Neck

Neck ROS

• Neck pain or stiffness

• Pain with movement

• Radiation of pain to shoulders/arms

• Numbness or tingling in arms/hands

• Weakness in upper extremities

• Headaches (especially occipital)

• Recent trauma or whiplash

• Difficulty swallowing

• Swelling or lumps in the neck

• Voice changes

• Heat/cold intolerance (thyroid‑related)

Neck Red Flags

• New gait instability

• Bowel/bladder dysfunction

• Bilateral numbness/weakness

• Drop attacks

• Severe limitation of ROM in all directions

• History of cancer

• Fever + neck stiffness

• Sudden severe neck pain after trauma

Neck PE

A. Inspection

1. Symmetry

2. Masses

3. Lesions

2. Range of Motion

(Must perform all)

• Flexion

• Extension

• Sidebending

• Rotation

B. Auscultation

• Auscultate carotids prior to palpation

C. Palpation

1. Musculature

2. Thyroid

   • Examine from behind

   • Proper hand placement

   • Have patient swallow

3. Carotids — one at a time

OSCE add-ons: Neck

• Inspect for tracheal deviation

• Palpate lymph nodes (anterior/posterior cervical, supraclavicular)

• Palpate parotid and submandibular glands

• Auscultate thyroid for bruits (if enlarged)

Neck Special Tests

1. Spurling Test

Indication: suspected cervical radiculopathy
Positive: reproduction of radicular pain

2. Shoulder Abduction Relief Test

Indication: radiculopathy (C5–C6)
Positive: symptom relief

3. Lhermitte Sign

Indication: cervical myelopathy, MS
Positive: electric shock sensation down spine with neck flexion

4. Upper Limb Tension Test

Indication: nerve root irritation

5. Thyroid Special Maneuvers

(From standard neck exam)

• Swallow test → thyroid masses move upward

• Tongue protrusion test → thyroglossal duct cyst moves upward

6. Carotid Bruit Auscultation

Indication: suspected carotid stenosis, TIA symptoms

Diagnosis Trigger: Neck pain

Think:

• Cervical strain

• Cervical radiculopathy

• Cervical myelopathy

• Meningitis

• Carotid dissection

• Thyroiditis

Clues:

• Pain radiating to arm → radiculopathy

• Bilateral symptoms + gait issues → myelopathy

Diagnosis Trigger: Neck mass

Think:

• Thyroid nodule

• Thyroid goiter

• Lymphadenopathy

• Thyroglossal duct cyst

• Branchial cleft cyst

• Malignancy

Clues:

• Moves with swallowing → thyroid

• Moves with tongue protrusion → thyroglossal cyst

Diagnosis Trigger: Carotid Bruit

Think:

• Carotid stenosis

• Atherosclerosis

• Aneurysm

Diagnosis Trigger: Thyroid Enlargement

Think:

• Graves disease

• Hashimoto thyroiditis

• Multinodular goiter

• Thyroid cancer

Diagnosis Trigger: Limited ROM

Think:

• Muscle strain

• Cervical fracture (if trauma)

• Meningitis (pain with flexion)

• Severe arthritis

Differentials: Neck Pain

• Muscle strain

• Cervical radiculopathy

• Cervical myelopathy

• Meningitis

• Carotid dissection

• Fibromyalgia

Differentials: neck mass

• Thyroid nodule

• Thyroid cancer

• Lymphadenopathy (infectious vs malignant)

• Lipoma

• Cystic lesions (branchial cleft, thyroglossal)

Differentials: thyroid abnormalities

• Hyperthyroidism (Graves)

• Hypothyroidism (Hashimoto)

• Thyroiditis

• Goiter

• Thyroid malignancy

Differentials:

• Radiculopathy

• Myelopathy

• MS

• Peripheral neuropathy

Differentials: vascular findings

• Carotid stenosis

• Carotid dissection

• Aneurysm