Central and apical axillary nodes and clinical examination of the axilla
THE CONTEXT
This passage completes the description of central axillary nodes and describes apical nodes, lymphatic involvement and clinical landmarks.
Central and apical nodes
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Central nodes receive lymph from the anterior, posterior and lateral groups and drain into the apical group. They also receive some direct vessels from the axillary floor and are closely related to the intercostobrachial nerve.
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Apical nodes lie deep to the clavipectoral fascia along the axillary vessels.
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Apical nodes receive lymph from the central group, upper part of the breast, thumb and its web. Lymphatics from the thumb accompany the cephalic vein.
Infection and lymph node examination
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Infection of axillary hair follicles and sebaceous glands causes boils.
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Axillary nodes drain the upper limb, breast, and anterior and posterior body walls above the umbilicus. Infection or malignancy within these territories can involve the axillary nodes.
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Bimanual examination of axillary nodes is clinically important. The left axillary nodes are palpated with the right hand, and the right nodes with the left hand.
Procedural landmarks
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An axillary abscess should be incised through the axillary floor, midway between the anterior and posterior folds and nearer the medial wall. This avoids the main vessels along the anterior, posterior and lateral walls.
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Axillary arterial pulsations can be felt against the lower part of the lateral axillary wall.