Thompson Test

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Original Editor - Heather Paulis, Lauren Tréhout

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Search Strategy

To get some information about this topic, following databases were used: Pubmed, Medline and Pedro. The following keywords were entered: Thompson test, Simmonds test, Thompson-Simmonds test, diagnose Achilles rupture. I went to the library as well and copied some pages out of certain books.

Definition/Description

The Thompson test examines the integrity of the Achilles tendon and is performed as a clinical test to identify the presence of a complete tear of the tendon. 

Examination 

Simmonds described in 1957 how the rupture of the Achilles tendon could be tested by squeezing the calf muscles. Thompson however had noted this effect in 1955. The Simmonds-Thompson test is an indication for a possible complete rupture, but its mechanism is not clear. (1)
Simmonds and Thompson used an ultrasound to get dynamic images of the calfs of 2 young adults. With transverse compression, the M. Gastrocnemius moved proximally, according to the ankle movement. No proximal movement of the M. Soleus muscle could be seen. Using contrast liquid, Thompson and Doherty found out in 1962 that the squeezing test gave no plantar flexion when the M. Soleus muscle alone was divided (1). 

1.  Scott BW, Al Chalabi A. How the Simmonds–Thompson test works.
    J Bone Joint Surg Br 1992;74:314-5.

Clinically relevant anatomy 

To make it more clearly, Simmonds and Thompson separated the M.Gastrocnemius tendon from the M. Soleus down to 10 cm above the Achilles tendon, because that is the place where the fibres form the tendon. By squeezing the calf, the M. Soleus deformed which made the overlying  M. Gastrocnemius tendon to bow away from the Tibia which resulted in the plantar flexion. The M. Soleus did not move longitudinal, but the M. Gastrocnemius muscle moved about 1 cm proximally, as showed our ultrasound findings. This proves that the M. Soleus has to be 100% ruptured to get no plantar flexion.
The result of the Simmonds-Thompson test mainly gives an idea about the integrity of the M. Gastrocnemieus.   Plantar flexion is caused by posterior flexing of the calf muscles and lesser by proximal movement of the bellies of the M. Gastrocnemius.

Characteristics/Clinical Presentation

The patient is often young or middle aged. Typically he feels a sharp pain in the posterior lower extremity of the leg. He is usually able to walk and the symptoms are minimal but we notice a significant decrease in plantar flexion strength. It happens often while running or jumping, sports such as basketball, tennis or football.
These tears are the result of a violent contraction of the large calf muscles. In some cases it can happen after a long history of Achilles tendonitis.

An Achilles tear or rupture is diagnosed by a "pop" felt behind the ankle.
 

Diagnostic Procedures 

The patient lies prone with the foot over the end of the table or he can also lie prone with the knee flexed to 90°.
The patient and his leg have to be relaxed.
 

Outcome measures

The examiner squeezes the calf muscles, which means the M. gastrocnemius - soleus complex, with his hand and observes for plantar flexion of the foot.
A normal response is that the foot goes in plantar flexion during the maneuver, but this does not exclude a partial tear or strain of the tendon. If there is a lack of foot movement after squeezing the calf muscle, it can be a positive sign of a complete Achilles tendon rupture. If the plantar flexion of the foot is greatly decreased or absent, we can suppose that the Achilles tendon is ruptured.
According to (2) there is no foot movement only when the M. Soleus tendon is 100% ruptured. There is no validity of the Thompson test and we always need to have a MRI, ultrasound or surgical intervention to be sure that there is a rupture. (3) 

2. Journal of Trauma-Injury Infection & Critical Care:
March 1962 - Volume 2 - Issue 2 - ppg 126-129
T . Campbell Thompson, M.D and John H. Doherty, M.D
3. Simmonds FA. The diagnosis of the ruptured Achilles tendon. Practitioner
    1957;179:56-8.

Recent Related Research (from Pubmed)

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References 

Book 1: Examination of musculoskeletal injuries (Second edition)/ Sandra J. Schultz – Peggy A. Houglum – David H. Perrin p.410
Book 2: Orthopedic nursing secrets – Questions and Answers Reveal the Secrets of Successful Care of Musculoskeletal Patients/ Michael E. Zychowicz, RN, MS, NP-C p.15-16
Book 3: Special Tests for Orthopedic Examination (Third Edition)/ Jeff G. konin p.328                                               Thompson TC, Dorerthy J. Spontaneous rupture of the tendon of the Achilles’: a new clinical diagnostic test. Anat Rec. 1967; 158:126.                                                                                                                                                           Thompson TC. A test for rupture of the tendo achillis. Acta Orthop Scand. 1962;32:461-5.

Article 1 from: Continuing medical education:
Clarification of the Simmonds–Thompson test for rupture of an Achilles tendon
James Douglas, MD/Michael Kelly, MB BS/Piotr Blachut, MD
Can J Surg, Vol. 52, No. 2, April 2009

Article 2 from:  The journal of bone and joint surgery:
How the Simmonds-Thompson test works?
B.W Scott, A. Al Chalabi
(See Portfolio)

References,
1. Journal of Trauma-Injury Infection & Critical Care:
    March 1962 - Volume 2 - Issue 2 - ppg 126-129
    T . Campbell Thompson, M.D and John H. Doherty, M.D
2. O’Brien T. The needle test for complete rupture of the Achilles tendon.
    J Bone Joint Surg Am 1984;66:1099-101
3.  Simmonds FA. The diagnosis of the ruptured Achilles tendon. Practitioner
    1957;179:56-8
4. Scott BW, Al Chalabi A. How the Simmonds–Thompson test works.
    J Bone Joint Surg Br 1992;74:314-5
5. Thompson TC. A test for rupture of the tendon achillis. Acta Orthop
    Scand 1962;32:461-5.
6.  Thompson TC, Doherty JH. Spontaneous rupture of tendon of
    Achilles: a new clinical diagnostic test. J Trauma 1962;2:126-9.