Physical examination maneuver

Physical Exam

C-spine and Neck Palpation

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How to Perform

With the patient seated or standing and the neck muscles relaxed, palpate the posterior midline over the cervical spinous processes from the occiput downward, then palpate the paraspinal muscles, the trapezius, and the lateral neck, noting any tenderness, step-off, muscle spasm, or masses.

How to Interpret

Showing 1 of 10 findings

Cervical Spine Injury

Bony tenderness of the posterior midline cervical spine after blunt trauma
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulWide CI
Evidence:Moderate

Related Bedside Tests

Head and Neck Lymph Node PalpationMembers
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Head and Neck Lymph Node Palpation
Rule in:VHInfectious Mononucleosis, HMalignant Lymphadenopathy, SHThyroid Carcinoma +9 more
Rule out:SHMalignant Lymphadenopathy, MHInfectious Mononucleosis, ICConjunctivitis +9 more
🎬Video coming soon
Lung Auscultation
Rule in:VHChronic Obstructive Pulmonary Disease, VHPneumothorax, HMainstem Bronchus Intubation +29 more
Rule out:VHChronic Obstructive Pulmonary Disease, HPleural Effusion, SHInterstitial Lung Disease +28 more
🎬Video coming soon
Spleen Palpation
Rule in:VHSplenomegaly, HMalaria, SHCirrhosis +13 more
Rule out:SHMyelofibrosis, MHInfectious Mononucleosis, MHSplenomegaly +13 more
🎬Video coming soon
Inguinal Lymph Node Palpation
Rule in:SHInfectious Mononucleosis, ICMalignant Lymphadenopathy, IELymphoma +2 more
Rule out:MHInfectious Mononucleosis, NHMalignant Lymphadenopathy, IELymphoma +2 more
Oxygen SaturationMembers
Sign in
Oxygen Saturation
aka Pulse oximetry
Rule in:HMortality, SHPneumonia, MHCardiac Tamponade +8 more
Rule out:ICCardiac Tamponade, NHHepatopulmonary Syndrome, NHMortality +8 more
FreeAxillary Lymph Node Palpation
Axillary Lymph Node Palpation
Rule in:SHBreast Cancer, SHHIV Infection, SHInfectious Mononucleosis +4 more
Rule out:MHInfectious Mononucleosis, NHBreast Cancer, NHHIV Infection +4 more

Related Systems / Regions

HematologicImmunologicMusculoskeletalNeckRespiratory

Related Diagnoses

Cervical Spine InjuryCervical SpondylolisthesisEsophageal RuptureMalignant LymphadenopathyMechanical Neck PainPneumomediastinumReactive LymphadenitisTension PneumothoraxTracheobronchial Injury

Related Chief Complaints

Arm NumbnessArm WeaknessChest PainChest Pain After VomitingCollapseCrackling Under the Skin of the NeckDeviated WindpipeEnlarged Neck GlandFeverFixed Neck LumpGrowing Neck MassHard Neck LumpInability to Move the NeckLow Blood PressureMidline Neck TendernessNeck LumpNeck Muscle SpasmNeck PainNeck Pain After a Car AccidentNeck Pain After a FallNeck Pain After TraumaNeck Pain After WhiplashNeck StiffnessNeck Swelling After VomitingNight SweatsOne-sided Chest FindingsPainless Neck MassPersistent Swollen GlandRapid BreathingRespiratory DistressSevere BreathlessnessShortness of BreathTender Swollen Gland in the NeckTingling in the ArmsTrachea Pushed to One SideWeight Loss

References

  • Tran J, Jeanmonod D, Agresti D, Hamden K, Jeanmonod RK. Prospective validation of modified NEXUS cervical spine injury criteria in low-risk elderly fall patients. West J Emerg Med. 2016;17(3):252-257. doi:10.5811/westjem.2016.3.29702. PMID: 27330655. PMCID: PMC4899054.
  • Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343(2):94-99. PMID: 10891516.
  • Jin Y, He YS, Zhang MM, Parajuly SS, Chen S, Zhao HN, Peng YL. Value of contrast-enhanced ultrasonography in the differential diagnosis of enlarged lymph nodes: a meta-analysis of diagnostic accuracy studies. Asian Pac J Cancer Prev. 2015;16(6):2361-2368. doi:10.7314/apjcp.2015.16.6.2361. PMID: 25824765.
  • Roberts DJ, Leigh-Smith S, Faris PD, Blackmore C, Ball CG, Robertson HL, Dixon E, James MT, Kirkpatrick AW, Kortbeek JB, Stelfox HT. Clinical presentation of patients with tension pneumothorax: a systematic review. Ann Surg. 2015;261(6):1068-1078. PMID: 25563887.
  • Myburgh C, Larsen AH, Hartvigsen J. A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Arch Phys Med Rehabil. 2008;89(6):1169-1176. PMID: 18503816.
  • Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Pract. 1988;27(4):373-376. PMID: 3049914.
  • Koullias GJ, Korkolis DP, Wang XJ, Hammond GL. Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients. Eur J Cardiothorac Surg. 2004;25(5):852-855. PMID: 15082293.
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.