Thomas Test

<div class="noeditbox">Welcome to  [[Arkansas Colleges of Health Education School of Physical Therapy Musculoskeletal 1 Project]].  This space was created by and for the students at Arkansas Colleges of Health Education School in the United States. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div>

Original Editor - Tyler Shultz

Top Contributors - Aurelie Canas Perez, Maddison Jones, Admin, Ashtyn Madden, Kim Jackson, Magdalena Hytros, Rachael Lowe, Lucinda hampton, Shelby Morrison, Joao Costa, Yvonne Yap, Tyler Shultz, Johnathan Fahrner, Kevin Campion, Leana Louw, Sue Safadi, Tony Varela, Matt Huey, Kai A. Sigel, Wanda van Niekerk, Oyemi Sillo, Naomi O'Reilly and Adam Vallely Farrell  

<div class="noeditbox">Welcome to  [[Arkansas Colleges of Health Education School of Physical Therapy Musculoskeletal 1 Project]].  This space was created by and for the students at Arkansas Colleges of Health Education School in the United States. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div>

Purpose

The Thomas Test measures hip flexor length and distinguishes tightness between one joint and two joint muscles.

1. Impaired range of motion of the hip may be an underlying cause to other conditions such as: psoas syndrome; patellofemoral pain syndrome; lower back pain, osteoarthritis; rheumatoid arthritis.
2. Often associated with runners, dancers, and gymnasts who complain of hip "stiffness" and reported "snapping" feeling when flexing at the waist.

Image: Overview of the hip and thigh - anterior and posterior views

Relevant Anatomy

There are various muscles making up the hip flexor group being tested in the Thomas Test:

Hip Flexor Muscle	Picture (Muscle in green)	Number of Joints Crossed	Main Function	Additional Movement
Iliopsoas: Composed of iliacus and psoas major		One joint: Hip	Hip flexion	Hip external rotation
Pectineus		One joint: hip	Hip flexion	Hip abduction
Adductor Longus & Brevis		One joint: hip	Hip adduction	Hip flexion and external rotation
Adductor Magnus		One joint: hip	Adductor part: Hip flexion, adduction, external rotation	Hamstring part: Hip extension and internal rotation.
Rectus femoris		Two joints: Hip and knee	Hip flexion	Knee extension
Tensor fascia lata		Two joints: Hip and knee	Hip abduction, flexion, internal rotation	Knee extension
Sartorius		Two joints: Hip and knee	Hip flexion, abduction, external rotation	Knee flexion

"The copyright holder has given special permission to use these images in Physiopedia"

This 16 minute video is a good summary of the lower extremity muscles.

How to Remember Every Muscle of the Lower Limb and Leg | Corporis

Technique

• Patient is supine ,with lower gluteal folds at the end of the table and their hips and knees flexed. (Patient may hold the legs in flexion with their hands).
• Therapist makes sure that the patient’s lower back is in a neutral pelvic tilt.
• Patient keeps the unaffected leg flexed, and slowly lowers the affected leg and lets it extend as far as it can.

Interpretation

Thomas test: The following structures may be considered during a positive test.

Sign	Structures affected
Extended knee	Quadriceps, rectus femoris
Flexed hip	Psoas muscles
Abducted hip	Tensor fascia lata, iliotibial band
Tibia lateral rotation	Biceps femoris

A modified version of the test is one in which the patient lies down on their back, at the very edge of the table, with both legs hanging freely. The patient must then flex their knee and pull it back to their chest as close as they can, using both arms while doing so. The other leg can hang The lumbar spine must remain flat and in contact with the table during the test. The second video below shows technique.

Viewing

An easy test to perform, as shown in this 40 second video.

Thomas Test video provided by Clinically Relevant

This 40 second video shows the modified test.

Reliability

Studies that test the reliability of the Thomas study are very limited.

1. One study has demonstrated that the modified Thomas test has a very good inter-rater reliability. Another has demonstrated that the modified Thomas test, has an average of only moderate levels of reliability. Further research is required to prove or to refute the reliability of the Thomas test.
2. Peeler & Anderson conducted a study in 2006 examining the reliability of the Thomas test for assessing hip range. Their study calls into question the reliability of the technique when used to score range of motion and iliopsoas muscle flexibility about the hip joint using both goniometer and pass/fail scoring methods.

Resources

This 17 minute video is a good summary of the muscles of the hip and thigh.