The Neck - Examination Techniques

Shoulder pain is one of the most common musculoskeletal complaints. It may be due to problems intrinsic to the shoulder (85% of the time) or due to referred pain (most commonly from the neck). Causes vary by age of the patient.

Inspection:

A detailed description of the examination of the internal structures of the neck is included in the head and neck module. Here, we will primarily focus on the musculoskeletal examination of the neck.

The neck moves in flexion, extension, rotation and lateral flexion. These movements arise from the inter-related actions of the vertebrae, intervertebral discs, ligaments and muscles in the neck.

While the patient is seated, begin inspection by identifying the most prominent musculoskeletal structure in the neck, the spinous process of C7. This structure is even more prominent if the patient slightly flexes his or her neck forward.

Palpation:

Next, palpate the neck. Palpate the cervical vertebrae, noting any bony tenderness. Move laterally to palpate the paraspinous muscles. Then, ask the patient to turn his or her head to the side so you can palpate the sternomastoid muscle on the opposite side. Also palpate the trapezius muscle, evaluating for tenderness or palpable muscle spasms.

Range of Motion:

Ask your patient to flex his or her head forward as far as possible. The chin should be able to come close to the anterior chest, if not touch it. Then, ask your patient to extend his or her head as far as possible. This movement should not cause pain, and the patient should be able to look at the ceiling without difficulty. Evaluation continues as you ask your patient to look as far laterally as is possible in both directions. Lastly, ask your patient to laterally flex his or her neck, trying to touch his or her ear to shoulder.

There is a wide range of normal with regard to the neck's range of motion, and age related degeneration may limit movement. If the patient is able to complete functional duties without pain or discomfort, this is likely normal, and may not need further evaluation.