A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
- Gait pattern or examination of gait and balance:
- Freely selected walking speed or measurement of the time to cover a defined gait distance (e.g., 10 m).
- Walking and counting test
- Stand-up and walk test (“Timed Up and Go” test) to assess mobility or body balance: stand up from a chair (with armrests! ), walk 3 m forward to an object, turn around the object, return to the chair, sit down. Measurement of time in seconds (s)Assessment: 20-29 s: relevant mobility impairment; > 30 s: pronounced mobility impairment.
- Stand-up test (“chair-rise test”; chair-raising test): 5 times standing up from a (preferably fixed) chair with folded arms without pause; thereby measuring the time in seconds (s) Assessment: At a time > 11 s there is increased risk of falling.
- Body or joint posture (upright, bent, gentle posture).
- Malpositions (deformities, contractures, shortenings).
- Muscle atrophies (side comparison!, if necessary circumference measurements).
- 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! ); restricted 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?
- If necessary, palpation of prominent bone points, tendons, ligaments; musculature; joint (joint effusion? ); soft tissue swelling; pressure pain (localization!).
- If necessary, measurement of joint mobility and range of motion of the joint (according to the neutral zero method: the range of motion is given as the maximum deflection of the joint from the neutral position in angular degrees, where the neutral position is designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first). Comparative measurements with the contralateral joint (side comparison) can reveal even small lateral differences.
- If necessary, special functional tests depending on the affected joint.
- Auscultation (listening) of the heart [due todifferential diagnosis: bradycardic/tachycardic cardiac arrhythmias leading to impaired consciousness].
- Palpation of the abdomen (abdomen) (tenderness?, tapping pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing tapping pain?)
- Inspection (viewing).
- Ophthalmic examination – including visual acuity check [visual acuity reduction].
- ENT medical examination [due todifferential diagnoses: balance disorders, vertigo (dizziness)]
- Neurological examination – including testing of reflexes, gait/standing tests, testing of extremity/oculomotor function [see under differential diagnoses: nervous system].
- Psychiatric examination [due todifferential diagnosis: dementia]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
