Related Experiment Video
Updated: May 27, 2026
Electroencephalography Network Indices as Biomarkers of Upper Limb Impairment in Chronic Stroke
Published on: July 14, 2023
Hoover's sign for the diagnosis of functional weakness: a prospective unblinded cohort study in patients with
Laura McWhirter1, Jon Stone, Peter Sandercock
1Division of Clinical Neurosciences, Bramwell Dott Building, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
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.
