Inspection of lymph nodes

It is usually believed that in a healthy person, lymph nodes are not visible and palpation is not available. This rule, which is fair in most cases, should be accepted only with certain reservations. So, given the wide prevalence among the population of various dental diseases (caries, periodontitis, periodontitis, etc.), one has to reckon with the fact that many people manage to easily probe the submaxillary lymph nodes. In practically healthy people, due to small, sometimes inconspicuous injuries of the skin of the lower limbs, small (pea-sized) inguinal lymph nodes can be palpable. In the opinion of several authors, the detection of single small axillary nodes during palpation may also not be a serious diagnostic symptom. Nevertheless, it should be emphasized once again that a more significant enlargement of the lymph nodes, especially in those cases when it is detected already during examination, always serves as a symptom of a disease, sometimes very serious.

When examining different groups of lymph nodes, the obtained data must necessarily be compared with the results of examination and palpation of the same-named (symmetric) group of lymph nodes on the other hand.

Palpation of lymph nodes

When palpation is determined primarily by the size of the lymph nodes, which are usually compared with the size of some round objects (the size of "with millet grains", "with lentils", "with small (medium, large) pea", "with hazelnut", " with a pigeon egg "," with a walnut "," with a chicken egg, "etc.).

Specify the number of enlarged lymph nodes, their consistency (doughty, soft elastic, dense); pay attention to the mobility of the lymph nodes, soreness in palpation (a sign of inflammatory processes), adhesion to one another in conglomerates and adhesion to surrounding tissues, the presence of edema of the surrounding subcutaneous tissue and hyperemia of the corresponding skin area, the formation of fistula and cicatricial changes (for example, in tuberculous lymphadenitis ). In this case, the lesion can concern individual lymph nodes, their regional group (with inflammation, malignant tumors) or is systemic, manifesting a generalized increase in lymph nodes of different groups (eg, in leukemia, lymphogranulomatosis ).

Palpation of the lymph nodes is carried out with the tips of slightly bent fingers (usually the second - the fifth fingers of both hands), gently, carefully, with light, sliding movements (as though "rolling" through the lymph nodes). At the same time, a definite sequence is observed in the study of lymph nodes.

Initially, palpation of the occipital lymph nodes, which are located in the area of attachment of the muscles of the head and neck to the occipital bone. Then they move on to feeling behind the ear lymph nodes that are behind the ear on the mastoid process of the temporal bone. Parotid salivary glands palpate parotid lymph nodes. The maxillary (submandibular) lymph nodes, which increase with various inflammatory processes in the oral cavity, are probed in the subcutaneous tissue on the body of the lower jaw behind the chewing muscles (when palpated these lymph nodes are pressed to the lower jaw). The chin lymph nodes are determined by the movement of the fingers of the hands from behind in front of the middle line of the chin area.

Surface cervical lymph nodes palpate in the lateral and anterior regions of the neck, respectively along the posterior and anterior edges of the sternocleidomastoid muscles. A prolonged increase in the cervical lymph nodes, which sometimes reach a considerable size, is noted in cases of tuberculous lymphadenitis and lymphogranulomatosis. However, in patients with chronic tonsillitis along the anterior edges of the sternocleidomastoid muscles, it is often possible to detect chains of small dense lymph nodes.

With gastric cancer in the supraclavicular area (in the triangle between the legs of the sternocleidomastoid muscle and the upper edge of the clavicle), a dense lymph node ("Virchow gland" or "Virchow-Troisier gland") can be detected, which is the metastasis of the tumor.

When palpation of the axillary lymph nodes slightly withdraw the patient's hands in the sides. The fingers of the palpating hand are injected as deep as possible into the armpit (for hygienic reasons, the shirt or shirt of the patient is taken into the palpating hand). The withdrawn hand of the patient returns to its original position; while the patient should not press it tightly to the body. Palpation of the axillary lymph nodes is carried out by the movement of the palpating fingers in the direction from top to bottom, which slide along the lateral surface of the patient's chest. The increase in axillary lymph nodes is observed with metastases of breast cancer, as well as with any inflammatory processes in the upper limbs.

At palpation of the elbow lymph nodes grasp the lower third of the forearm of the patient's hand with a brush of his own hand and bend it at the elbow joint at a straight or obtuse angle. Then with the index and middle fingers of the other hand, with sliding longitudinal movements, the sulci bicipitales lateralis et medialis are felt slightly above the epicondyle of the shoulder (the latter are the medial and lateral grooves formed by the tendon of the biceps muscle).

Inguinal lymph nodes are probed in the area of the inguinal triangle (fossa inguinalis) in a direction transverse to the puarth ligament. An increase in inguinal lymph nodes can occur with various inflammatory processes in the lower extremities, the anus, the external genitalia. Finally, the popliteal lymph nodes are palpated in the popliteal fossa with the shin slightly bent at the knee joint.

The increase in regional lymph nodes, for example on the neck, as well as in other areas, is sometimes the main complaint of patients leading them to the doctor. It is rarely possible to see enlarged lymph nodes that deform the corresponding part of the body. The main method of examining the lymph nodes is palpation. It is advisable to feel the lymph nodes in a certain order, beginning with the occipital, parotid, submandibular, sub-chin, then probing the supraclavicular, subclavian, axillary, cubital, inguinal.

Lymph node enlargement is observed with lymphoproliferative diseases (lymphogranulomatosis), systemic connective tissue diseases, in tumors (metastasis). To clarify the cause of enlarged lymph nodes, in addition to general clinical and laboratory studies, a biopsy (or removal) of the node for its morphological study is performed. The musculoskeletal system (joints, muscles, bones) is examined after the lymph nodes. In this case, the study begins with the clarification of complaints, most often pain or restriction of movements in the joints, then perform an examination and palpation.