Physical Examination Procedures
A fixed sequence prevents omissions
Examination converts history into testable hypotheses. Work in a consistent order: vital signs and general observation, inspection (posture, symmetry, gait, skin, swelling), palpation (temperature, tone, tenderness, trigger points, joint play), active then passive then resisted range of motion, orthopedic special tests, neurologic screening, and vascular screening when indicated.
Know what each maneuver measures. Active range reflects willingness and mechanics; passive range adds capsular information and end-feel (capsular, bony, empty); resisted testing isolates contractile tissue. Special tests modify probability rather than render verdicts - a positive Spurling test raises the likelihood of cervical radiculopathy, but a negative test does not eliminate it. Always compare sides, and complete posture and leg-length assessment before soft-tissue work alters resting tone.
Traps
Manipulating before the exam is finished; treating a single positive test as a diagnosis; labeling a test "positive" without naming the structure it implicates; omitting vital signs in a patient with headache or dizziness; skipping gait.
Worked example
Low back pain with left straight leg raise positive at 40 degrees, diminished left Achilles reflex, and weak plantarflexion - document findings in that order so the S1 reasoning is visible and reproducible on re-examination.
Rule of thumb
If the history hints at a visceral or systemic source, organize the exam to exclude it rather than to find a manipulable segment.