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296 PHYSICAL EXAMINATION
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>>
PAST HEALTH
HISTORY
MEDICAL
UNIT 2
HISTORY
HEAD, NECK AND
REGIONAL LYMPH
NODES SPECIFIC
Hypo or hyperthyroidism, hypo or hyperparathyroidism, sinus infections,
migraine headache, cancer, head injury, skull fracture, Bell’s palsy,
Cushing syndrome, lymphadenopathy, recent lumbar puncture
NON–HEAD, NECK
Phaeochromocytoma
AND REGIONAL
LYMPH NODES
SPECIFIC
SURGICAL
HISTORY
Thyroidectomy, parathyroidectomy, facial reconstruction, cosmetic surgery, neurosurgery, other
surgery related to the head or neck
MEDICATIONS Antibiotics, steroids, anticonvulsants, chemotherapy, thyroxine, propranolol, analgesics, oral
131
), propylthiouracil, methimazole
COMMUNICABLE
contraceptives, radioiodine (I
Meningitis, encephalitis
DISEASES
INJURIES AND
ACCIDENTS
Obstruction caused by foreign bodies, trauma to the head or neck, chemical splashes to the face,
noxious fumes, sports injuries, motor vehicle accidents
SPECIAL NEEDS Tracheostomy, paralysis
FAMILY HEALTH
HISTORY
Head and neck diseases that are familial are listed.
Thyroid disease, migraines
SOCIAL HISTORY The components of the social history are linked to head and neck factors or pathology.
ALCOHOL USE Predisposes to accidents and head injury
TOBACCO USE Cigarette smoking is a primary risk for cancer of the lips, oral cavity and pharynx
WORK
Risk of head injury, exposure to toxins or chemicals, carbon monoxide
ENVIRONMENT
HOME
ENVIRONMENT
Risk of falls and head injury due to loose rugs or absence of handrails, carbon monoxide exposure
TABLE 9.1 Classication of headaches
Vascular aetiologies > Migraine headaches
> Cluster headaches
> Subarachnoid haemorrhage
> Subdural haematoma
> Infarction
> Cerebral aneurysm
> Temporal arteritis
> Vasculitis
Muscle contraction > Tension headache
Intracranial
aetiologies
> Brain tumours
> Increased intracranial pressure from hydrocephalus, pseudotumor cerebri
> Intracranial infection (e.g. meningitis, encephalitis, abscess)
> Ischaemic cerebrovascular disease
Systemic
aetiologies
> Infection
> Post-lumbar puncture
> Hypertension
> Exertion from coitus, cough, exercise
> Postictal
> Phaeochromocytoma
> Premenstrual syndrome
>>
HEAD, NECK AND REGIONAL LYMPH NODES 297
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TABLE 9.1 continued>>
Food-related
aetiologies
Facial or cervical
aetiologies
Ocular-related
aetiologies
Metabolic
aetiologies
Drug aetiologies
Environmental
aetiologies
Miscellaneous
aetiologies
> Nitrites (e.g. hot dogs, bacon, processed meats)
> Tyramine (e.g. cheese, chocolate)
> Monosodium glutamate (MSG) (e.g. Chinese food)
> Alcohol
> Some articial sweeteners
> Food allergy
> Sinusitis
> Temporomandibular joint dysfunction
> Dental lesions
> Trigeminal neuralgia
> Cervical spine radiculopathy
> Narrow angle glaucoma
> Uveitis
> Extraocular muscle paralysis
> Eye strain
> Hypoxia
> Hypercapnia
> Hypoglycaemia
> Alcohol and alcohol withdrawal
> Caffeine and also caffeine withdrawal
> Nitrates
> Oral contraceptives
> Oestrogen
> Nicotine
> Change in barometric pressure (from weather or altitude)
> Carbon monoxide poisoning
> Tobacco smoke
> Glaring or ickering lights
> Odours
> Fever
> Inuenza
> Head trauma
> Otitis media
> Parotitis
> Pregnancy
> Fatigue and decreased sleep
> Psychogenic disorders
> Stress
It is worth noting that a way to categorise headaches is provided by the
International Headache Society (IHS). In 2018 the IHS published the third edition
of the International Classication of Headache Disorders (ICHD-3). This edition
contains the most current guidelines. Headaches are classied into three parts.
Part 1: primary headaches; Part 2: secondary headaches; and Part 3: neuropathies
and facial pains and other headaches (IHS, 2018).
CHAPTER 9
PERSON-CENTRED HEALTH EDUCATION
When conducting a health assessment, opportunities for the provision of personcentred health education will arise. This is a significant consideration in relation
to the assessment process for examination of the head, neck and regional lymph
nodes. These occasions are identified as individualised education, and may generate
further data that can be added to the assessment. All education given should be
documented so that in future, health professionals can assess the impact of previous
information provided to the consumer. (Refer to Chapter 1 for initiating health
education.) Refer to the following examples.
298 PHYSICAL EXAMINATION
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UNIT 2
INDIVIDUALISED HEALTH EDUCATION INTERVENTIONS
Assessing the consumer for the following health-related activities can assist in identifying the
need for education about these factors. This information provides a bridge between the health
maintenance activities and head and neck function.
Sleep
Diet
Stress
May be increased due to head injury
Recent weight gain or loss
Demands of employment, home, school
HEALTH EDUCATION
Risk factors for migraine headache
The following are risk factors for people who are susceptible to developing migraine
headaches. These risks should be considered when gathering health assessment data for
a person who has verbalised experiencing headaches.
> Adolescence to age 40
> Female
> Family history of migraines
> Allergies
> Increased stress
> Caffeine intake
> Oral contraceptive and hormone use
> Tyramine, monosodium glutamate, sultes, or nitrite consumption
> Sleep disorders
Non-pharmacological headache intervention
Consumers should be informed of alternative strategies that may reduce or alleviate a
headache. Some suggestions include relaxation techniques, a quiet environment, a dark
room, lying down, walking, music, muscle stretching, warm or cool compresses to the head,
herbal tea, and a neck or temple massage. Encourage the consumer to experiment with
these techniques to determine what is effective, and to use the effective method when
headaches occur.
PUTTING IT IN CONTEXT
The consumer experiencing migraines
You are a community nurse visiting a 55-year-old female who had surgery 4 days ago.
As you are performing a dressing change, the woman tells you that she has had migraine
headaches all her life and she ‘can’t take them anymore’. She condes to you that all her
past healthcare providers dismissed her headaches as ‘nothing’. She also tells you that a
lot of her family members suffer from migraines.
> How would you respond to this consumer?
> What questions would you ask her?
> What non-pharmacological strategies could you suggest she use?
PLANNING FOR PHYSICAL EXAMINATION
The planning phase refers to evaluating subjective data to narrow the focus on
physical examination, determining what objective data needs to be gathered,
as well as considering the environment and equipment that will be required.
At this time, you will identify which of the four diagnostic techniques you will
need to implement the physical examination, and how you will sequence these.
For the physical examination of the head, neck and regional lymph nodes, you will
include inspection, palpation and auscultation.
HEAD, NECK AND REGIONAL LYMPH NODES 299
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Objective data is:
> collected during the physical examination of the consumer
> usually collected after subjective data
> information that is measured or observed by the clinician as opposed to being
reported by the consumer
> vital to the overall health assessment, to enable you to make clinical decisions
that are representative of the whole consumer picture.
Evaluating subjective data to focus physical assessment
Before commencing the physical examination of the consumer’s head, neck and
regional lymph nodes, consider what information the health history has provided.
Critical consideration, linked to knowledge of anatomy and physiology, should focus
the physical assessment so your examination will be more effective and efficient.
Environment
Assessing the head, neck and regional lymph nodes requires a physical environment
in the healthcare setting that has:
> a flat table/surface for the consumer to lie on
> minimal noise for accurate auscultation of specific sounds
> adequate lighting
> adequate privacy for the consumer.
CHAPTER 9
Equipment
Assemble items before placing the consumer on the examination table. Materials
should be arranged in order of use and within easy reach.
> Stethoscope
> Glass of water
> Flat table/surface.
IMPLEMENTATION: CONDUCTING THE
PHYSICAL EXAMINATION
Implementation of the physical examination requires you to consider your scope
of practice. In this section, depending on your context, you may be performing a
foundation assessment or the addition of advanced assessment techniques if you are
practising in a specialised area.
EXAMINATION IN BRIEF: HEAD, NECK AND REGIONAL LYMPH NODES
Examination of the head
Inspection
> Shape of the head
Palpation
Examination of the scalp
Inspection and palpation
Examination of the face
Inspection
> Symmetry
> Shape and features
Examination of the neck
Inspection
Palpation
Examination of regional lymphatics: the thyroid gland
Inspection
Palpation
> Anterior approach
> Posterior approach
Auscultation
Examination of regional lymphatics: the lymph nodes
Examination of the mandible
Palpation and auscultation
Inspection
Palpation
300 PHYSICAL EXAMINATION
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UNIT 2
General approach to examination of head, neck and regional
lymph nodes
Physical examination of the head, neck and regional lymph nodes has two
major components:
1. assessment of the head and neck
2. assessment of the lymph nodes.
Prior to the assessment:
1. Meet the consumer and explain the examination techniques that you will
be using.
2. Ensure that the environment is at a warm, comfortable room temperature to
provide the consumer comfort.
3. Use a quiet room that will be free from interruptions.
4. Ensure that the light in the room provides sufficient brightness to allow
adequate observation of the consumer.
5. Place the consumer in an upright sitting position on the examination table,
or gain access to the head of the supine, bedbound consumer by removing
nonessential equipment or bedding (for consumers who cannot tolerate the
sitting position).
6. If the consumer is wearing a wig or headpiece, ask the consumer to remove it.
7. Visualise the underlying anatomic structures during the examination process
to permit an accurate description of the location of any pathology.
8. Always compare the right and left sides of the head, neck and face.
9. Use the same systematic approach every time the examination is performed.
Examination of the head
Inspection
Shape of the head
E
1. Have the consumer sit in a comfortable position.
2. Face the consumer, with your head at the same level as their head.
3. Inspect the head for shape and symmetry.
N
The head should be normocephalic and symmetrical.
Hydrocephalus is an enlargement of the head without enlargement of the
A
facial structures (see
Hydrocephalus is caused by an abnormal accumulation of cerebrospinal fluid
P
within the skull.
Acromegaly is an abnormal enlargement of the skull and bony
A
facial structures.
Acromegaly is caused by excessive secretion of growth hormone from the
P
pituitary gland (see
Craniosynostosis is characterised by abnormal shape of the skull or bone
A
growth at right angles to suture lines, exophthalmos, and drooping eyelids.
Craniosynostosis is caused by the premature closure of one or more sutures of
P
the skull before brain growth is complete.
Figure 9.7A).
Figure 9.7B).
Palpation
E
1. Place the finger pads on the scalp and palpate all of its surface, beginning
in the frontal area and continuing over the parietal, temporal and
occipital areas.
2. Assess for contour, masses, depressions and tenderness.
3. Palpate the temporal artery, which is located anterior to the tragus of the ear.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
HEAD, NECK AND REGIONAL LYMPH NODES 301
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N
The normal skull is smooth, nontender, and without masses or depressions. The
temporal artery is usually a weaker peripheral pulse (1+/4+ or 1+/3+) than the
other peripheral pulses of the body (see
Table 6.2 in Chapter 6: pulse is explained,
including the flow quality of the pulse). The artery is nontender, smooth and
readily compressible.
Masses in the cranial bones that feel hard or soft are abnormal.
A
These types of masses may be carcinomatous metastasis from other regions of
P
the body or may result from lymphomas, multiple myeloma or leukaemia.
Palpation elicits localised oedema over the bony frontal portion of the skull.
A
Osteomyelitis of the skull may develop following acute or chronic sinusitis if the
P
infection extends out from the sinuses into the surrounding bone.
Firm palpation reveals a softening of the outer bone layer.
A
Craniotabes is a softening of the skull caused by hydrocephalus or
P
demineralisation of the bone due to rickets, osteogenesis imperfecta or syphilis.
A temporal artery that is hard in consistency and tender is abnormal.
A
This can indicate temporal arteritis. In temporal arteritis, the temporal arteries
P
A. Hydrocephalus
ALAMY STOCK PHOTO/BOAZ ROTTEM
may also be more tortuous.
Examination of the scalp
Inspection and palpation
E
1. Part the hair repeatedly all over the scalp and inspect the scalp for lesions or masses.
2. Place the finger pads on the scalp and palpate for lesions or masses.
N
The scalp should be shiny, intact, and without lesions or masses.
A laceration or a laceration with bleeding is abnormal.
A
Direct trauma can cause lacerations to the scalp.
P
A gaping laceration with profuse bleeding is abnormal.
A
If the laceration on the scalp is gaping, it indicates a deep wound that may
P
further indicate a compound skull fracture as a result of some type of trauma.
Palpation reveals a localised, easily movable accumulation of blood in the
A
subcutaneous tissue.
Haematomas can result from direct trauma to the skull.
P
Palpation may reveal either single or multiple masses that are easily movable.
A
They are round, firm, nontender, and arise from either the skin or the
subcutaneous tissue.
These are sebaceous cysts that form as a result of retention of secretions from
P
sebaceous glands.
Nonmobile, fatty masses with smooth, circular edges may be palpated deeper in
A
the scalp.
These masses are benign fatty tumours known as
P
lipomas.
B. Acromegaly
FIGURE 9.7 Abnormal head shapes
SCIENCE SOURCE/CLINICAL PHOTOGRAPHY, CENTRAL MANCHESTER UNIVERSITY HOSPITALS NNHS
FOUNDATION TRUST, UK
CHAPTER 9
Examination of the face
Inspection
Symmetry
E
1. Have the consumer sit in a comfortable position facing you.
2. Observe the consumer’s face for expression, shape, and symmetry of the
following structures: eyebrows, eyes, nose, mouth, ears.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
302 PHYSICAL EXAMINATION
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UNIT 2
FIGURE 9.8 Bell’s palsy. Note the drooping
left lower eyelid and left side of the mouth.
SOURC E: COURT ESY OF MA RY A. HITC HO
N
The facial features should be symmetrical. Both palpebral fissures should be
equal and the nasolabial fold should present bilaterally. It is important to
remember that slight variations in symmetry are common. Slanted eyes with
inner epicanthal folds are normal findings in consumers of Asian descent.
Structures are absent or deformed. There is a definite asymmetry of facial
A
expression, palpebral fissures, nasolabial folds and the corners of the mouth.
Asymmetry of the palpebral fissures, nasolabial folds, the mouth and facial
P
expression may indicate damage to the nerves innervating facial muscles (cranial
nerve VII), as in stroke or Bell’s palsy (
Figure 9.8).
PUTTING IT IN CONTEXT
Sensitivity to consumers with facial disgurement
Scarring can have a signicant impact on a person’s self-esteem, especially when visible
on the face. You are working in the plastics surgical ward and you are admitting a consumer
who has multiple partial thickness burns to her face and upper extremities. She has been
admitted for skin grafts. As you meet her for the rst time, she says, ‘I look horrible. I know
people don’t like to look at me and I am very self-conscious of this.’
> How would you respond verbally and nonverbally to her comment and
her disgurement?
ALAMY STOCK PHOTO/TATIANA DYUVBANOVA
FIGURE 9.9 Down syndrome
FIGURE 9.10 Scleroderma
SOURC E: COURT ESY OF THE S CLERODE RMA FOUN DATION, W WW.
SCLERODERMA.ORG
Shape and features
E
1. Face the consumer.
2. Observe the shape of the consumer’s face.
3. Note any swelling, abnormal features, or unusual movement.
N
The shape of the face can be oval, round or slightly square. There should be no
oedema, disproportionate structures, or involuntary movements.
Inspection of the face may reveal slanted eyes with inner epicanthal folds;
A
a short, flat nose; and a thick, protruding tongue.
These findings are likely to indicate the presence of
P
or Trisomy 21, a chromosomal aberration (
An abnormally wide distance between the eyes is
A
Hypertelorism is a congenital anomaly.
P
Facial skin is shiny, contracted and hard. The face appears to have furrows
A
Figure 9.9).
Down syndrome,
hypertelorism.
around the mouth (Figure 9.10).
Scleroderma is a collagen disease of unknown cause. Sclerosis of the skin, as well
P
as visceral organs (oesophagus, lungs, heart, muscles, kidneys), occurs.
The face is thin with sharply defined features and prominent eyes
A
exophthalmos) in Graves’ disease (Figure 9.11).
(
Graves’ disease is an autoimmune disorder associated with increased circulating
P
levels of T
The consumer’s face is round and swollen with characteristic periorbital oedema
A
and T4.
3
and dry, dull skin (Figure 9.12).
This condition is known as myxoedema and is associated with hypothyroidism.
P
FIGURE 9.11 Exophthalmos of Graves’ disease
SCIENCE PHOTO LIBRARY/CLINICAL PHOTOGRAPHY
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
HEAD, NECK AND REGIONAL LYMPH NODES 303
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CHAPTER 9
FIGURE 9.12 Myxoedema
SCIEN CE PHOTO L IBRARY / DR P. MARAZ ZI
FIGURE 9.13 This shows a cachectic face in a
40-year-old man with tuberculosis. Also note his
cachectic torso.
GETTY IMAGES/RO BERT NICKELSBERG
CLINICAL REASONING
Body art piercing
Over the last decade there has been a surge in people receiving body art such as piercing
and tattoos. Although this has become a more common and accepted practice, it is not
without risks. Bloodborne infections can occur and include hepatitis B and C, HIV, STIs and
staphylococcal infections. Australia and New Zealand have guidelines in place for safe
piercing and tattooing (refer to relevant legislation in Australia, for example Queensland
Government, 2016, 2017; NSW Health, 2022; and HealthEd Ministry of Health New Zealand,
2019).
A case to consider
Your consumer has a history of acne, chronic sinusitis and allergies. She informs you that
she plans to get her eyebrows and nares pierced.
> How would you respond to her?
> How would you encourage this consumer to have her body piercing done safely?
As piercing is a common practice, it is important to check the body artist practices,
according to the relevant legislative requirements. Ensure use of sterile equipment and
appropriate and relevant post care. Penetrating the surface of the skin means there is a
risk of infection for the individual. Post care includes information about healing times (an
eyebrow usually takes about 6–8 weeks and a nose about 8–12 weeks), and the appropriate
cleansing procedure to utilise (to keep the site clean to reduce the risk of infection).
The eyes are sunken and the cheeks are hollow in cachexia (see Figure 9.13).
A
Cachexia is a profound state of wasting of the vital tissues that is associated
P
with cancer, malnutrition and severe chronic illnesses.
The consumer’s face is immobile and expressionless with a staring gaze and
A
raised eyebrows in Parkinson’s disease.
Parkinson’s disease is the degeneration of basal ganglia, resulting from a
P
deficiency of the neurotransmitter dopamine.
The faces of some Caucasians show a dusky blue discolouration beneath the eyes
A
(‘allergic shiners’) along with creases below the lower eyelids (Dennie’s lines) and
open mouth due to mouth breathing.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
304 PHYSICAL EXAMINATION
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UNIT 2
FIGURE 9.14 Allergic facies
SCIEN CE PHOTO L IBRARY / DR P. MARAZ ZI
FIGURE 9.15 This young boy has a
characteristic nasal crease from the
repeated action of the ‘nasal salute’
caused by allergies.
The consumer with chronic allergies or allergic rhinitis develops this
P
characteristic of allergic facies or allergic gape. This can occur in seasonal or
perennial allergic rhinitis (
A transverse crease is noted across the nose.
A
This is a characteristic finding in consumers with allergies and allergic rhinitis
P
Figure 9.14).
who frequently are observed to do the ‘nasal salute’ or upwards wiping of the
Figure 9.15).
nose (
The consumer has a rounded ‘moon face’ along with red cheeks and excess hair
A
on the jaw and upper lip (Figure 9.16).
This is the facies of Cushing syndrome, which is caused by increased production
P
of adrenocorticotropic hormone (ACTH) or prolonged steroid ingestion.
Examination of the mandible
Palpation and auscultation
E
1. Use the fingertips of both index and middle fingers to locate the
temporomandibular joint anterior to the tragus of the ear on both sides.
2. Hold the fingertips firmly in place over the joints and ask the consumer to
open and close the mouth.
3. As the consumer opens and closes the mouth, observe the relative
smoothness of the movement and whether or not the consumer notices
any discomfort.
4. Remove the hands.
5. Hold the bell of the stethoscope over the joint.
6. Listen for any sound while the consumer opens and closes the mouth.
N
The consumer should experience no discomfort with movement. The
temporomandibular joint should articulate smoothly and without clicking
or crepitus.
The consumer complains of tenderness when the mouth is opened and closed.
A
Palpation or auscultation reveals clicking or crepitus.
Tenderness in the joint may be from the inflammation of migratory arthritis.
P
Crepitus is present from the articulation of irregular bone surfaces found
A
in osteoarthritis.
Clicking may follow a ‘snapping’ sound if there is displaced cartilage.
P
The mouth remains in an open and fixed position.
A
Following a wide yawn or trauma to the chin, the temporomandibular joint is
P
dislocated and will not function. This condition requires reduction.
FIGURE 9.16 Cushing syndrome
SCIENCE SOURCE/CLINICAL PHOTOGRAPHY, CENTRAL MANCHESTER
UNIV ERSIT Y HOSPITA LS NHS FOU NDATION TR UST, UK
Examination of the neck
Inspection
E
1. Have the consumer sit facing you, with the head held in a central position.
2. Inspect for symmetry of the sternocleidomastoid muscles anteriorly, and the
trapezii posteriorly.
E
3. Have the consumer touch the chin to the chest, to each side, and to each
shoulder.
4. Assess for limitation of motion.
5. Note the presence of a stoma or tracheostomy.
N
The muscles of the neck are symmetrical with the head in a central position.
The consumer is able to move the head through a full range of motion without
complaint of discomfort or noticeable limitation. The consumer may be
breathing through a stoma or tracheostomy.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
HEAD, NECK AND REGIONAL LYMPH NODES 305
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Asymmetry of the neck is abnormal (see Figure 9.17).
A
Asymmetrical masses can be benign or malignant, but they all must be
P
evaluated further.
The consumer complains of pain with flexion or rotation of the head.
A
Pain with flexion can be associated with the pain and muscle spasm caused by
P
meningeal irritation of meningitis (see Chapter 7). Generalised discomfort may
be related to trauma, spasm, inflammation of muscles or diseases of the
vertebrae.
There is a slight or prominent lateral deviation of the consumer’s neck. The
A
sternocleidomastoid muscles, and to a lesser extent the trapezii and scalene
muscles, may also be prominent on the affected side. The muscles frequently
hypertrophy as a result of powerful contractions.
This condition is called
P
torticollis (Figure 9.18). Causes can be:
1. congenital: resulting from a haematoma or partial rupture at birth of the
sternocleidomastoid, causing a shortening of the muscle
2. ocular: a head posture assumed to correct for ocular muscle palsy and
resulting diplopia
3. acute spasm: commonly associated with the inflammation of viral myositis
or trauma such as sleeping with the head in an unusual position
4. other: phenothiazine therapy and Parkinson’s disease, as the result of
increased cholinergic activity in the brain.
Range of motion of the neck is reduced.
A
Degenerative changes of osteoarthritis may result in decreased ability for full
P
FIGURE 9.17 This right neck mass was
identied as squamous cell carcinoma.
COUR TESY OF DR. D ANIEL D. ROO NEY
range of motion. This condition is usually painless unless nerve root irritation
has occurred. Crepitus, or a crunching sound on hyperextension of the neck,
may also be observed.
CHAPTER 9
Palpation
E
1. Stand in front of the consumer.
2. With the finger pads, palpate the sternocleidomastoid muscles.
3. Note the presence of masses or tenderness.
4. Stand behind the consumer.
5. With the finger pads, palpate the trapezius.
6. Note the presence of masses or tenderness.
N
The muscles should be symmetrical without palpable masses or spasm.
A mass is palpated in the musculature.
A
A mass may be a tumour, either primary or metastatic.
P
A spasm may be felt in the muscles.
A
Muscle spasm may be due to varied causes such as infections, trauma, chronic
P
inflammatory processes or neoplasms.
URGENT FINDING
Immobilisation of potential neck injury
If a neck injury is suspected, the cervical spine is the most vulnerable as over half of all
spinal injuries occur in the cervical area. Careful handling of the victim, minimising spinal
alignment and calling for emergency assistance are key precautions. Watch for the
following assessment cues that reect the signs of spinal injury: the head or neck is in an
abnormal position, breathing difculties, loss of function in limbs (ANZCOR, 2016).
FIGURE 9.18 Torticollis
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
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