Homan’s Sign Test for DVT: What You Need to Know

Published on: February 12, 2023
Woman sitting on the sofa and massaging her painful calf.

Deep vein thrombosis, or DVT, is a serious condition that can lead to a pulmonary embolism and even death. If a blood clot occurs, usually in the lower leg, it can break loose and enter the lungs. The Homan’s sign test is a quick way to identify DVT, which can save a person’s life.

DVT is a common condition – over a million people each year have DVT. The risk factors for this condition include certain blood clotting disorders and risk factors such as smoking, obesity, heart disease and genetics. The most common risk factor is long periods of limited movement.

DVT often occurs when a person has been bedridden. This could be after surgery or due to an illness. The early signs of DVT can include redness, swelling and pain, usually in the leg, especially the calf. Quick diagnosis and treatment are needed to reduce the risk of a deadly pulmonary embolism.

What Is the Homan’s Sign Test?

Dr. John Homan created the Homan’s sign test back in the 1940s as a non-invasive option to identify DVT. This can help diagnose DVT in time to seek treatment. A positive Homan’s sign can alert medical professionals to seek more definitive tests to determine if the patient has DVT.

The basics of the Homan’s sign test are performing a forced dorsiflex on the leg that is suspected to have DVT and checking for pain behind the knee and calf. The pressure of performing the test can cause mechanical pressure in the posterior tibial vein, which can cause pain if DVT is present.

How Is the Homan’s Sign Test Performed?

Only a medical professional trained in the Homan’s sign should perform this test. The doctor, nurse or other professional sits in front of the patient, who should be seated on an exam table or other seating options. The patient will need to extend the identified leg straight out in front of them.

During the test, the medical professional will create the dorsiflex of the foot with one hand and squeeze the back of the calf with the other hand. The repeated squeezing of the calf causes mechanical pressure that can cause discomfort in the back of the calf if there is a DVT present in the calf or lower leg area.

If there was not pain before the Homan’s sign test, but there is pain and tenderness during the test, this can indicate a positive Homan’s sign test. This does not necessarily mean the patient has DVT – it indicates that further testing and diagnosis is needed with ultrasonography or venography.

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Is Homan’s Sign Testing Accurate?

There are risks of false positive or negatives with the Homan’s sign test. While a negative Homan’s sign test does usually indicate there is not a blood clot in the lower leg veins, there could still be DVT in the thigh or groin area, less common places for DVT, but still possible.

If there is a positive Homan’s sign test, it’s possible there’s something else causing the pain in the calf. A sore muscle, baker’s cyst, cellulitis and sciatica can cause pain when the leg is extended and dorsiflexion is performed on the ankle or foot. Further testing is needed for a positive DVT diagnosis.

Benefits and Risks of Homan’s Sign

The benefits of performing Homan’s sign tests is that it can be a non-invasive and inexpensive way to identify DVT. Not all cases of DVT have the typical swelling, redness, pain and warm-to-the-touch symptoms. Homan’s sign tests can rule out DVT in the lower leg or trigger more testing.

While Homan’s sign is a well-recognized test for early signs of DVT, it does have risks. It must be performed in the correct manner to achieve the desired outcome. If the patient is unfamiliar with the difference between regular calf pain and Homan’s sign, they may misinterpret the response.

Another risk is if the Homan’s sign test is performed too rigorously. Forceful dorsiflexion and pulsating squeezes on the calf could jolt the blood clot loose if the leg does have DVT. This can put the patient at high risk, which is why this procedure should only be performed by a trained medical professional.
Doctor squeezing patient's calf while performing Homan’s sign test.
Those at risk of DVT due to a health condition or low mobility circumstance should know the signs of possible DVT. If there are symptoms, having a medical professional perform a Homan’s sign test can determine if more testing or diagnosis may be needed and possibly DVT treatment.

It is important to seek medical attention if you believe that you may have a blood clot in your leg. This is a life and death situation where a simple Homan’s sign test could indicate that you need immediate treatment for deep vein thrombosis in your lower leg.

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