THE NECK

INSPECTION:
Inspect for symmetry and any masses or scars.
Look for enlargement of the parotid or submandibular glands
Note for any visible lymph nodes
PALPATION:
LYMPH NODES:
o Using the pads of your index and middle fingers, move the skin over the underlying
tissue in each area. NOTE: the patient should be relaxed, with neck flexed slightly
forward and, if needed, slightly toward the side being examined.
o You can usually examine both sides at once.
o What to assess: size, shape, delimitation (discrete or matted together), mobility,
consistency, and any tenderness.
o REMEMBER: Small, mobile, discrete, nontender nodes, sometimes termed
SHOTTY, are frequently found in normal persons.
o FEEL IN SEQUENCE FOR THE FOLLOWING NODES:
Preauricular in front of the ear
Posterior Auricular superficial to the mastoid process
Occipital at the base of the skull posteriorly
Tonsillar at the angle of the mandible
Submandibular midway between the angle and the tip of the mandible.
(These nodes are usually smaller and smoother than the lobulated
submandibular gland against which they lie)
Submental in the midline a few centimeters behind the tip of the
mandible. (NOTE: It is helpful to feel with one hand bracing the top of the
head with the other.)
Superficial Cervical superficial to the sternocleidomastoid
Posterior Cervical along the anterior end of the trapezius
Deep Cervical Chain deep to the sternomastoid and often inaccessible to
examination. (Hook your thumb and fingers around either side of the
sternomastoid muscle to find them.)
Supraclavicular deep in the angle formed by the clavicle and the
sternomastoid. (Flex the patients neck slightly forward toward the side being
examined.)
o UNEXPLAINED tender or enlarged nodes call for:
Reexamination of the regions they drain
Careful assessment of lymph nodes elsewhere so that you can distinguish
between regional and generalized lymphadenopathy (abnormal enlargement
of the lymph nodes)
o Difference of Lymph Node with band of Muscle or Artery:
Lymph Node can be rolled in two directions (UP & DOWN, and SIDE TO
SIDE)
Neither a muscle nor an artery will pass this test.

TRACHEA
o INSPECT: deviation from its usual MIDLINE POSITION. (Masses may push the
trachea to one side)
o Feel for any DEVIATION.
o Place your finger along one side of the trachea and note the space between it and the
sternomastoid. (The spaces should be symmetric.)

THYROI D GLAND
o INSPECT:
Tip the patients head back a bit. Using tangential lighting directed
downward from the tip of the patients chin, inspect the region BELOW THE
CRICOID CARTILAGE for the gland. (The light helps produce a lower,
shadowed portion for easier visualization)
Let the patient sip some water and extend the neck and swallow. Watch for
upward movement of the thyroid gland, noting its contour and symmetry.
The thyroid cartilage, the cricoid cartilage, and the thyroid gland all rise with
swallowing and fall to their resting positions.
o PALPATION:
Ask the patient to flex the neck slightly forward to relax the sternomastoid
muscles.
Place the fingers of both hands on the patients neck so that your index
fingers are just below the cricoids cartilage.
Ask the patient to sip and swallow water as before. Feel for the thyroid
isthmus rising up under your finger pads. It is often but not always palpable.
Displace the trachea to the right with the fingers of the left hand; with the
right hand fingers, palpate laterally for the right lobe of the thyroid in the
space between the displaced trachea and the relaxed sternomstoid. Find the
lateral margin. In similar fashion, examine the left lobe.
(The lobes are somewhat harder to feel than the isthmus. The
anterior surface of a lateral lobe is approximately the size of the
distal phalanx of the thumb and feels somewhat rubbery.)
NOTE: size, shape, and consistency of the gland and identify any nodules or
tenderness