Neck Exam

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

Examination of the neck can be a challenge because of the many bones, joints, and ligaments that make up the underlying cervical spine. The cervical spine is composed of seven vertebrae stacked in gentle C-shaped curve. The anterior part of each vertebra is made up of the thick bony body, which is linked to the body above and below by intervertebral discs. These discs help provide stability and shock absorption to the cervical spine. The posterior elements of the vertebra, which include the laminae, transverse, and spinous processes and the facet joints, form a protective canal for the cervical spinal cord and its nerve roots.

The cervical spine supports the head and protects the neural elements as they come from the brain and from the spinal cord. Therefore, injuries or disorders affecting the neck can also affect the underlying spinal cord and have potentially catastrophic consequences. The significant motion that occurs in the neck places the cervical spine at increased risk for injury and degenerative changes. The cervical spine is also a common source of radicular pain in the shoulder. For this reason, the neck should be evaluated as a routine part of every shoulder exam.

When examining the neck, it is important to have the patient remove enough clothing so that the entire neck and upper shoulders can be seen and palpated.

1. Inspection

Look at the neck from behind starting from the base of the skull and down to the upper back. There should be near perfect symmetry and the head should sit in the midline. Tilting to one side may suggest muscle spasm, such as with torticollis.
Observe the form and bulk of the paraspinous muscles that surroun

Examination of the neck is best performed in a sitting or standing position, and should follow a stepwise approach. It is important to have the patient remove enough clothing so that the surface anatomy of the neck and shoulders can be seen. The exam should begin with inspection, looking for a lack of symmetry. This is followed by palpation, looking for tender spots or an abnormal step off between the vertebrae. Next, range of motion is assessed, first actively and then against resistance to assess the strength. Finally,

Transcript