Physical Exam

Head and Neck Lymph Node Palpation

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Video coming September 2026

How to Perform

With the patient seated and the neck muscles relaxed, use the pads of the fingers and gentle circular pressure to palpate the cervical node groups systematically — preauricular, posterior auricular, occipital, tonsillar, submandibular, submental, the anterior and posterior cervical chains, and the supraclavicular fossae — comparing the two sides. Note the size, consistency, tenderness, and mobility of any node.

How to Interpret

Infectious Mononucleosis

Posterior cervical lymphadenopathy in an adolescent or young adult

Rule in

Somewhat helpful

Rule out

Minimally helpful

Evidence:Limited

Malignant Lymphadenopathy

Lymph node tenderness, detecting a malignant or granulomatous cause of lymphadenopathy

Rule in

Not helpfulWide CI

Rule out

Not helpfulDerived CI

Evidence:Limited

References

Research in progress on one or more findings above; ratings may change.

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Aronson MD, Komaroff AL, Pass TM, Ervin CT, Branch WT. Heterophil antibody in adults with sore throat: frequency and clinical presentation. Ann Intern Med. 1982;96(4):505-508. PMID: 6895981.
Shorter ES, Whiteside MM, Harthan JS, et al. Diagnostic accuracy of clinical signs, symptoms and point-of-care testing for early adenoviral conjunctivitis. Clin Exp Optom. 2022;105(7):702-707. PMID: 34751088.
Campanella P, Ianni F, Rota CA, Corsello SM, Pontecorvi A. Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis. Eur J Endocrinol. 2014;170(5):R203-R211. PMID: 24536085.
Cañete EJ, Sison-Peña CM, Jimeno CA. Clinicopathological, biochemical, and sonographic features of thyroid nodule predictive of malignancy among adult Filipino patients in a tertiary hospital in the Philippines. Endocrinol Metab (Seoul). 2014;29(4):489-497. doi:10.3803/EnM.2014.29.4.489. PMID: 25325270. PMCID: PMC4285043.
Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. Predictive index for carcinoma of thyroid nodules and its integration with fine-needle aspiration cytology. Head Neck. 2009;31(7):856-866. PMID: 19340874.
Fitch CP, Rapoza PA, Owens S, et al. Epidemiology and diagnosis of acute conjunctivitis at an inner-city hospital. Ophthalmology. 1989;96(8):1215-1220. PMID: 2797725; and Zegans ME, Sanchez PA, Likosky DS, et al. Clinical features, outcomes, and costs of a conjunctivitis outbreak caused by the ST448 strain of Streptococcus pneumoniae. Cornea. 2009;28(5):503-509. PMID: 19421049.
Ben-Baruch S, Canaani J, Braunstein R, et al. Predictive parameters for a diagnostic bone marrow biopsy specimen in the work-up of fever of unknown origin. Mayo Clin Proc. 2012;87(2):136-142. PMID: 22226833.
Chau I, Kelleher MT, Cunningham D, et al. Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients. Br J Cancer. 2003;88(3):354-361. PMID: 12569376.
Vassilakopoulos TP, Pangalis GA. Application of a prediction rule to select which patients presenting with lymphadenopathy should undergo a lymph node biopsy. Medicine (Baltimore). 2000;79(5):338-347. PMID: 11039082.
Slap GB, Brooks JSJ, Schwartz JS. When to perform biopsies of enlarged peripheral lymph nodes in young patients. JAMA. 1984;252(10):1321-1326. PMID: 6471252.
Viacava EP, Pack GT. Significance of supraclavicular signal node in patients with abdominal and thoracic cancer: a study of one hundred and twenty-two cases. Arch Surg. 1944;48:109-119.
Ebell MH, Smith MA, Barry HC, Ives K, Carey M. The rational clinical examination. Does this patient have strep throat? JAMA. 2000;284(22):2912-2918. PMID: 11147989.
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.
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.