Hoover’s sign of leg paresis is a maneuver aimed to separate organic from non-organic paresis of the leg.
Weakness that is clinically inconsistent with any recognized neurological disease is a common problem for Neurologists. Although it has been considered to have a physical cause, a loss or disturbance of normal function may be attributed to a psychological cause. Neurologists use physical challenges to elicit motor behaviors or sensory reports discrepant with patterns seen in genuine neurologic diseases. Several terms such as "non-physiological," "nonorganic," "functional" or "hysterical" have been employed by neurologists to label findings that imply a voluntary or nonsensical component.
Dr. Charles Franklin Hoover is remembered primarily for his contributions in distinguishing "organic" weakness from "functional" (i.e., psychogenic) weakness of the lower extremities. In 1908, Hoover published an article in journal of the American medical association in which he described his sign for testing this functional weakness.
He described it as follows: "If a normal person, lying on a couch in the dorsal position, be asked to lift the left foot off the couch with the leg extended, the right heel will be observed to dig into the couch as the left leg and thigh are elevated.
If you place your hand under the Achilles tendon of the right side and sense the muscular resistance offered by the right leg you will observe that the right heel is pressed onto the couch with the same force, which is exhibited in lifting the left leg off the couch.
In other words, the right heel is employed to fix a point of opposition against the couch during the effort to lift the left leg. This will always occur if the healthy person makes a free and uninhibited effort to lift the left leg.
The patient is asked to raise the paralyzed limb. If the patient is making an honest effort, the examiner should feel the "normal" limb's heel 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, because that effort is not being transmitted to either leg.
It should be noted that this is not the hoover sign of COPD (which is also known as litten sign or litten phenomenon).
Reference:
Sekerci R, Sarikcioglu L. Hoover's sign. J Postgrad Med. 2013 Jul-Sep;59(3):216-7. doi: 10.4103/0022-3859.118041. PMID: 24029200.
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P. J. Koehler, M. S. Okun
Neurology Nov 2004, 63 (9) 1693-1697; DOI: 10.1212/01.WNL.0000142977.21104.94
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