Hoover's sign – Functional leg paresis

  • Hoover’s sign is a clinical sign used to differentiate between unilateral organic and functional leg weakness
  • This is based on the principle of synkinetic movements

Eliciting Hoover’s sign

  • Patient is asked to lie down in supine position
  • The examiner keeps the palm of his hand under the heel of the patient’s normal leg
  • The patient is asked to lift his ‘paretic’ leg
  • Normally there is synkinetic hip extension in the normal limb and the examiner can feel the pressure on his palm
  • In patients with organic paresis, there is accentuation of this response and the examiner can use the straightened normal limb as a lever to lift the whole limb and lower body
  • In patients with functional paresis, there is no synkinetic hip extension and the examiner fails to appreciate any downward force
    • This occurs because the patient does not make any effort to raise the leg
  • Similarly, the patient can be asked to raise the normal limb
  • Patients with functional leg paresis unconsciously press down with the ‘paretic’ limb, whereas no response is obtained in those with organic paresis

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