Hoover's sign (leg paresis): Difference between revisions
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'''Hoover’s sign''' of leg paresis is one of two signs named for [[Charles Franklin Hoover]].<ref name="urlGeorge Crile, Charles Hoover and John Phillips">{{cite web |url=http://www.cwru.edu/artsci/dittrick/cemetery/stop13.htm |title=George Crile, Charles Hoover and John Phillips |work= |accessdate=}}</ref> |
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| ⚫ | '''Hoover’s sign''' of [[leg]] [[paresis]] is one of two signs named for [[Charles Franklin Hoover]].<ref name="urlGeorge Crile, Charles Hoover and John Phillips">{{cite web |url=http://www.cwru.edu/artsci/dittrick/cemetery/stop13.htm |title=George Crile, Charles Hoover and John Phillips |archive-url=https://web.archive.org/web/20160303182445/http://www.cwru.edu/artsci/dittrick/cemetery/stop13.htm |archive-date=2016-03-03 |url-status=dead }}</ref> It is a maneuver aimed to separate [[Organic disease|organic]] from non-organic [[paresis]] of the leg.<ref name="pmid15534257">{{cite journal |vauthors=Koehler PJ, Okun MS |title=Important observations prior to the description of the Hoover sign |journal=Neurology |volume=63 |issue=9 |pages=1693–7 |date=November 2004 |pmid=15534257 |doi= 10.1212/01.wnl.0000142977.21104.94|s2cid=6279447 |url=http://www.neurology.org/cgi/pmidlookup?view=long&pmid=15534257}}</ref> The sign relies on the principle of [[Synergist muscle|synergistic contraction]].{{cn|date=June 2022}} |
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==Description== |
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Involuntary extension of the "normal" leg occurs when flexing the contralateral leg against resistance. To perform the test, the examiner should hold one hand under the heel of the "normal" limb and ask the patient to flex the contralateral hip against resistance (while the patient is [[supine position|supine]]), asking the patient to keep the weak leg straight while raising it.{{cn|date=August 2021}} |
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==Interpretation== |
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If the patient is making an honest effort, the examiner should feel the "normal" limb's heel extending (pushing down) against his or her hand as the patient tries to flex (raise) the "weak" leg's hip. Feeling this would indicate an organic cause of the paresis. If the examiner does not feel the "normal" leg's heel pushing down as the patient flexes the hip of the "weak" limb, then this suggests functional weakness (sometimes called "conversion disorder"), i.e. that effort is not being transmitted to either leg.{{cn|date=August 2021}} |
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| ⚫ | Alternatively, if a patient reports weakness of hip extension, and appears to have weakness upon direct testing of hip extension, Hoover's test can also be applied. If an examiner places one hand behind the heel of the patient's weak leg and asks her or him to push against it, no movement will be felt. If the patient is asked to raise the other leg (i.e. flexion at the contra-lateral hip), the examiner will feel pressure on his or her hand as the patient involuntarily extends the weak hip. This can be pointed out to the patient in a non-confrontational manner, to help persuade the patient of the functional nature of the weakness.<ref name=Stone>{{cite journal|last1=Stone |first1=Jon |last2=Sharpe |first2=Michael |title=Hoover's Sign |journal=Practical Neurology |date=Oct 2001 |volume=1 |page=50 |doi=10.1046/j.1474-7766.2001.00607.x |url=http://www.pn.bmj.com/content/1/1/50.full.pdf |access-date=1 August 2014 |url-status=dead|archive-url=https://web.archive.org/web/20140808044911/http://www.pn.bmj.com/content/1/1/50.full.pdf |archive-date=2014-08-08 }}</ref> In the context of a positive Hoover's sign, functional weakness (or "conversion disorder") is much more likely than malingering or [[factitious disorder]].<ref name=Stone /> |
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Strong hip muscles can make the test difficult to interpret.<ref name="pmid14707320">{{cite journal |author=Sonoo M |title=Abductor sign: a reliable new sign to detect unilateral non-organic paresis of the lower limb |journal=J. Neurol. Neurosurg. Psychiatr. |volume=75 |issue=1 |pages=121–5 |date=January 2004 |pmid=14707320 |pmc=1757483 |doi= |url=http://jnnp.bmj.com/cgi/pmidlookup?view=long&pmid=14707320}}</ref> |
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Strong hip muscles can make the test difficult to interpret.<ref name="pmid14707320">{{cite journal |author=Sonoo M |title=Abductor sign: a reliable new sign to detect unilateral non-organic paresis of the lower limb |journal=J. Neurol. Neurosurg. Psychiatry |volume=75 |issue=1 |pages=121–5 |date=January 2004 |pmid=14707320 |pmc=1757483 |url=}}</ref> |
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Efforts have been made to use the theory behind the sign to report a quantitative result.<ref name="pmid9840352">{{cite journal|vauthors=Ziv I, Djaldetti R, Zoldan Y, Avraham M, Melamed E |title=Diagnosis of "non-organic" limb paresis by a novel objective motor assessment: the quantitative Hoover's test |journal=J. Neurol. |volume=245 |issue=12 |pages=797–802 |date=December 1998 |pmid=9840352 |doi=10.1007/s004150050289 |s2cid=13359062 |url=http://link.springer.de/link/service/journals/00415/bibs/8245012/82450797.htm |url-status=dead|archive-url=https://web.archive.org/web/19990828020516/http://link.springer.de/link/service/journals/00415/bibs/8245012/82450797.htm |archive-date=1999-08-28 }}</ref> |
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==See also== |
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* [[Hoover's sign (pulmonary)]] |
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==References== |
==References== |
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Latest revision as of 16:28, 18 October 2024
 | This article may require cleanup to meet Wikipedia's quality standards. The specific problem is: May not comply with standards for medical articles, see WP:MEDRS and WP:MEDREF. (December 2022) |
| Hoover's sign (leg paresis) | |
|---|---|
| Differential diagnosis | Conversion disorder |
Hoover’s sign of leg paresis is one of two signs named for Charles Franklin Hoover.[1] It is a maneuver aimed to separate organic from non-organic paresis of the leg.[2] The sign relies on the principle of synergistic contraction.[citation needed]
Description
[edit]Involuntary extension of the "normal" leg occurs when flexing the contralateral leg against resistance. To perform the test, the examiner should hold one hand under the heel of the "normal" limb and ask the patient to flex the contralateral hip against resistance (while the patient is supine), asking the patient to keep the weak leg straight while raising it.[citation needed]
Interpretation
[edit]If the patient is making an honest effort, the examiner should feel the "normal" limb's heel extending (pushing down) against his or her hand as the patient tries to flex (raise) the "weak" leg's hip. Feeling this would indicate an organic cause of the paresis. If the examiner does not feel the "normal" leg's heel pushing down as the patient flexes the hip of the "weak" limb, then this suggests functional weakness (sometimes called "conversion disorder"), i.e. that effort is not being transmitted to either leg.[citation needed]
Alternatively, if a patient reports weakness of hip extension, and appears to have weakness upon direct testing of hip extension, Hoover's test can also be applied. If an examiner places one hand behind the heel of the patient's weak leg and asks her or him to push against it, no movement will be felt. If the patient is asked to raise the other leg (i.e. flexion at the contra-lateral hip), the examiner will feel pressure on his or her hand as the patient involuntarily extends the weak hip. This can be pointed out to the patient in a non-confrontational manner, to help persuade the patient of the functional nature of the weakness.[3] In the context of a positive Hoover's sign, functional weakness (or "conversion disorder") is much more likely than malingering or factitious disorder.[3]
Strong hip muscles can make the test difficult to interpret.[4]
Efforts have been made to use the theory behind the sign to report a quantitative result.[5]
See also
[edit]References
[edit]- ^ "George Crile, Charles Hoover and John Phillips". Archived from the original on 2016-03-03.
- ^ Koehler PJ, Okun MS (November 2004). "Important observations prior to the description of the Hoover sign". Neurology. 63 (9): 1693–7. doi:10.1212/01.wnl.0000142977.21104.94. PMID 15534257. S2CID 6279447.
- ^ a b Stone, Jon; Sharpe, Michael (Oct 2001). "Hoover's Sign" (PDF). Practical Neurology. 1: 50. doi:10.1046/j.1474-7766.2001.00607.x. Archived from the original (PDF) on 2014-08-08. Retrieved 1 August 2014.
- ^ Sonoo M (January 2004). "Abductor sign: a reliable new sign to detect unilateral non-organic paresis of the lower limb". J. Neurol. Neurosurg. Psychiatry. 75 (1): 121–5. PMC 1757483. PMID 14707320.
- ^ Ziv I, Djaldetti R, Zoldan Y, Avraham M, Melamed E (December 1998). "Diagnosis of "non-organic" limb paresis by a novel objective motor assessment: the quantitative Hoover's test". J. Neurol. 245 (12): 797–802. doi:10.1007/s004150050289. PMID 9840352. S2CID 13359062. Archived from the original on 1999-08-28.