Neck (standard tests)

Case 1

You are doing clinical practice at a general practitioner's office. Your supervisor has scheduled a healthy 60-year-old woman for you for a clinical examination due to neck pain. The woman reports that she works as a nurse in a nursing home. Over the past year, she has had neck pain with some radiating pain down towards both shoulders. She has also noticed slightly reduced mobility in her neck.

Neck examination

• Perform standard neck examination
  • Inspection
  • Active movement
  • Passive movement
  • Isometric movement
  • Palpation

1. You perform an inspection, what are you looking for?
2. You ask the patient to perform active movements, what do you expect to find?
3. You perform passive movements, what do you expect to find?
4. You perform isometric movements. The patient indicates local neck pain during extension; which muscles are important for neck extension?
5. Finally, you palpate the neck muscles, locate and name the muscles.

Inspection of the neck

Active movement of the neck

Passive movement of the neck

Isometric movement of the neck

Palpation of the neck

Clinical findings

• Upon inspection, slightly straightened cervical lordosis.
• With active movement, you find symmetrically reduced mobility in the neck.
• Pain at the endpoints of the range of motion with a hard and painful end-feel.
• No radiating pain to the arm.
• Tender neck muscles, especially in the trapezius muscle.

Cases