Springing test for differentiating a cervical rib tip from a supraclavicular lymph node

Abstract

The palpable tip of a cervical rib can be easily mistaken for an enlarged, hard supraclavicular lymph node. These two swellings, however, can be differentiated by the springing test, in which the clinician applies intermittent pressure on a point corresponding to the surface marking of a cervical rib shaft and checks for transmission of the springing movement to the swelling. The tip of a cervical rib will move but a supraclavicular lymph node will not. This test should be routinely done in all patients having a solitary, hard supraclavicular swelling as it will save many patients from an unneccessary surgical exploration for lymph node biopsy.