The Hoover Sign

Weakness, Atonia and Wasting of the Muscles in the Aged: Diagnostic Methods*

“…In 1908, Dr. C. F. Hoover of Cleveland, Ohio, described a “new sign for the detection of malingering and functional paresis of the lower extremities.” Since that time, re‐evaluations and practical applications of this sign have been made, particularly by Arieff (19). The method described by Hoover combined with electromyography constitutes the current technique.…”

“…This makes it possible to obtain objective diagnostic signs in mild cases of hemiparesis with weakness, and also in cases of low back pain, sciatic neuritis, and lumbosacral radiculitis due to such factors as herniation of the nucleus pulposus and osteoarthritic abnormalities. A bathroom scale is used, as described by Arieff (19). When the right leg of a normal person in the supine position is raised and the left leg is placed on the scale, the left leg exerts 12 pounds of pressure.…”

“…As applied to such cases, this method of testing the muscles has not only diagnostic (19) but medicolegal value.…”

Charles Franklin Hoover (1865?1927)

“…" Hoover used only clinical observation to confirm the utility of his sign. Arieff and colleagues later tested the specificity of Hoover's sign by comparing electrophysiological responses in patients with hemiplegia and sciatica with those elicited in patients with likely functional lower extremity weakness who had a positive Hoover's sign and affirmed the validity of the sign [2]. But who was Hoover and what was the context in which he developed his sign [3][4][5] In 1894 a visit to Cleveland led to his assuming the directorship of the physical signs.…”