Hoover’s sign for the diagnosis of functional weakness

In a study of 124 patients with suspected stroke who presented with leg weakness, clinical evaluation ultimately determined that in eight patients (6%) the weakness was functional.

For functional weakness:

Sensitivity Specificity Predictive values at prevalence of 6%
Positive Negative
Hoover’s sign* 63%
(95% CI: 24 to 91)
(95% CI: 97 to 100)
100% 3%
* “was considered positive when there was weakness of voluntary hip extension in the presence of normal involuntary hip extension during contralateral hip flexion against resistance”.
Of note, the abductor sign is an alternative test for functional weakness. (PMID: 14707320)


McWhirter L, Stone J, Sandercock P, & Whiteley W (2011). Hoover’s sign for the diagnosis of functional weakness: a prospective unblinded cohort study in patients with suspected stroke. Journal of psychosomatic research, 71 (6), 384-6 PMID: 22118379

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