A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
- Gait (fluid, limping).
- Body or joint posture (upright, bent, gentle posture) [asymmetry of the skull; shoulder, chest or pelvic asymmetry / pelvic obliquity (= leg length difference < 2 cm); leg length difference; rib hump].
- Malpositions (deformities, contractures, shortenings) [sagittal: Thoracic spine kyphosis / to the rear (dorsal) convex curvature of the spine , lumbar spine lordosis / to the front convex curvature of the spine].
- Muscle atrophies (lateral comparison!, if necessary circumferential measurements) [lumbar bulge].
- Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment).
- Palpation (palpation) of vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of paraverebral muscles); soft tissue swelling; tenderness (localization! ); limited mobility (spinal movement restrictions); “tapping signs” (testing for painfulness of spinous processes, transverse processes, and costotransverse joints (vertebral-rib joints) and back muscles); illiosacral joints (sacroiliac joint) (pressure and tapping pain?; compression pain, anterior, lateral, or saggital); hyper- or hypomobility? [deformation of the vertebral bodies.]
- Palpation of the joints [osteoarthritis (joint wear)]
- Functional tests
- Adams pre-bend test (Adams test; pre-bend test): the patient bends his upper body forward by about 90 degrees with the legs extended and lets the arms hang down. Looking at the back from behind, scoliosis is usually noticeable:
- That one side is higher than the other
- That a rib hump is formed
- The lumbar muscles on this side more prominent (lumbar bulge), ie it strengthens any existing rib hump or lumbar bulge on the convex side of the bend
- Finger-to-floor distance (at maximum forward tilt of the upper body with arms hanging down).
- Length of ischiocrural muscles (knee extension deficit at 90° hip flexion).
- Adams pre-bend test (Adams test; pre-bend test): the patient bends his upper body forward by about 90 degrees with the legs extended and lets the arms hang down. Looking at the back from behind, scoliosis is usually noticeable:
- Neurologic examination (abdominal wall reflexes, peripheral intrinsic reflexes; sensitivity; strength level of characteristic muscles).
- Inspection (viewing).
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
