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
- Gait pattern [waddling gait?; evidence of muscular weakness?]
- Stand-up and walk test (“Timed Up and Go” test): 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.
- 5 times to stand up from a (preferably fixed) chair with folded arms without pause; thereby measuring the time in seconds (s) (“chair-rise test”; chair-raising test)Assessment: at a time > 11 s there is increased risk of falling.
- Body or joint posture (upright, bent, gentle posture).
- Malpositions (deformities, contractures, shortenings) [skeletal changes:
- Epiphyseal distortions (“double joints“, “rosary”).
- Breast shape deformities (“bell thorax”, “funnel or keel chest“).
- Harrison’s groove – lateral chest indrawing along the diaphragmatic attachment line.
- Disproportionately large skull with flat back of the head: square skull (caput quadratum).
- Kraniotabes – softening of the occipital bones (yielding of the bones of the skull under finger pressure).
- Rachite rosary – swelling of the ribs in the area of the cartilage-bone junction.
- Bending of long tubular bones – in crawling child the arms, in running child the legs.
- “bow legs” due to coxa vera]
- Muscle atrophies (side comparison!, if necessary circumference measurements) [“frog belly” due to hypotonia of the abdominal muscles with general adynamia of the musculature].
- If necessary, also hand strength measurement
- Palpation (palpation) of the vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of the 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? [diffuse bone pain; esp. lumbar spine, pelvis, and lower extremity].
- Palpation (palpation) of prominent bone points, tendons, ligaments; musculature; joint (joint effusion?); soft tissue swelling; tenderness (localization!).
- 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.
- Inspection (viewing).
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
