Topic Overview

Lymph Nodes and Lymphatic Drainage of Upper Limb

Lymph Nodes

Major Groups Related to Upper Limb

1. Supratrochlear (epitrochlear) nodes

   • Location → above medial epicondyle of humerus.

   • Drain → medial fingers, medial hand, medial forearm.

   • Clinical → enlargement in infections of hand/forearm.

2. Axillary lymph nodes (already studied in axilla)

   • Pectoral (anterior) → anterior chest wall, breast.

   • Subscapular (posterior) → posterior chest wall, scapular region.

   • Humeral (lateral) → most of upper limb (except those with cephalic vein).

   • Central → receive from above groups.

   • Apical → receive from central nodes and cephalic vein lymphatics; drain into subclavian trunk.

Lymphatic Drainage

Superficial Lymphatics

• Accompany superficial veins.

• Along basilic vein (medial) → to supratrochlear nodes → humeral axillary nodes.

• Along cephalic vein (lateral) → directly to apical axillary nodes.

Deep Lymphatics

• Accompany deep veins (radial, ulnar, brachial).

• Drain into humeral axillary nodes.

Final Pathway

• All axillary nodes → apical nodes → subclavian lymph trunk → thoracic duct (left) or right lymphatic duct (right) → venous system.

Clinical Anatomy

• Infections of hand/forearm → cause painful enlargement of supratrochlear nodes.

• Axillary lymphadenitis → due to infections or metastatic spread (e.g., breast carcinoma).

• Sentinel lymph node biopsy → detects earliest spread of breast cancer (commonly involves anterior/pectoral group).

• Tuberculosis → causes matted axillary nodes; may form cold abscess.

• Lymphedema of upper limb → seen after axillary node dissection (post-mastectomy).

• Virchow’s node (left supraclavicular node) → may be involved in metastatic spread from thoracic/abdominal cancers (though not directly upper limb, important clinically).