Neck and Clavicle
Assess range of motion by rotating the child's head toward the right shoulder and then the left shoulder. Bend the neck laterally so that the ear approaches each shoulder. A limited range of neck motion could be associated either with Klippel-Feil syndrome (Van Kerckhoven & Fabry, 1989) or with congenital torticollis. Congenital torticollis is often associated with cranio-facial asymmetry and flattening of the face on the affected side. Amass in the sternocleidomastoid muscle is found with torticollis.
Palpation of the clavicles can detect a fracture that may be associated with a traumatic delivery. Local tenderness shortly after birth will soon lead to a "lump" on the clavicle as the fracture heals with abundant callus. This can also result in torticollis. Congenital pseudoarthrosis of the clavicle can be clinically diagnosed by a painless and non-tender bulbous deformity in the region of the mid-clavicle. Absence of one or both clavicles could imply cleidocraniodysostosis.
J Pediatr Health Care. 2003;17(1) © 2003 Mosby, Inc.
Cite this: Pediatric Orthopedic Physical Examination of the Infant: A 5-Minute Assessment - Medscape - Jan 01, 2003.