Abstract
This position, with the patient partially recumbent, is advantageous for examining the axilla and for access to the vascular dynamics in the neck. Inspection of the axillae for abnormal pigmentation may reveal acanthosis, sometimes associated with diabetes and, more rarely, is a marker of cancer. Lymph nodes palpated here are much more suggestive of systemic illness compared to those found in the neck and inguinal area.
Arterial dynamics are more easily palpated in the neck than in the extremities. In addition, the semi-supine position is safer than the sitting should excessive vagal stimulation from palpation be encountered. Bounding carotid pulsations correlate with high cardiac output and with rapid runoff or reflux of a cardiac valve. A hypokinetic carotid pulse reflects a reduced stroke volume from central pump failure or a reduced effective blood volume in the central circulation. Note is also made of pulsatile changes from respiratory maneuvers, revealing signs of inadequate cardiac filling from pericardial constriction. Mention is made of the diagnostic value and limitations of a bruit heard over a carotid artery.
Guidelines are presented for using the degree of distention of the jugular vein to estimate the adequacy of venous return to the heart. The observation is a sensitive measure of right-sided myocardial function.
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Phillips, R.E. (2018). Neck: Semi-supine. In: The Physical Exam. Springer, Cham. https://doi.org/10.1007/978-3-319-63847-8_19
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DOI: https://doi.org/10.1007/978-3-319-63847-8_19
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