The physical examination starts with the first clinical interaction
between the patient and clinician. It begins with how the patient
responds to the initial greeting: getting up, walking, sitting down,
and posture during these activities. Appearance (general health,
weight, muscle bulk, and grooming), attitude and behavior (degree
of distress and reactions to specific examination maneuvers), and
gait (ataxia, walking with a limp, or requiring a cane or walker)
can provide important information. The presence or absence of masses
or lesions, signs of injury or trauma, and limb asymmetry regarding
skin, hair, nails, or temperature changes should be noted. Alignment
of the spine (scoliosis, kyphosis, loss of curvature) and range
of motion (ROM) should be noted. Pain-exacerbating maneuvers, such
as the straight-leg raising test, Spurling’s maneuver of
the neck, Patrick’s test of the hip, and spinal ROM tests,
may yield important diagnostic information. Joint shape, swelling,
redness, and tenderness should be noted. Measurement of vital signs
may prove useful in evaluating stress, pain (which alters vital
signs in young children), and side effects of medication.