Clinical examination is an art and has to be learnt, as it does not come naturally. All patients must be respected, made to feel at ease and assured of their confidentiality and dignity.
A detailed history should always be taken followed by clinical examination.
It is often assumed that clinical examination begins on the couch. This should not be the case, as significant information can be gained by observing the patient as they enter the room and walk towards you or as you approach them.
If the patient is seated they should be asked to stand as this is usually the first part of any orthopaedic clinical examination, except when the hand is being examined. You will observe whether the patient is tall, short, fat, thin, ill, well, energetic or slow. Observe if there is pain or if there are stigmata of orthopaedic disease such as blue sclera (osteogenesis imperfecta), café-au-lait spots (neurofibromatosis), multiple exostoses (diaphyseal aclasis; Figure 1.1), etc.