Hoover test is used to detect malingering. What observation indicates a positive malingering sign?

• A. The patient exerts downward force on the contralateral leg.
• B. There is no downward force despite attempting to lift the leg.
• C. Pain increases with hip flexion.
• D. Knee extension is resisted.

Answer: (B)

The test looks for genuine effort versus feigning symptoms by watching how the opposite leg responds when one leg is asked to lift. As you ask the patient to lift the tested leg, you place your hand under the heel of the opposite leg. If the patient is truly trying, the contralateral leg will press downward into your hand, showing real effort. A positive malingering sign is when there is no downward force on the contralateral leg despite the patient attempting to lift the leg, suggesting the person is not genuinely exerting effort. This is distinct from options that describe pain with movement or a generalized weakness response, which do not specifically indicate malingering.