Diagnostic Tests for Neck symptoms
Diagnostic Test list for Neck symptoms:
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Neck symptoms
includes:
- Physical examination
- General appearance - e.g. pale and sweating must consider heart attack; photophobia (dislike for light) must consider meningitis or subarachnoid hemorrhage.
- Pulse rate. If elevated must consider Grave's disease, subacute thyroiditis, early Hashimoto's thyroiditis or meningitis
- Examine for painful neck stiffness (which suggests meningitis or subarachnoid hemorrhage) or painless neck resistance (may be found with cervical spine spondylosis)
- Look for signs of hyperthyroidism including agitation, restlessness, enlarged thyroid (goiter), warm and sweaty palms, fine tremor, protruding eyes. May suggest Grave's disease, subacute thyroiditis or early Hashimoto's thyroiditis
- Examine for signs of hypothyroidism - e.g. slow heart rate, slowed reflexes, coarse dry brittle hair, dry cool skin, goiter.
- If neck lump is present, watch neck lump when swallowing. If the lump moves with swallowing this would suggest thyroid lump or thyroglossal cyst
- If neck swelling is present, feel neck swelling to determine if neck swelling is localized or diffuse (generalized neck swelling). Localised neck masses or swellings may be thyroglossal cysts, branchial cleft cyst, aneurysm, an enlarged lymph node due to Hodgkin's disease, metastatic cancer, sarcoidosis, a cystic hygroma, carotid body tumor, Reidel's struma, thyroid benign tumors or malignant thyroid cancer. Diffuse swellings would be Graves disease, subacute thyroiditis, superior vena cava syndrome, non-toxic goiter, venous distention of congestive heart failure or superior vena cava syndrome and subcutaneous emphysema
- If neck swelling is present, determine if neck swelling is midline or lateral (to the side) to the midline. Midline swellings are thyroglossal cysts, adenoma of the thyroid, Reidel's struma and thyroid cyst. Lateral swellings include a pharyngeal pouch, bronchial cyst, pulsion diverticulum, stone of Wharton's duct, Virchow's node, cervical rib, metastatic lymph nodes or Hodgkin's lymphoma, metastatic cancer, cystic hygroma, carotid body tumor and some thyroid masses
- Feel all neck lymph nodes for enlargement - The causes of enlarged cervical lymph nodes include infection (e.g. tonsillitis, glandular fever, toxoplasmosis, tuberculosis, cat scratch fever), metastatic tumor (from head, neck, chest or abdomen), primary cancer (lymphoma, lymphosarcoma) and sarcoidosis.
- Feel for enlarged supraclavicular lymph nodes (just above the collar bone)? - must consider lung cancer, cancer of the gastrointestinal tract, infections of the neck, arm, larynx or thyroid.
- Inspection of neck, noting willingness to move head and neck, level of shoulders, any tendency to hold neck to side and the contour of neck form the side - e.g. person with torticollis (wry neck) holds head away from the painful side; person with whiplash or cervical spondylosis (degeneration) tends to hold the neck stiff, the head forward and tends to turn the body rather than turn the head.
- Feel the neck including each cervical vertebral bone and joint. Also feel the front of the neck looking for signs of enlarged tender neck lymph nodes, muscle spasm and thyroid disease
- Examine the movement of the neck and notice any reduced range of movement and pain associated with the movements
- Full neurological examination including power, reflexes and sensation. If abnormalities must consider a cervical spine fracture, herniated disk, spinal cord tumor, cervical spondylosis (degeneration) and Pancoast's tumor (cancer in the tip of the lung)
- Examine ears, nose and throat
- Feel for crepitus (crackling sensation felt on feeling the skin of the chest or neck) which is present in subcutaneous emphysema. It is caused by air tracking from the lungs and is usually due to a pneumothorax and less commonly it can follow rupture of the esophagus
- Examine the Internal jugular vein for height and character. It gives information about the function of the right side of the heart. Position the patient lying down at a 45 degree angle. If the height is more than 3 cm above the sternal angle it is often a sign of failure of the right ventricle of the heart or volume overload
- Signs of right ventricular failure? - Examine the cardiovascular system for signs of right ventricular failure ( e.g. blue skin of the peripheries, tender enlarged liver, ankle swelling, istended abdomen due to ascites); tricuspid heart valve stenosis or regurgitation ( e.g. distinctive heart murmur); constrictive pericarditis (e.g. low blood pressure, impalpable heart beat, soft heart sounds, enlarged liver and spleen, swollen ankles).
- Signs of vea caval obstruction? - Examine for signs of superior vena caval obstruction ( obstruction of the large vein that returns blood from head, neck and upper limbs to the heart) e.g. blue face, swelling of the eyes, nil pulsation of the internal jugular vein, bulging veins on chest wall.
- Blood tests
- Full blood count and ESR
- Electrolytes
- Calcium, phosphate and alkaline phosphatase
- Thyroid function tests
- Prostatic specific antigen (PSA) in males if appropriate
- HLA-B27 antigen test for Ankylosing Spondylitis (occasionally will affect the neck, especially in young person)
- Rheumatoid factor for Rheumatoid arthritis
- Serum electrophoresis for Multiple myeloma
- Blood culture for vertebral osteomyelitis
- Mantoux test, if suspect tuberculous cervical lymphadenitis or abscess
- Urine tests
- Radiological investigations
- X-Ray of cervical spinal - can detect arthritis changes, fractures, reduced bone mass, reduced bone height.
- CT or MRI of cervical spine - perform if radiation of pain into arms or if the person has persistent neck pain. Can detect spinal canal stenosis or nerve root compression.
- CT Brain, if there is neck stiffness and suspect meningitis or subarachnoid hemorrhage
- Bone scan - can detect the early development of malignant disease, osteomyelitis and inflammatory disease before changes are apparent on plain X-Ray.
- Bone densitometry - can predict an increased risk of osteoporosis.
- Neck ultrasound scan will help differentiate benign thyroid cysts
- Radioactive iodine uptake and scan will help differentiate thyroid tumors and enlargements
- Angiography will be useful in diagnosing aortic aneurysms, innominate aneurysms and subclavian aneurysms
- CT Scan of the chest cavity may detect lung cancer or other chest tumors that may the cause of superior vena caval obstruction
- Chest X-Ray may help diagnose generalized lymph node enlargement, lung cancer, chronic lung disease, small heart of constrictive pericarditis or the enlarged heart of right heart failure
- Echocardiogram will help diagnose congestive cardiac failure which can cause generalized neck swelling due to venous distention. It can also detect heart valve disease, assess heart function and can detect pericarditis all of which may cause bulging neck veins
- Esophagogram - will help detect Zenker's diverticulum (a pouch opening from the esophagus).
- Needle aspiration of thyroid cyst
- Lymph node biopsy - will be useful in diagnosing sarcoidosis, lymphomas and metastatic cancer.
- Bone marrow examination - may help identify lymphoma.
- Spinal tap (after a CT Scan of brain) - if there is neck stiffness.
- Mantoux test - if suspect Skeletal tuberculosis (more commonly occurs in middle back, knees and hips) or if suspect tuberculous cervical lymphadenitis or abscess.
- Electromyographic (EMG) studies and Nerve conduction studies - to screen arm pain and differentiate neurological diseases from nerve compression syndromes.
- Electrocardiogram - may help detect angina, heart attack.
- Exercise tolerance test - may help diagnose angina.
- Pulmonary function tests - will help differentiate congestive cardiac failure.
- Cardiac catherisation may be required to measure pressures within the heart if suspect congestive cardiac failure
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