Figure 118 illustrates the anatomy of the axillary nodes.

When examining axillary nodes, take the weight of the subject’s arm in your non-palpating hand.

In the illustrations, the arm is raised to demonstrate the position of the cupped hand palpating the apical nodes. In practice, the arm lies by the subject’s side as your hand is drawn down over the medial wall, searching for apical and medial axillary nodes (figure 119a,b). The anterior nodes are compressed against the anterior wall of the axilla (figure 119c), and the lateral and posterior axillary nodes are examined from behind (figure 119d,e).

1. Lateral
2. Apical
3. Anterior
4. Posterior
5. Medial
6. Anterior axillary fold (pectoralis major)
7. Posterior axillary fold (teres major and tendon of latissimus dorsi)

This is followed by examination of the infraclavicular and supraclavicular lymphatic drainage sites (figure 120a–c).

Other lymphatic sites: epitrochlear nodes are palpated just above the medial epicondyle of the humerus (figure121).

Popliteal nodes may be palpable deeply placed over the popliteal vein in the lower aspect of the popliteal fossa (figure 122).

Other lymphatic sites: epitrochlear nodes are palpated just above the medial epicondyle of the humerus (figure 121).

Popliteal nodes may be palpable deeply placed over the popliteal vein in the lower aspect of the popliteal fossa (figure 122).

The horizontal group of inguinal nodes lies below and parallel to the inguinal ligament, and the vertical group along the femoral vein, in the femoral triangle (figure 123). Inguinal nodes are commonly palpable in normal subjects (figure 124a,b), but are the site of a number of specific diseases, particularly related to anal pathology (table 11, page 339).

Lymphatic drainage of the lower limb and perineum is to the iliac and paraaortic nodes, and that of the alimentary tract to the preaortic nodes; the testis drains to both aortic groups. Palpate deeply along the midline when looking for these paraaortic groups (figure 125).

When searching for evidence of abdominal and other malignancy, make sure you also examine the liver and spleen (figure 126a–c).