STUDY - Technical - New Dacian's Medicine
Homans'
sign (Classical / Allopathic Medicine)
Homans’ sign is
the elicitation of deep calf pain 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).
ALERT:
If you strongly suspect deep vein thrombosis (DVT), elicit Homans’ sign carefully to avoid detaching the clot, which could cause pulmonary embolism, a life-threatening condition.
If you strongly suspect deep vein thrombosis (DVT), elicit Homans’ sign carefully to avoid detaching the clot, which could cause pulmonary embolism, a life-threatening condition.
HISTORY:
Ask the patient about associated signs and symptoms, such as throbbing, aching, heavy, or tight sensations in the calf. Also, ask about leg pain during or after exercise or routine activity.
Ask the patient if he has experienced shortness of breath or chest pain, which may indicate a pulmonary embolism.
Ask the patient about predisposing events, such as leg injury, recent surgery, childbirth, use of hormonal contraceptives, associated diseases (cancer, nephrosis, hypercoagulable states), and prolonged inactivity.
Ask the patient about associated signs and symptoms, such as throbbing, aching, heavy, or tight sensations in the calf. Also, ask about leg pain during or after exercise or routine activity.
Ask the patient if he has experienced shortness of breath or chest pain, which may indicate a pulmonary embolism.
Ask the patient about predisposing events, such as leg injury, recent surgery, childbirth, use of hormonal contraceptives, associated diseases (cancer, nephrosis, hypercoagulable states), and prolonged inactivity.
Eliciting Homans'
sign
To elicit Homans’ sign, first, support the patient's thigh with one hand and his foot with the other. Bend his leg slightly at the knee; then firmly and abruptly dorsiflex the ankle. The resulting deep calf pain indicates a positive Homans sign. (The patient may also resist ankle dorsiflexion or flex the knee involuntarily if Homans’ sign is positive.)
PHYSICAL ASSESSMENT:
Inspect and palpate the patient's calf for warmth, tenderness, redness, swelling, and the presence of a palpable pulse in the lower extremity.
Measure the circumferences of the patient's calves. The calf with a positive Homans’ sign may be larger because of edema and swelling.
To elicit Homans’ sign, first, support the patient's thigh with one hand and his foot with the other. Bend his leg slightly at the knee; then firmly and abruptly dorsiflex the ankle. The resulting deep calf pain indicates a positive Homans sign. (The patient may also resist ankle dorsiflexion or flex the knee involuntarily if Homans’ sign is positive.)
PHYSICAL ASSESSMENT:
Inspect and palpate the patient's calf for warmth, tenderness, redness, swelling, and the presence of a palpable pulse in the lower extremity.
Measure the circumferences of the patient's calves. The calf with a positive Homans’ sign may be larger because of edema and swelling.
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 a mild oral analgesic.
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 a mild oral analgesic.
PEDIATRIC
POINTERS:
Homans’ sign is seldom assessed in children, who rarely have DVT or thrombophlebitis.
Homans’ sign is seldom assessed in children, who rarely have DVT or thrombophlebitis.
PATIENT
COUNSELING:
If the patient is put on long-term anticoagulant therapy, instruct him to report signs of prolonged clotting time. These include black tarry stools, brown or red urine, bleeding gums, and bruises. Also, stress the importance of keeping follow-up visits so that coagulation studies can be done to monitor treatment.
If the patient is put on long-term anticoagulant therapy, instruct him to report signs of prolonged clotting time. These include black tarry stools, brown or red urine, bleeding gums, and bruises. Also, stress the importance of keeping follow-up visits so that coagulation studies can be done to monitor treatment.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)