| General |
- Vital signs
- General appearance, mood, affect, or emotional state
- Gait, posture
|
| Back – patient sitting |
- Spine curvature, evidence of previous injury or surgery
- Spinal (including sacrum and coccyx), paraspinal and sacroiliac joint tenderness
|
| Abdomen – patient supine |
- Appearance: Fat distribution, scars, or evidence of previous trauma or surgery
- Evidence of masses, hernia, inguinal adenopathy, pubic symphysis pain
- Light palpation or stroking: Evaluate for allodynia
- Single digit deep palpation: Differentiate focal versus diffuse pain, trigger points (focal area that worsens with abdominal wall flexion)
|
| Extremity – patient supine |
- Hip flexion, extension, internal and external rotation; hip abduction and adduction to evaluate for range of motion
- Muscle strength, tone, spasticity, or asymmetry
|
| Pelvic – patient lithotomy |
- External genitalia: Lesions, abrasions, ulcerations, erythema, or edema of clitoris, urethral meatus, vulva, and/or vestibule (cotton swab examination if patient has dyspareunia and/or vulvar pain)
- Single digit vaginal examination: Tenderness or spasticity of pelvic floor muscles (pubococcygeus, obturator internus, piriformis), urethra, bladder, cervix, lower uterine segment, and vaginal fornices
- Bimanual examination: Uterine size, mobility, adnexal masses, and tenderness
- Rectovaginal examination: Tenderness and/or nodularity of rectovaginal septum and uterosacral ligaments
- Speculum examination: Lesions, ulcerations, or erythema of vaginal mucosa, cervix, and posterior vaginal fornix; cervical and/or vaginal cultures if purulent discharge noted
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