The Thomas test is a

physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patien ...

test, named after the

Welsh Welsh may refer to: Related to Wales * Welsh, referring or related to Wales * Welsh language, a Brittonic Celtic language spoken in Wales * Welsh people People * Welsh (surname) * Sometimes used as a synonym for the ancient Britons (Celtic peop ...

orthopaedic Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...

Hugh Owen Thomas Hugh Owen Thomas (23 August 1834 – 6 January 1891) was a Welsh orthopaedic surgeon. He and his nephew Robert Jones have been called "the Fathers of orthopaedic surgery". Thomas was descended from a line of Welsh bone setters and placed great i ...

(1834–1891), to rule out

hip In vertebrate anatomy, hip (or "coxa"Latin ''coxa'' was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77) in medical terminology) refers to either an anatomical region or a joint. The hip region is ...

flexion Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...

contracture In pathology, a contracture is a permanent shortening of a muscle or joint. It is usually in response to prolonged hypertonic spasticity in a concentrated muscle area, such as is seen in the tightest muscles of people with conditions like spasti ...

(fixed partial flexion of the hip) and psoas syndrome (injury to the psoas muscle).

Description

The test consists of 3 steps: * Step 1: The patient lies supine on the examination table, holding their knee to their chest. The clinician passes the palm of her/his hand beneath the patient's spine to identify lumbar lordosis. * Step 2: The "unaffected" hip is flexed until the thigh just touches the abdomen to obliterate the lumbar lordosis. The pelvis should be in neutral tilt (not tilted anteriorly or posteriorly). * Step 3: The clinician then passively ranges the affected hip into extension. Once the pelvis begins to tilt anteriorly, stop the passive range of motion, hold the affected thigh in this position, and measure the angle between the affected thigh and table to reveal the fixed flexion deformity of the hip. It is important to control the pelvic tilt to ensure that the Thomas test is valid for evaluating peak hip extension angle.

Interpretation

If the iliopsoas muscle is shortened, or a contracture is present, the lower extremity on the involved side will be unable to fully extend at the hip. This constitutes a positive Thomas test. Sometimes, with a very flexible patient, the Thomas test will be normal despite a psoas dysfunction being present. However, in the patient with a normal hip joint, a positive test is a good indicator of psoas hypertonicity. Other signs from the Thomas test: * opposite/

contralateral Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

hip flexes without knee extension- tight

iliopsoas The iliopsoas muscle (; from lat, ile, lit=groin and grc, ψόᾱ, psóā, muscles of the loins) refers to the joined psoas major and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. They are usua ...

* hip abducts during the test- tight

tensor fasciae latae The tensor fasciae latae (or tensor fasciæ latæ or, formerly, tensor vaginae femoris) is a muscle of the thigh. Together with the gluteus maximus, it acts on the iliotibial band and is continuous with the iliotibial tract, which attaches to the ...

* knee extension occurs- tight

rectus femoris The rectus femoris muscle is one of the four quadriceps muscles of the human body. The others are the vastus medialis, the vastus intermedius (deep to the rectus femoris), and the vastus lateralis. All four parts of the quadriceps muscle attach to ...

* Lateral rotation of tibia- tight

biceps femoris The biceps femoris () is a muscle of the thigh located to the posterior, or back. As its name implies, it has two parts, one of which (the long head) forms part of the hamstrings muscle group. Structure It has two heads of origin: *the ''long h ...

The hip flexion contracture is physiologic in the first 3 months of life and if it is absent in this period it may be a sign of developmental dysplasia of the hip. It is used to identify unilateral fixed flexion deformity of the hip.

Risk factors & associations

Psoas syndrome is often associated with runners, dancers, and gymnasts who complain of hip "stiffness" and reported "snapping" feeling when flexing at the waist.

References

Musculoskeletal examination {{med-sign-stub