Lymphadenopathy is defined as  inflammatory or non-inflammtory enlargement of lymph nodes.

Cervical Lymph Nodes

The lymph nodes of the neck should be examined by standing behind patient with the patient’s neck slightly flexed. The nodes must be examined from above downwards-submental, submandibular, tonsillar, cervical, posterior auricular and occipital groups.

In the left supra-clavicular fossa, a lymph node may be palpable (Virchow’s node) which occurs due to metastasis from stomach or testicular malignancy.

Axillary Lymph Nodes

The axillary glands should be examined by inserting the fingers in the axilla with the patient’s arm slightly abducted. The arm is then abducted and the apical, anterior, posterior, medial and lateral groups of lymph nodes are examined.

The supratrochlear lymph nodes

The supratrochlear lymph nodes are palpated on the medial aspect of the arm between the groove of biceps and brachialis muscle an inch above the arm fold.

The inguinal nodes

The inguinal nodes are examined in the supine position with the thigh extended. Both the medial and lateral groups of lymph nodes are examined.

Scalene nodes

Scalene nodes are present behind the sternomastoid muscle and may be palpable. In suspected malignancy, biopsy it taken from that area, even if the nodes are not palpable.

What To Examine?

Inspection:

Most of the superficial lymph nodes are visible when enlarged. The site of lymphadenopathy often gives the clue to its cause. Tuberculosis often affects the upper deep cervical nodes, secondary syphilis affects supratrochlear nodes, carcinoma of stomach affects the left supraclavicular nodes whereas filariasis affects the inguinal nodes.

The skin overlying the lymph nodes may show redness indicating underlying inflammation. Ulceration or sinus may be present in tuberculosis.

Palpation

Raised temperature tenderness is noted. If present, suggests acute inflammation. The surface is smooth normally but matted in tuberculosis and irregular in malignancy and inflammation.

The consistency of the nodes is noted. Normally it is firm.

It is rubbery in Hodgkin’s disease, firm and shotty in syphilis, matted in tuberculosis and hard in malignancy.

The mobility of the nodes is noted. Normally they are mobile and free from skin. In certain inflammatory conditions and malignancy they may be fixed and non-mobile.