Purpose:

• To assess hip flexor tightness or contractures (primarily of the iliopsoas muscle).
• Commonly used to evaluate children with neuromuscular or orthopedic conditions that may impact hip function.

Anatomy Reviewed:

• Iliopsoas muscle: Major hip flexor spanning the lumbar spine to the femur.
• Secondary hip flexors: Rectus femoris, sartorius, tensor fasciae latae.

Indications:

• Suspected hip flexion contracture in conditions like:
  • Cerebral palsy (spasticity-related contractures).
  • Spinal cord injuries.
  • Postural abnormalities in neurodevelopmental disorders.
• Evaluation of pelvic tilt or compensatory mechanisms in gait abnormalities.

Procedure:

1. Position the patient supine on an examination table.
2. Ensure the pelvis remains neutral (no anterior/posterior tilt).
3. Ask the patient to hold one knee (unaffected/contralateral side) close to their chest to flatten the lumbar lordosis.
4. Allow the tested leg to relax and hang over the edge of the table.
5. Observe for any elevation of the thigh off the table or inability to fully extend the hip.

Normal Findings:

• Tested leg lies flat on the table with the hip in neutral extension.

Positive Thomas Test:

• Thigh elevation off the table suggests tightness in the iliopsoas.
• Knee extension with thigh elevation indicates rectus femoris tightness.
• Lateral deviation of the leg suggests involvement of tensor fasciae latae or sartorius.

Interpretation:

• Unilateral findings: May indicate asymmetric spasticity or unilateral contracture.
• Bilateral findings: Suggest systemic issues (e.g., generalized spasticity, neuromuscular disorders).

Applications:

• Identifies functional limitations impacting posture and gait.
• Helps in planning rehabilitation strategies, such as stretching programs or botulinum toxin injections.
• Aids in preoperative assessment for surgical interventions like tendon releases or hip realignment procedures.

Limitations:

• Requires patient cooperation, challenging in younger children or those with cognitive delays.
• False positives may occur with improper technique or compensatory pelvic tilt.

Modifications for Children:

• Use gentle manual assistance for positioning in children with poor motor control.
• Combine with dynamic gait analysis or other physical assessments to gain comprehensive insight.

Key Notes for Practice:

• Always check for associated joint abnormalities (e.g., hip subluxation/dislocation).
• Document the degree of hip flexion contracture in degrees for accurate follow-up.
• Correlate findings with imaging studies when available (e.g., hip X-rays or gait labs).

• https://www.physio-pedia.com/Thomas_Test