Examination of the axilla
This is a basic clinical skill directed usually to evaluate the axillary lymph nodes.
- Usually best as a chaperoned examination which is easy to forget when the patient is suspected of having a systemic disease such as lymphoma or sarcoidosis and specific breast examination is not done.
- Inspect before touching (eg for gross nodes, acanthosis nigricans), then ask the patient to drop the shoulder and take a deep breath to facilitate relaxation.
- Full examination may require palpation from both the front and back. During either approach to the examination supporting the patient’s arm and elbow with the non-examining hand will aid relaxation.
- Axillary nodes are palpated using a circular motion with the pads of the three middle fingers of the examining hand, in all four aspects of the axilla in a diamond pattern. A fair amount of pressure is necessary, so warn the patient and the anterior part of the examination relates to the tail of the breast.
- Start with palpation of the central nodes deep in the apex of the axilla. Some patients will 'jump'
- Proceed down the mid-axillary chestwall, moving the pads of your fingers medially along the inside border of the pectoral muscle and the pectoral node chain.
- Palpate the subscapular nodes along the inside the muscle of the posterior axillary fold
- Then check the the lateral nodes with the palm of the hand facing the humeral head
If nodes are located note their firmness, quantity and degree of mobility.