Neck examination

Approach

Patient sitting in chair
Glass of water nearby (take the hint) - be prepared to examine the thyroid in full
Expose the neck down to clavicles - undo the top buttons of a shirt
Ask the patient to remove any jewellery

Inpect

Site of lump
- Midline, supraclavicular
- Size
- Skin changes
- Scars
Protrusion of the tongue
- Ask patient to open mouth and stick tongue out as far as possible
- Moves on protrusion = thyroglossal cyst (related to base of tongue by patent fibrous track running from the central portion to the hyoid bone)
- Does not move on protrusion = thyroid lump
Swallowing
- Place glass of water in patient's hands
- Ask to take sip of water, hold in mouth, swallow
- If moves on swallowing = thyroid gland issue / thyroglossal cyst

Palpate

From the back
- be gentle, watch for discomfort
- Use fingertips (obviously!) to elicit physical signs
- Demonstrate the boundaries of the triangles of the neck
Palpate the triangles
- Anterior triangle: anterior border of Sternocleidomastoid, midline, ramus of mandible
- Posterior triangle: anterior border of trapezius, clavicle, posterior border of sternocleidomastoid
Determine whether the lump is solid or cystic
Confirm your findings (if necessary) by examining from the front

Percussion

Auscultation

Differential diagnosis of neck lumps

Position	Solid	Cystic
Midline	Thyroid	Thyroglossal cyst
Anterior triangle	Lymphadenopathy Chemodectoma	Cold abscess
Posterior triangle	Lymphadenopathy	Pharyngeal pouch Cystic hygroma
Within SCM	Sternocleidomastoid tumour

Continuing the examination (depending on appropriateness)

Examine the thyroid gland in full
Examine the neck thoroughly using the up and down technique
- Palpate from the chin backwards to below the ears
- Palpate down the anterior border of sternocleidomastoid to clavicle
- Move laterally along the clavicle and then up the posterior border of sternocleidomastoid
- Finish by palpating the back of the scalp for occipital lymph nodes

Cervical lymph nodes:

Surgical Notes