Examination of the neck includes inspection for any scars, masses, or glandular or nodal enlargement. Inspect the trachea, noting any deviation. Next inspect the thyroid gland as the patient swallows, noting any enlargement. Evaluate by palpation the lymphatic chains as well as the presence of any masses in the neck. When evaluating lymph nodes for pathology, note their size, shape, consistency, mobility, and tenderness. Note if only one region has enlarged lymph nodes or if all nodes are enlarged. It is easy to mistake a band of muscle for a lymph node just as it is easy to miss abnormally enlarged lymph nodes if a careful exam is not performed. A lymph node can be rolled from side to side and up and down whereas a band of muscle cannot.
In the neck region, ganglion masses or enlargements of the cervical organs (thyroid, submaxillary glands, cervical portion of the parotid, carotid aneurysms, esophageal diverticula, thyroglossal duct cysts, tumors or tracheal deviations) can be palpated.
Introduction
- Follows the IP-PASS examination methodology
- Inspection
- Palpation
- Passive Range of Motion
- Active Range of Motion
- Strength & Neurovascular
- Special Tests
Inspection
- Skin
- Color: erythema, ecchymosis, white, black
- Trophic changes (altered hair growth, sweat production)
- Scars
- Swelling
- Muscle tone: atrophy, hypertrophy
- Deformity: asymmetry, rotation, amputation
- Areas of emphasis for neck exam
- Resting position of neck, exaggerated kyphosis or lordosis
- Swelling or masses
- Lymphadenopathy
- Tracheal deviation
Palpation
- Palpate for
- Effusion
- Clicking
- Snapping
- Crepitus
- Tenderness
- Temperature
- Masses
- Areas of Emphasis
- Spinous Process
- Trapezius
- Paracervical Muscles
- Sternocleidomastoid
- Scalenes
- External Occipital Protuberance
- Mastoid Process
- Cervical lymph nodes
Range of Motion
- Flexion: 45-60° from neutral
- Extension: 45-80° from neutral
- Rotation: 80-85° from neutral
- Lateral Flexion (Sidebending): 45° degree from neutral
Strength and Neurovascular
Strength
- Flexion
- Sternocleidomastoid
- Anterior Scalene
- Longus Colli Cervicis
- Longus Capitus
- Rectus Capitus Anterior
- Extension
- Sternocleidomastoid
- Spinalis Cervicis
- Spinalis Capitus
- Semispinalis Cervicis
- Semispinalis Capitus
- Splenius Cervicis
- Iliocostalis Cervicis
- Longissimus Cervicis
- Rectus Capitus Posterior Major
- Rectus Capitus Posterior Minor
- Obliquus Capitus Superior
- Rotation
- Sternocleidomastoid
- Scalenes
- Spinalis Cervicis
- Spinalis Capitus
- Longissimus Capitis
- Rectus Capitus Posterior Major
- Obliquus Capitus Inferior
- Sidebending or Side Flexion
- Rectus Capitus Lateralis
- Obliquus Capitus Superior
Motor Nerves
- C1-C3
- Lower Cervical Nerve
- Middle Cervical Nerve
- Suboccipital Nerve
Sensory Nerves
- Need image
Dermatomes
- C5: Lateral deltoid
- C6: Lateral elbow, Dorsal thumb
- C7: dorsal, proximal 2nd or 3rd digit
- C8: dorsal, proximal 5th digit
- T1: Medial elbow
Myotomes
- C5: Elbow flexion
- C6: Wrist extension
- C7: Elbow extension
- C8/T1: Pink abduction
Reflexes
- C5/C6: Biceps
- C5/C6: Brachioradialis
- C7/C8: Triceps
Special Tests
- Nonspecific Intracervical Spinal Lesions
- Upper Limb Tension Test
- Lhermittes Sign
- Shoulder Abduction Relief Sign
- Spurlings Test
- Bakodys Sign
- Hoffman Sign
- Cervical Distraction Test
- Lhermittes Sign
- Cervical Headache
- Cranial Cervical Flexion Test
- Cervical Radiculopathy
- Spurlings Test
- Shoulder Abduction Test
- Valsalva Maneuver
- Cervical Distraction Test
- Upper Limb Tension Test
- Lhermittes Sign
- Bakodys Sign
- Hoffman Sign
- Thoracic Outlet Syndrome
- Adson test
- Costoclavicular Test
- Wrights Test
- Elevated Arm Stress Test
- Cyriax Release Test
