication (Handbook of Signs & Symptoms (Third Edition))
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