Diagnosis of deep thrombophlebitis: a symptom of Homans

The Homans symptom is one of the leading symptoms for the detection of thrombophlebitis of deep vessels of the lower limbs. It helps to diagnose in the first 2-4 days from the beginning of the process. Thrombophlebitis is a rather urgent problem, according to statistics, 1/5 of the population suffers from the disease. It is characterized by inflammation of the veins (phlebitis), a violation of blood flow and the formation of blood clots inside the vascular bed.

Superficial and deep thrombophlebitis

Surface thrombophlebitis often occurs in the area of varicose veins and can be detected visually. With superficial inflammation, the vessels located between the skin and the muscles suffer. There is a sharp pain along the damaged vein, redness of the skin, the temperature rises. At palpation, the doctor discovers compacted nodules at the points of attachment of the thrombus. Most often, the diagnosis is not difficult.

Another situation occurs with deep thrombophlebitis, because the veins located inside the muscles are invisible. Approximately 50% of patients do not even realize that they have thrombophlebitis. In a chronic process, venous valves are destroyed, skin pigmentation occurs, and trophic ulcers may occur. To suspect a deep thrombosis is possible on the following grounds:

• Painful pains in the muscles of the lower leg, which increase with prolonged standing or when the foot is lowered;
• Feeling of raspiraniya in the legs;
• Swelling of the lower leg;
• Compaction of subcutaneous tissue.

Upon examination, the Homans symptom appears positive - this is the most characteristic sign of inflammation and deep vein thrombosis. It allows you to put a preliminary diagnosis already during the initial examination.

How is deep thrombophlebitis diagnosed?

The Homans symptom is described by the American doctor J. Homans in 1934. To determine the deep thrombophlebitis, the patient is placed on the back, with the leg being asked to bend at the knee joint at a right angle. With the rear movement of the foot (toward oneself) the soreness in the hind muscles of the legs becomes sharper. As the author himself believed, the positive symptom of Homans is due to the squeezing of the affected deep veins with muscles.

Measuring the circumference of the right and left shin helps diagnosis, respectively, the affected limb will have a larger diameter.

The Homans symptom is not the only sign of the disease. On examination, increased skin sensitivity, pain when pressing on the shin in the anteroposterior direction (a symptom of Moses), local soreness when feeling the inner and the back of the shin. Local temperature rises.

Instrumental diagnostic methods: ultrasound examination of vessels, duplex scanning, rheovasography.

Differential diagnosis

Symptoms similar to thrombophlebitis may occur in other leg diseases. Puffiness of the lower limbs is observed with lymphostasis, circulatory insufficiency, traumatic damage, arthrosis of the knee joints. In these cases, the Homans symptom is negative.

Sometimes soreness and swelling occur even after minor trauma, especially in old age. It is necessary for a person to make an awkward movement, jump or run, as there is a hematoma between the muscles. A few days later she sinks to her ankles, her leg becomes cyanotic in this place.

Since diseases accompanied by swelling and pain in the legs, there is a large number, do not neglect the surgeon's advice. It is he who will find out the cause of the pathology.