FRCEM Revision Guide • Musculoskeletal OSCE Stations • St Emlyn's

Examiner / observer · 1 of 3

Neck examination

Preparation · Inspection

Provide a chair or couch, tendon hammer and suitable sensory equipment. Agree a non-traumatic practice context before movement. Discuss trauma and meningism decisions verbally; do not simulate injury with forced or repeatedly provocative movements.

History and safety

Asks about pain, injury, radiation, weakness, numbness, hand clumsiness and walking difficulty.

Asks about onset, function, occupation, fever, cancer and relevant bladder/bowel symptoms.

After trauma, maintains appropriate spinal precautions and uses the full cervical-spine pathway before routine movement or provocative testing. Key step

Inspection

Inspects posture, alignment, scars, swelling, bruising and wasting while preserving necessary spinal precautions.

Looks for relevant neurological signs, including ptosis/miosis when indicated.

St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 1 of 3

Examiner / observer · 2 of 3

Neck examination

Palpation · Selected clinical signs

Palpation

Gently assesses cervical midline and paraspinal temperature, swelling and tenderness; examines the supraclavicular region only if relevant.

Avoids unnecessary movement in suspected injury and does not add routine carotid palpation to a musculoskeletal examination.

Movement

Assesses comfortable active flexion, extension, lateral flexion and rotation only when safe, without forcing movement.

In trauma, limits active rotation testing to appropriately selected low-risk patients within the complete NICE pathway. Key step

Selected clinical signs

Interprets Hoffmann’s sign with tone, reflexes, power, sensation and gait rather than as a diagnosis by itself.

Asks about Lhermitte’s electric-shock symptoms without repeatedly provoking them.

Does not diagnose thoracic outlet syndrome from radial-pulse loss during Adson’s manoeuvre alone.

Reserves Kernig’s/Brudzinski’s for clinically indicated meningitis assessment, does not force the neck and does not let absent signs delay urgent treatment. Key step

St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 2 of 3

Examiner / observer · 3 of 3

Neck examination

Upper limb neurology · Finish

Upper limb neurology

Compares upper limb tone and proximal/distal power using MRC 0–5, recording pain limits.

Uses the C5 elbow-flexion, C6 wrist-extension, C7 elbow-extension, C8 finger-flexion and T1 little-finger-abduction anchors without assuming exclusive root supply.

Compares dermatomal/peripheral nerve sensation with suitable modalities and maps deficits.

Compares supported biceps, brachioradialis and triceps reflexes and assesses finger–nose, rapid alternating movements and pronator drift.

Further assessment

Assesses lower limbs and gait when myelopathy is suspected. Key step

Selects relevant shoulder examination and further investigation/referral, documenting neurological findings and limitations.

Finish

Thanks the patient.

Restores comfort and offers help with dressing where needed.

Ask the candidate

Was a routine movement sequence appropriate? Explains the trauma assessment and any precautions or movement restrictions, rather than retrospectively justifying forced testing.

What would neurological findings change? Integrates upper limb findings with gait/lower limbs when needed and states the appropriate further assessment.

Feedback

What went well:

One thing to improve:

Try again focusing on:

St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 3 of 3

Neck examination

Your task

Starting information

Neck examination

Neck examination

Preparation

History and safety

Inspection

Neck examination

Palpation

Movement

Selected clinical signs

Neck examination

Upper limb neurology

Further assessment

Finish

Ask the candidate

Feedback