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

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 positive if the patient's

• opposite/ contralateral hip flexes without knee extension- tight iliopsoas
• hip abducts during the test- tight tensor fasciae latae
• knee extension occurs- tight rectus femoris
• Lateral rotation of tibia- tight biceps 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