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, mucous membranes, and sclerae (white part of eye) [local hypertrichosis (increased body and facial hair; without a male pattern of distribution)? Skin retraction over the defect? Teleangiectasias (vascular veins)? Lipomas (fatty growths)? Pigmentation]
- Palpation (palpation) of vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of paraverebral musculature); 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?
- Neurological examination [due toneurological deficits?]
- Orthopedic examination [due toclubfoot? knock knees? Flexion contractures in the hip joint (joint stiffness in flexion position)?]
- Urological examination [due tobladder and rectal disorders? Enuresis nocturna (nocturnal enuresis)?]
Square brackets [ ] indicate possible pathological (pathological) physical findings.