Thomas test

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Thomas test
Medical diagnostics
Purposeused to rule out hip flexion contracture

The Thomas test (or Hugh Owen Thomas well leg raising test) is a physical examination test, named after Dr. Hugh Owen Thomas (18341891), 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.

Physical examination Process by which a medical professional investigates the body of a patient for signs of disease

A physical examination, medical examination, or clinical examination is the process by which a medical practitioner examines the body of a patient for any possible signs or symptoms of a medical condition. It generally consists of a series of questions regarding patient medical history followed by an examination of the symptoms. Together, the medical history and the physical examination aids in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record. The physical examination may be used to investigate a patient's symptoms or complaints or as a routine screening procedure in an asymptomatic patient, in which case it is referred to as a routine physical, general medical examination or check-up.

Hugh Owen Thomas Welsh surgeon

Hugh Owen Thomas was a Welsh surgeon. He is considered the father of orthopaedic surgery in Britain.

Orthopedic surgery medical specialty concerned with the human apparatus of movement

Orthopedic surgery or orthopedics, also spelled orthopaedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

Contents

Description

The patient supine on the examination table and holds the uninvolved knee to his or her chest, while allowing the involved extremity to lie flat. Holding the knee to the chest flattens out the lumbar lordosis and stabilizes the pelvis.

Supine position

The supine position means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it allows access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities.

Interpretation

If the iliopsoas muscle is shortened, or a contracture is present, the lower extremity on the involved side will be unable to fully extend at the hip. This constitutes a positive Thomas test. [1] Sometimes, with a very flexible patient, the Thomas test will be normal despite a psoas dysfunction being present. However, in the patient with a normal hip joint, a positive test is a good indicator of psoas hypertonicity. [1]

Other signs from the Thomas test:

Iliopsoas

The iliopsoas refers to the joined psoas and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. As such, they are usually given the common name iliopsoas. The iliopsoas muscle joins to the femur at the lesser trochanter, and acts as the strongest flexor of the hip.

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. [2]

The test consists of 3 steps:

Related Research Articles

Human leg lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The human leg, in the general word sense, is the entire lower limb of the human body, including the foot, thigh and even the hip or gluteal region. However, the definition in human anatomy refers only to the section of the lower limb extending from the knee to the ankle, also known as the crus. Legs are used for standing, and all forms of locomotion including recreational such as dancing, and constitute a significant portion of a person's mass. Female legs generally have greater hip anteversion and tibiofemoral angles, but shorter femur and tibial lengths than those in males.

Thigh area between the pelvis and the knee; upper leg

In human anatomy, the thigh is the area between the hip (pelvis) and the knee. Anatomically, it is part of the lower limb.

Lordosis or saddle back, curvature of the spine

Lordosis is the normal inward lordotic curvature of the lumbar and cervical regions of the human spine. The normal outward (convex) curvature in the thoracic and sacral regions is termed kyphosis or kyphotic. The term comes from the Greek lordōsis, from lordos.

Hip anatomical region

In vertebrate anatomy, hip refers to either an anatomical region or a joint.

The psoas sign, also known as Cope's psoas test or Obraztsova's sign, is a medical sign that indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocaecal in orientation.

Psoas major muscle long fusiform muscle located on the side of the lumbar region of the vertebral column and brim of the lesser pelvis

The psoas major is a long fusiform muscle located on the side of the lumbar region of the vertebral column and brim of the lesser pelvis. It joins the iliacus muscle to form the iliopsoas.

Iliacus muscle

The iliacus is a flat, triangular muscle which fills the iliac fossa. It forms the lateral portion of iliopsoas, providing flexion of the thigh and lower limb at the acetabulofemoral joint.

The rectus femoris muscle is one of the four quadriceps muscles of the human body. The others are the vastus medialis, the vastus intermedius, and the vastus lateralis. All four parts of the quadriceps muscle attach to the patella by the quadriceps tendon.

Muscles of the hip

In human anatomy, the muscles of the hip joint are those muscles that cause movement in the hip. Most modern anatomists define 17 of these muscles, although some additional muscles may sometimes be considered. These are often divided into four groups according to their orientation around the hip joint: the gluteal group; the lateral rotator group; the adductor group; and the iliopsoas group.

Lumbar plexus

The lumbar plexus is a web of nerves in the lumbar region of the body which forms part of the larger lumbosacral plexus. It is formed by the divisions of the first four lumbar nerves (L1-L4) and from contributions of the subcostal nerve (T12), which is the last thoracic nerve. Additionally, the ventral rami of the fourth lumbar nerve pass communicating branches, the lumbosacral trunk, to the sacral plexus. The nerves of the lumbar plexus pass in front of the hip joint and mainly support the anterior part of the thigh.

The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint.

In medicine, physiotherapy, chiropractic, and osteopathy the hip examination, or hip exam, is undertaken when a patient has a complaint of hip pain and/or signs and/or symptoms suggestive of hip joint pathology. It is a physical examination maneuver.

Acetabular labrum

The acetabular labrum is a ring of cartilage that surrounds the acetabulum of the hip. The anterior portion is most vulnerable when the labrum tears.

Anterior compartment of thigh

The anterior compartment of thigh contains muscles which extend the knee and flex the hip.

A GALS screen is an examination used by doctors and other healthcare professionals to detect locomotor abnormalities and functional disability relating to gait, arms, legs and the spine.

The leg raise is a strength training exercise which targets the iliopsoas. Because the abdominal muscles are used isometrically to stabilize the body during the motion, leg raises are also often used to strengthen the rectus abdominis muscle and the internal and external oblique muscles.

Ober's test is used in physical examination to identify tightness of the iliotibial band . During the test, the patient lies on his/her side with the unaffected leg on the bottom with their shoulder and pelvis in line. The lower hip and knee can be in a flexed position to take out any lordosis of the lumbar spine.

Pelvis lower part of the trunk of the human body between the abdomen and the thighs (sometimes also called pelvic region of the trunk

The pelvis is either the lower part of the trunk of the human body between the abdomen and the thighs or the skeleton embedded in it.

References

  1. 1 2 Chila, Anthony G.; et al., eds. (2010). Foundations of Osteopathic Medicine. Published under the auspices of the American Osteopathic Association (3rd ed.). Lippincott Williams & Wilkins. ISBN   978-0-7817-6671-5.
  2. Musculoskeletal Examination, 2nd edition (2002), chapter 11, p. 327