Examination of the knee joint begins with standing the patient, then asking them to walk. Look for any lurch and observe the foot and patella progression angles. Next ask the patient to sit with their legs hanging over the couch. Observe the patella height and tracking. Then palpate for an effusion and for areas of tenderness. After this, examine the cruciate and collateral ligaments. Depending on the findings, so far further special tests would be a dial test for the posterolateral corner, meniscal stimulation tests or patellofemoral tests. Included in the chapter is clinical evaluation of the acutely injured knee in the child.

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.

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.

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.

Sterilization is the process that destroys all forms of microbial life and is carried out in healthcare facilities by either chemical or physical methods. Disinfection, however, is a process that eliminates all pathogenic microorganisms, except bacterial spores or viruses.

Cleaning is a physical process that removes contamination but does not necessarily destroy microorganisms.

Bow leg and knock knees

Bow leg (Figure 4.1) and knock knees are common referrals to children’s orthopaedic clinics. Most are physiological; however, pathological causes must be excluded (Table 4.1).

The leg alignment in the coronal plane (varus and valgus) undergoes a unique pattern of changes from birth until adulthood, as described by Salenius and Vankka [1]. Most newborn babies have an average knee varus of 10°–15°. This begins to be corrected during the second year of life, reaching about 10° of valgus at around 4 years of age. The valgus alignment then gradually decreases, reaching the adult value (5° of valgus) around 8 years of age (see Figure 4.2). The standard deviation (SD) is 8° (more in the boys, 10°, and less in the girls, 7°).

Children with physiological genu varum and internal tibial torsion typically come to medical attention after the standing age (between 12 and 24 months), usually because of parental concern regarding the appearance of the legs, and these children have no other significant findings on clinical examination.