The patient must be suitably undressed for proper observation and may be seated or standing. The examiner should note the following traits:
- Head and neck posture (alignment, curvature)
- Shoulder levels
- Muscle spasm or any asymmetry (atrophy, torticollis)
- Facial expression (pain experience)
- Bony and soft tissue contours
- Evidence of ischemia in either upper limb
- Normal standing and sitting posture
- Willingness to move
Anterior: From the front, the chin should be in line with the sternum. Look if the head is tilted or rotated. Watch the level of the shoulders and look for any asymmetry, postural compensation, protrusions or soft tissue contours.
Lateral: From the side, the ear lobe should be in line with the acromion process and the highest point on the iliac crest.
Posterior: From the back, the head should be in midline and the shoulders level. Observe the position of the scapulae and its relation to the spine. The spine should be straight with the PSIS level.