Neck examination

Examination of the neck is best accomplished with the patient sitting or standing. The head
should be in the midline position, comfortably held in extension. The size and position of
anatomical neck structures should be noted.

Examination of the neck includes

1. Assessment of the size and position of the anatomic structures

2. neck vessels
3. presence of head tilt
4. presence of masses or enlarged lymph nodes
5. palpation of the thyroid gland.

Older infant –Flexion, extension, rigidity , Thyroid enlargement, branchial cleft cysts

Assessment of the size and position of the anatomic structures

Check for symmetry, head control in infants, posture to one side (an indicator of torticollis) and range of
motion.
Neck vessels

Distended or pulsating neck veins may indicate obstruction to right heart return (eg,
mediastinal masses) or impaired cardiac function (eg, pericarditis or poor myocardial
contractility).

Presence of head tilt

A head tilt can result from several different conditions. In the

infant, Torticollis may be the result of sternocleidomastoid
muscle fibrosis secondary to in utero pressure or trauma during
delivery; myopathy; denervation; or venous occlusion. Head tilt
also may occur in patients with a visual defect and in those with a
posterior fossa tumor or neuroblastoma.

Presence of masses or enlarged lymph nodes

Moving the hands from the midline to lateral structures of the

neck, the examiner should feel for presence or absence of
abnormal masses.

*Additional notes*

(Within the sternocleidomastoid muscle, a firm mass could be

caused by fibrosis or a benign or malignant tumor. Branchial
cleft cysts palpable in the upper portion of the neck are soft and smooth. Cystic hygromas
and lymphangiomas of the neck, which generally transilluminate easily, may vary in size
and shape and are not tender. Additional detectable soft tissue structures include
hemangiomas, dermoid cysts, lipomas, and neurofibromas)

A few shotty, freely movable, nontender lymph nodes in

the anterior and posterior cervical chain are palpable in
many young children and are considered normal.
Enlarged, firm, nontender, freely movable, or fixed neck
nodes may be found in patients with lymphoma, Hodgkin
disease, and other metastatic disease. Enlarged nodes
that are tender, warm, and painful to movement are
compatible with lymphadenitis. Numerous infectious and
noninfectious causes for lymphadenopathy and
lymphadenitis must be considered for a complete
differential diagnosis

Palpation of the thyroid gland (older infant)

Below the thyroid cartilage, the thyroid gland separates into two symmetric lobes and
curves posteriorly around the sides of the trachea and esophagus. Palpation of the thyroid is
accomplished best with the examiner positioned behind the standing or sitting patient. The
fingers of the examiner's hands are gently positioned over the respective lobes, which are
normally soft, smooth, and not enlarged. The thyroid gland moves upward when the patient
swallows. Only repetitive palpation of the thyroid of many patients will give the examiner
the feel for normal size, shape, and contour.

Head and Neck • Check for symmetry, head control in infants, posture to one side (an indicator of
torticollis), range of motion • Feel the anterior and posterior fontanels

Head and Neck • Older infant –Flexion, extension, rigidity –Thyroid enlargement, branchial • Older
infant –Flexion, extension, rigidity –Thyroid enlargement, branchial cleft cysts

Lymph Nodes • Small, nontender, English pea size, soft, and freely moveable lymph nodes are common
primarily in the cervical region