Hoover's sign for the diagnosis of functional weakness: a prospective unblinded cohort study in patients with suspected stroke

J Psychosom Res. 2011 Dec;71(6):384-6. doi: 10.1016/j.jpsychores.2011.09.003. Epub 2011 Oct 6.


Objective: Hoover's sign - weakness of voluntary hip extension with normal involuntary hip extension during contralateral hip flexion against resistance - is a commonly used sign in the diagnosis of functional weakness of the lower limb. However, little is known about the performance of this sign in clinical practice.

Methods: Hoover's sign was tested as part of the diagnostic work-up of 337 patients presenting to hospital with suspected stroke. We made a gold-standard diagnosis of stroke, functional disorder, or other diagnosis based on clinical history and examination, imaging and clinical follow-up. We calculated the sensitivity, specificity, positive and negative predictive values of Hoover's sign for a diagnosis of functional weakness in patients who presented with leg weakness.

Results: We consecutively recruited 337 consecutive patients with suspected stroke, 124 of whom presented with leg weakness. 8 of these patients had a diagnosis of functional disorder. The sensitivity of Hoover's sign for a diagnosis of functional weakness in those who presented with leg weakness was 63% (95% CI: 24 to 91), and the specificity was 100% (95% CI: 97 to 100).

Conclusions: In this cohort, Hoover's sign was moderately sensitive and very specific for a diagnosis of functional weakness. Further studies are required to assess inter-observer variability and performance of the test in larger numbers of patients with functional weakness.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Hip / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Muscle Weakness / diagnosis*
  • Muscle Weakness / physiopathology
  • Neurologic Examination*
  • Predictive Value of Tests
  • Prospective Studies
  • Sensitivity and Specificity
  • Stroke / diagnosis*
  • Stroke / physiopathology