Physical Examination Procedures
Sequence the exam
Proceed from general to specific: vital signs (blood pressure, pulse, respirations, temperature, height/weight, BMI), posture and gait observation, active then passive range of motion, palpation (temperature, tone, tenderness, trigger points), segmental motion palpation, orthopedic and neurologic testing (dermatomes, myotomes, deep tendon reflexes, upper motor neuron signs), and functional tasks. Compare sides and record numbers-degrees, grades, distances-not adjectives.
Interpret tests correctly
No single test makes a diagnosis. Sensitivity and specificity govern meaning: a highly sensitive test such as straight leg raise is most useful when negative, because it helps rule out (SnNout); a highly specific test is most useful when positive (SpPin). Test value depends on pretest probability-in a low-risk patient, a positive result is more likely a false positive.
Traps
Treating a positive orthopedic test as a diagnosis rather than one data point. Failing to distinguish pain-limited from mechanically restricted motion. Missing a vascular or neurologic explanation for leg symptoms. Labeling hypertension from a single reading. Skipping cranial nerve and upper motor neuron screening when cervical or headache presentations are atypical.
Rule of thumb
Before performing any special test, ask: "If this were negative, would my plan change?" If the answer is no, the test adds little-but document what you did and why you did it.