Checking Homan's Sign

We learned in school that checking for Homan's Sign is controversial because you can throw a DVT in the process. Some instructors even said we should not check for it at all. The way my OB teacher taught me how to do Homan's Sign is to have the patient point their toes and then flex and ask them if they have any sharp pain when they do it. VS having the patient push down with their feet while you squeeze the calf. Do you check Homan's Sign, and if so what is your method?
my instructor told my class that it is done the way your OB teacher described, but is it strictly against our school's policy to do it due to the danger of throwing a DVT.

I haven't checked for a Homan's sign in many years for the reason you cited. In most cases at risk patients are put on Lovenox prophyllaxis (sp?) unless their medical condition contraindicates.

I did a lot of clinical hours on postpartum as a student and we did Homan's on everyone -- I even remember an NCLEX practice question saying you were supposed to do it as part of a postpartum assessment. I've also heard the same stuff about it possibly throwing the clot though and wondered if Homan's is still considered evidence based practice. We were taught to do it by lifting the patient's calf with one hand, then pulling back on the foot (dorsiflecting) with the other hand. Thanks to the OP for posting this question...I've wondered about this myself for a while!

I was taught to support the leg with one hand and then dorsiflex the foot with the other. If the patient feels a sharp pain then it is a positive Homan's Sign, but I was also told a positive Homan's always isn't indicative of a DVT. I don't see these done very often.

From what I remember, a positive Homan's sign is when there is pain the calf resulting from dorsiflexion (toes towards knees). I've sort of intentionally let my memory of it go because it's supposedly of little clinical value if any. Many people with a DVT have a negative Homan's sign, and many people with a positive Homan's sign have no DVT. Ultrasounds with (or even sometimes without) a positive D-Dimer seem to be pretty common these days for detecting a DVT.

Quote from HamsterRNFrom what I remember, a positive Homan's sign is when there is pain the calf resulting from dorsiflexion (toes towards knees). I've sort of intentionally let my memory of it go because it's supposedly of little clinical value if any. Many people with a DVT have a negative Homan's sign, and many people with a positive Homan's sign have no DVT. Ultrasounds with (or even sometimes without) a positive D-Dimer seem to be pretty common these days for detecting a DVT.

I just asked my professor about this yesterday, as I thought we weren't supposed to perform Homan's on a patient. She said if there are no obvious signs and symptoms of a DVT such as the warmth, redness and swelling of the calf we can perform it, but if there are obvious s/sx of a possible DVT then don't perform it because that can cause the clot to dislodge.

Just a little friendly FYI, because this term is misspelled often...the term is actually Homans' sign, not Homan's sign. It is named for John Homans. http://www.whonamedit.com/synd.cfm/2371.html

We were taught it (and even tested on it), but told we were not allowed to use it in clinicals for the reasons listed above.

It's not a very reliable method for determining DVT. Nevertheless, the charting at my work requires that we perform it. I ask the pt to do it (which is really no more invasive or risky than having them walk around, and we certainly don't tell all our pts not to walk around for concern about dislodging clots). I also firmly run my hands over their calves and ask if there are any tender spots. I just learned the other day that new research in pre-eclampsia finds that women who have >8 proteinuria in a 24-hour urine are at greater risk of developing DVTs postpartum, and that current recommendation is to have them on subcut heparin during their hospital stay. I had questioned the doctor because I had a s/p MgSO4 pt secondary to pre-eclampsia, and I was wondering why she was on heparin, as when I questioned her, she didn't have any risk factors that I could determine.

As someone else mentioned, I would not perform it if the pt already had s/sx of DVT.For those who work with pp women, do you check DTRs and for clonus? I would think checking for clonus would carry the same risks as checking for Homans sign.

Homans' sign is of little practical value these days. Off the top of my head, I recall the predictability being on the order of 30%. When faced with the non-zero risk of throwing a clot, what's the value given that the D-dimer and ultrasound are how it's diagnosed.