Examination of the wrist follows the pattern look, move, feel. Then perform provocative or instability tests as indicated. These provocative or instability tests are broadly dictated by the site of tenderness; for example, if there is radial tenderness, perform Finklestein’s test, and if there is tenderness over the scapholunate ligament,perform the Kirk Watson test.

This chapter presents different spinal pathologies and explains how to examine each case. The specific clinical tests and clinical signs are pointed out for each case. Cases covered include kyphosis, ankylosing spondylosis, cervical myelopathy, rheumatoid spine and spondylolisthesis, amongst others.

In this chapter, the general system of examining the various joints in the body is described. Most joints will follow the look, feel, move system, whereas some –for example, the elbow, wrist and ankle – will be best examined using the look, move, feel system.

Other concepts such as gait, generalized laxity, assessment of power and sensory testing are included. Listed at the end of the chapter are examples of how to approach ‘difficult situations’ that the reader may face in clinical practice or in examinations.

This chapter covers clinical examination of the child through growth and development. It includes neonatal presentation to the orthopaedic surgeon, e.g. with dislocating hips or obstetric brachial plexus palsy. All joint examinations in the child are described with the differences in a child compared to an adult emphasised. Included in the chapter are rotational profile assessment, leg length assessment, assessing a child with skeletal dysplasia and how to examine a child with spina bifida.

Hip examination starts with standing the patient, then walking the patient and describing the gait. The Trendelenburg test is then performed. The patient is then asked to lie on the couch and the pelvis squared. As the hip is a deep joint, palpation does usually yield much information. Thomas test is performed, followed by range of movement of the hip. Then, leg length is assessed. Finally, if required, impingement tests are performed. Other special tests such as Phelps' test are performed if there are hip contractures. In the ‘Advanced Corner’, other less commonly performed special tests are described.

This chapter includes cases that are seen mainly in the developing world. The chapter is divided into five sections: conditions that present in childhood such as rickets and sickle cell disease; post-traumatic presentations such as malunion, non-union and physeal growth arrest; problems related to infection such as osteomyelitis; late presentation of tumors; neglected presentations such as osteoarthritis and congenital talipes equinovarus.

Examination of the elbow starts with standing the patient and observing the carrying angle and looking for deformity and scars. The process flows best when movements are performed next, followed by palpation. If there is tenderness over the epicondyles, then provocation tests are performed, on the lateral side for tennis elbow and on the medial side for golfer’s elbow. Lastly, instability tests are performed. The pivot shift test is explained in more detail later in this chapter.

Clinical cases covering the spectrum of upper limb pathology are presented here. In the hand, these include congenital hand deficiencies, Dupuytren’s disease, rheumatoid disease, nerve lesions and tendon transfers. In the elbow, this includes osteoarthritis and in the shoulder, massive cuff tear, scapula winging and painful shoulder arthroplasty. Clinical examination findings for each of the cases are highlighted.

This chapter looks at a spectrum of paediatric clinical cases ranging from generalised conditions such as Ehlers– Danlos syndrome to tibial bowing and foot disorders. Skeletal dysplasia and rotational and other malalignments are also covered. The emphasis of the cases shown is to demonstrate how clinical features can contribute to management.

Brachial plexus examination is described in a simple manner for this difficult topic. A drawing of the brachial plexus is included, which is essential knowledge for learning to examine the brachial plexus. The system is: look, feel, move.

Inspection includes looking for Horner’s syndrome, which may indicate a preganglionic lesion. Palpation is for the presence of the pulse, sweating and the sensory testing. Motor testing is in a sequential manner whereby the examiner tests the myotomes, the muscles supplied by the branches off the roots, the muscles supplied by the branches off the trunks, the muscles supplied by the branches off the cords and then the terminal branches of the brachial plexus.

Included in the chapter is a section on how clinical examination findings influence treatment and also a section on the obstetric brachial plexus.

Foot and ankle examination begins with the patient standing. Then ask the patient to walk, observing the gait and the three rockers. If the diagnosis is pes planus or pes cavus, the relevant tests can be done at this point of the examination, a single leg tiptoe test or the Coleman block test, respectively. Inspection is then completed by asking the patient to sit and inspect the sole of the foot, between the toes and the shoes. Movements are performed in the joints from proximal to distal or distal to proximal, depending on the underlying pathology.

The chapter looks at a wide variety of pathology and the clinical examination findings related to these cases.

Examination of the adult spine follows a similar sequence for the cervical, thoracic and lumbar spines. The lumbar spine is emphasised in this chapter. The stepsinclude: Stand the patient and inspect. This is followed by palpation and then movement of the spine. Ask the patient to walk and then perform a complete neurological examination. With a cervical spine examination, the nerological examination is of the upper and lower limbs, whereas in the lumbar spine it is just the lower limb. For the thoracic spine, abdominal reflexes should also be performed.

This chapter covers disc disease including myelopathy in more detail. Other important conditions are also covered such as the bulbocavernosus reflex and tandem spinal stenosis.

This chapter includes clinical cases related to pathology in the hip, knee, foot and ankle and the lower limb in general. These include common conditions such as varus or valgus knee arthritis, hallux valgus and the cavovarus foot. Much less common conditions such as arthrodesis of the hip and knee, parameniscal cysts and poliomyelitis are also covered. The clinical findings related to each of these cases are explained.

The hand examination does not follow the pattern of the other joints such as look, feel, move. This is because there are varied pathologies in the hand and each is examined differently. The process described is to first perform a screening test that will allow the examiner to identify the pathology present and then to subsequently tailor the rest of the clinical examination. For example, if a lump is found, it will be examined differently to Dupuytren’s disease being found or to a tendon injury.

In addition, examination findings of various pathologies seen in the hand are described such as rheumatoid disease, first carpometacarpal joint arthritis and flexor tendon injuries.