Thomas test

The Thomas test (Hugh Owen Thomas well leg raising test) is a physical examination test, named after Dr. Hugh Owen Thomas (1834-1891), a British orthopaedic surgeon, used to rule out hip flexion contracture.

The patient lies supine on the examination table and brings one knee in direction to the chest/ flexes hip, while the other leg remains extended. The Thomas test is said to be also positive if the patient's

• opposite/ contralateral hip flexes without knee extension- tight iliopsoas
• hip abducts during the test- tight tensor fascia latae
• knee extension occurs- tight rectus femoris

^[1] 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.

The test consists of 3 steps:

• Step 1: the patient lies supine on the examination table. The clinician passes the palm of his hand beneath the patients spine to identify lumbar lordosis.
• Step 2: The "normal " hip is flexed till the thigh just touches the abdomen to obliterate the lumbar lordosis.
• Step 3: measure the angle between the affected thigh and the table to reveal the fixed flexion deformity of the hip.

References

1. ↑ Musculoskeletal Examination, 2nd edition (2002), chapter 11, p. 327