Neck abnormalities Flashcards
Causes of short neck
- Turner’s Syndrome
- Gorgylism
- Klippel- Feil Syndrome (Developmental anomaly of upper cervical vertebral column; with reduced number or fusion of them); Neck: vertebral fusion, cervical spina bifida, webbing and limited movement;
Association: Torticollis, Hemivertebrae, fused rib; Neurodefect - moebius syndrome, syringomyelia, deafness, micrognathia, cleft palate, congenital heart disease - Spondyloepiphyseal dysplasia
Steps in examination of Short Neck
- Note range of movement and any associated deformity like webbing, scar, low, M-shape hairline
- Note the height of patient and if there is facial dysmorphism
- Examine the limbs - short and deformed, limited flexion in gargoylism, increase carrying angle in Turner’s syndrome
- Spine examination - Abnormality and Sprengel shoulder (Congenital elevation of the scapula)
- Chest - Shield-like and widely spaced nipples, sign of COA
- Abdomen - hepatosplenomegaly
Causes of lateral neck masses
- Cervical LNs - viral (URI, Infectious Mononucleosis), Pyogenic, TB, Toxo, Kawasaki’s disease, tumor - Lymphoma, Leukaemia, secondary tumor
- Cystic Hygroma
- Branchial cyst
- Sternomastoid tumor
Steps in examination of neck masses
- Local examination - rmb to transluminate
- Look for infection or tumor in drainage areas: Throat, ears and scalp
- Other LN enlargement
- Hepatosplenomegaly
Causes of wry neck or torticollis or head tilting
- Muscular (sternomastoid tumor, myositis ossificans)
- Vertebral (Subluxation of atlanto-axial joint with URI;
Rheumatoid arthritis; Klippel- Feil syndrome; Scoliosis) - Soft tissue (cervical lymphadenitis; tonsillar abcess)
- Eye (4th nerve palsy)
- Ear (Vestibular disturbance)
- Brain (Posterior fossa tumor causing cerebellar damage)
- Drug induced dystonia (Phenothiazine, Metoclopramide)
Causes of webbing of neck
- Turner’s syndrome
- Noonan’s syndrome
- Escobak syndrome - Camptodactyly and Syndactyly)
Remark: Redundant skin fold at neck: Down’s; Patau’s; Klippel Feil syndrome
Brown Syndrome
Adduction of eye - Cannot elevate the eye so that eye becomes deviated (downwards) due to shortened superior oblique tendon/ adhesion between tendon and its sheath due to inflammation
Duane Syndrome
Defect in abduction with retraction of eyeball - adduction of affected eye - vertical /oblique movement of eyeball + narrowing of palpebral fissure;
Due to abnormal rectus muscle innervation or fibrosis of rectus muscle