Lymphatics of Upper Limb

Question 1

Superficial lymph vessels

Answer 1

Arise from lymphatic plexuses in the skin of the hand, then ascend up the arm in close proximity to the major superficial veins

• Vessels shadowing basilic vein - enter cubital lymph nodes found medially to the vein and proximally to medial epicondyle of humerus, terminate in lateral axillary lymph nodes
• Vessels shadowing cephalic vein - cross proximal part of arm and shoulder to enter apical axillary lymph nodes (some exceptions enter more superficial deltopectoral lymph nodes)

Question 2

Deep lymph vessels

Answer 2

Follow major deep veins
Terminate at humeral axillary lymph nodes
Drain lymph from joint capsules, periosteum, tendons and muscles

Question 3

Lymph nodes

Answer 3

• Pectoral (anterior) - 3-5 nodes, medial wall of axilla, receive lymph from anterior thoracic wall including most of the breast
• Subscapular (posterior) - 6-7 nodes, posterior axillary fold and subscapular blood vessels, receive lymph from posterior thoracic wall and scapular region
• Humeral (lateral) - 4-6 nodes, lateral wall of axilla posterior to axillary vein, receive majority of lymph drained from upper limb
• Central - 3-4 large nodes, base of axilla, receive lymph via efferent vessels from pectoral, subscapular and humeral axillary lymph node groups
• Apical - apex of axilla, close to axillary vein and 1st part of axillary artery, receive lymph from efferent vessels of central axillary lymph nodes and therefore all lymph node groups, also receive lymph from lymphatic vessels accompanying the cephalic vein

Question 4

Enlargement of axillary lymph nodes

Answer 4

• Infection of upper limb - results in lymphangitis, humeral group usually affected first, red, warm and tender streaks visible on skin of upper limb
• Infection of pectoral region or breast
• Metastasis of breast cancer

Question 5

Axillary lymph nodes dissection

Answer 5

Vital for staging breast cancer
Interruption of lymphatic drainage as a result of the procedure can result in lymphoedema (accumulated lymph in subcutaneous tissue leads to painful swelling of upper limb)
Also risk of long thoracic nerve damage (winging of scapula) or thoracodorsal nerve damage