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 and 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 by squeezing the calf. It is performed as a clinical test to identify the presence of a complete tear of the tendon.

Clinically relevant anatomy 

The calf musculature exists of the m. triceps surae group:
- m. gastrocnemius arises from two heads on the posterior surface of the femur, directly above the two condyles of the femur
- m. soleus comes from an inverted U-shaped origin from the posterior aspect of the tibia, membrana interossea and the head and upper 1/3 of the fibula
- m. plantaris arises from the distal lateral portion of the linea aspera.
M. gastrocenium and m. soleus blend together in the distal portion of the calf and form the tendon of Achilles. The plantaris tendon, when present, lies alongside the heel cord or is somewhat removed from it in its insertion into the medial aspect of the calcaneus. Tendons are strong, tough bands of inelastic fibrous connective tissue that connects muscle to bone. They consist of elongated cells, minimal ground substance and collagen fibers. The collagen fibers are packed closely together, parallel to the direction of force. Each collagen fibril is arranged into fascicles, which contain blood vessels and nerve fibers.

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Purpose

The goal of this test is to find out if there is a complete tear present in the achilles tendon.

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.