Technique of palpation of lymph nodes. Examination of lymph nodes
The technique of palpation of lymph nodes in different regions has its own peculiarities. During the examination, the doctor is always in front of the patient, with the exception of palpation of popliteal pits.
Nuchal lymph nodes. The doctor's hands are placed on the side surfaces, and the fingers of the left and right hands simultaneously feel the space above and below the edge of the occipital bone. Normally, these nodes are not palpable.
BTE Lymph nodes. The position of the doctor's hands is the same as before, fingers touch the behind-the-ear area from the base of the ear shells and over the whole surface of the mastoid processes. Normally, the lymph nodes are not palpable.
Parotid lymph nodes. Palpation is carried out in the direction forward from the goats from the zygomatic arches up to the angle of the lower jaw. Normally, the lymph nodes are not palpable.
Underarm lymph nodes. The patient's head is kept straight or better than herslightly tilt forward to relax the muscles of the study area. Both the doctor's brushes or one brush with the bent fingers in the supination position are set in the chin area at the level of the front surface of the neck and immerse into the soft tissues of the submaxillary region. Then, a sliding, raking movement is made to the edge of the jaw. At this point, the lymph nodes cling to the jaw, slip under the fingers. Palpation is performed sequentially - at the angle of the jaw, in the middle and near the anterior margin, since the lymph nodes are located along the inner edge of the jaw. Their number is up to 10, and the maximum value is up to 5 mm.
Chin lymph nodes. Palpation is performed with the right hand, and the left doctorSupport the head from behind, preventing it from tilting back. The patient's head should be slightly tilted forward to relax the muscles of the study site. The right hand with fingers in the supination position feels the entire chin area from the hyoid bone to the edge of the jaw. Lymph nodes are often not palpable.
Cervical lymph nodes. The study is carried out in the medial, and then inlateral cervical triangles, first with one, then on the other side, or simultaneously from both sides. When probing the lymph nodes in the anterior cervical triangle, the fingers should be placed in the position of pronation along the nerve muscle. It is better to palp 1-2 fingers - index and middle, starting from the angle of the lower jaw and continuing along the entire anterior edge of the nipple muscle. At palpation fingers are pressed to the frontal plane - to the spine, and not to the larynx. Especially draw attention to a thorough examination of the lymph nodes at the angle of the jaw in the region of the carotid triangle.
Lateral surfaces of the neck feel from both sides simultaneously oralternately. The doctor's stretched fingers are first installed across the posterior edge of the nipple muscles, probing the tissues from the mastoid processes to the clavicles. Then the two lateral surfaces of the neck are probed forward from the long muscles of the neck and the edges of the trapezius muscles. We draw attention to the inadmissibility of strong bending of fingers during palpation, the entire terminal phalanx of each finger should lie flat on the surface under investigation, making immersion, sliding and circular movements. Normally, single lymph nodes up to 5 mm are probed on the lateral surfaces of the neck.
Prehypertensive lymph nodes. Feels the entire front surface of the larynx andtrachea from the hyoid bone to the foveal fossa, with particular attention to the area of the thyroid gland. Usually the lymph nodes of this area are not palpable.
Axillary lymph nodes. The patient slightly (up to 30 °) withdraws his arms to the sides,than it improves access to the armpits. The doctor, using a vertical brush with straight or slightly bent fingers, enters along the humerus to the depth of the axillary fossa as far as the stop in the shoulder joint. After that, the patient drops his hands, and the doctor, pressing his fingers to the chest back, slides down to 5-7 cm. Lymph nodes as though rake out from the hole, slip under the fingers of the doctor. Manipulation is repeated 2-3 times in order to get a clearer idea of the condition of the lymph nodes.
In the armpits, lymph nodes palpable always in an amount of 5-10, the value of some of them reaches 10 mm, sometimes more.
Supraclavicular and subclavian lymph nodes feel in the supraclavicular and subclavian fossa. The supraclavicular space is examined from the nodal muscle to the clavicular-acromial junction. Do not forget about the areas between the legs of the nodding muscles, especially the right. Here, palpation is carried out with one index or middle finger. When examining the subclavian pits, their lateral areas at the edges of the deltoid muscles are carefully and deeply palpated. In healthy subclavian and subclavian lymph nodes are not palpable.