Review of Clinical Signs Series Editor: Frank L. Urbano, MD Homans ’ Sign in the Diagnosis of

eep venous thrombosis (DVT) is a common condition that can have serious complications. Deep venous thrombi have a high probability of propagating and leading to pulmonary emboli, which may cause chest pain, breathlessness, and sudden death. Thus, an accurate and timely diagnosis of DVT is imperative. Although DVT is often clinically silent, it may present with a number of signs, including calf pain, edema, and venous distention. Homans ’ sign1 D —pain associated with forced dorsiflexion of the ankle—is often elicited as part of the physical examination of the person with suspected DVT. However, a diagnosis based solely on the evaluation of clinical signs has proven unreliable, and specific diagnostic procedures (eg, venography, ultrasonography) should be performed in the diagnosis of DVT. Although a number of reports have questioned the clinical utility of Homans ’ sign, it is still widely used in clinical practice. This may stem from its historical role in clinical examination prior to the availability of the more reliable diagnostic studies, as well as from the ease of performing the Homans ’ sign test. This article reviews the history, elicitation, and clinical utility of Homans ’ sign. Diagnostic studies currently used in the definitive diagnosis of DVT are discussed also, as is the role of the clinical examination in stratifying patients prior to undergoing specific diagnostic tests.