Hip
Muscle Extensibility
Evidence: confirmed
Thomas Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Assessing Hip Flexor Contracture (tightness of Iliopsoas, Rectus Femoris, or TFL).
How to Perform
- Position: Patient lies supine at the edge of the table.
- Action: Patient pulls one knee to the chest to flatten the lumbar spine. The other leg hangs free.
- Observation: Observe if the straight leg rises off the table.
Interpretation of Results
- Positive (Tight Iliopsoas): The thigh lifts off the table.
- Positive (Tight Rectus Femoris): The knee extends (straightens) instead of hanging at 90°.
- Positive (Tight TFL): The leg abducts or internally rotates.
Diagnostic Accuracy
- Sensitivity: 31%
- Specificity: 57%
Clinical Context & Limitations
The Thomas Test should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Hip region, combining the Thomas Test with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment.
