Pain in calf on dorsiflexion of the foot (Homans' sign) may indicate?

JODHPUR AIIMS SNO-2018

Medical & Surgical Nursing

Easy

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

Homans' sign is defined as pain experienced in the calf muscle upon passive, forced dorsiflexion of the foot.
This sign is historically associated with the presence of Deep Vein Thrombosis (DVT), a condition where a blood clot forms in a deep vein, usually in the leg.
Thrombophlebitis is the inflammation of a vein associated with clot formation, so DVT is a type of thrombophlebitis.
The pain is believed to result from the stretching of the inflamed posterior tibial vein and surrounding calf muscles over the thrombus.

Option B: An aneurysm is a ballooning or bulge in the wall of an artery. It is an arterial disorder and does not cause pain in the calf specifically upon dorsiflexion of the foot.
Option C: Lymphedema is swelling caused by the accumulation of lymph fluid due to a blocked or damaged lymphatic system. It typically presents as chronic, often non-pitting, edema and is not associated with acute pain on dorsiflexion.
Option D: Cellulitis is a bacterial infection of the skin and subcutaneous tissues. It causes diffuse redness, warmth, swelling, and tenderness. The pain is generally constant and not specifically elicited by the Homans' maneuver.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of deep vein thrombosis (DVT) as background academic context rather than a clinical decision trigger.
Early recognition of potential DVT is a critical nursing responsibility because of the risk of the clot dislodging and traveling to the lungs, causing a life-threatening pulmonary embolism (PE).
A nurse's priority actions for suspected DVT include notifying the provider, ensuring the patient is on bed rest with the leg elevated, and strictly avoiding massage of the affected limb.
What if? If the patient with calf pain suddenly develops shortness of breath, chest pain, and tachycardia, the nurse must suspect a pulmonary embolism. The immediate priority shifts to applying oxygen, placing the patient in a high-Fowler's position, and activating the rapid response team or calling a code.

How to Approach the Question

First, identify the key clinical term in the question stem, which is 'Homans' sign'.
Recall the definition of Homans' sign: pain in the calf when the foot is dorsiflexed.
Access your knowledge base to link this specific sign to its associated medical condition.
Evaluate the given options. Thrombophlebitis (specifically DVT) is the classic condition indicated by a positive Homans' sign.
Briefly consider the other options (Aneurysm, Lymphedema, Cellulitis) and rule them out by recalling their distinct signs and symptoms, which do not include a positive Homans' sign.

Concept Tested & Keywords

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 521-523

E6 Medicine Davidson Principles Practice 24e p. 207-209