If there are breast-related symptoms, the examiner should always palpate both axillae and the infraclavicular and supraclavicular fossae to determine the presence of palpable lymph nodes. Lymph nodes are situated in loosely-woven connective tissue and are therefore easy to push away and can be shifted. The examiner should ‘catch’ the lymph nodes and feel them slipping away between their fingers. If the lymph nodes are palpable, their size, consistency and mobility should be assessed.
Preparation
- This examination should be carried out in both the supine and sitting position [Figures 83-86]. The examiner should stand next to or in front of the woman.
- The left axilla should be palpated with the right hand, and the right axilla should be palpated with the left hand.
Procedure
- Palpation of the axilla.
- Place the patient’s shoulder in 90° abduction.
- Using four fingers held together, palpate as high in the axilla as possible
[Figures 83-86].
Figure 83
Figure 84
Figure 85
Figure 86
- Place the arm of the abducted shoulder lightly against the patient’s body
[Figures 87-90].- Apply gentle pressure to the chest wall.
- Using four slightly bent fingers, carefully but firmly palpate along the ribs and intercostal spaces, working in a cranial to caudal direction and from the front to the back.
Figure 87
Figure 88
Figure 89
Figure 90
- Look for: tumours (lymph glands), pain.
- Carry out the same steps on the other axilla.
- Palpation of the posterior axillary fold
- Stand behind the patient.
- Take hold of the latissimus dorsi muscle between your thumb and fingers and palpate along the entire length of the posterior axillary fold on both sides [Figures 91, 92].
Figure 91
Figure 92
- Look for: tumours, pain.
- Palpation of the anterior axillary fold.
- Stand in front of the patient.
- Take hold of the pectoralis major muscle between your thumb and fingers and palpate along the entire length of the anterior axillary fold.
- Carry out this examination on the left and right side.
- Look for: tumours, pain.
- Palpation of the infraclavicular and supraclavicular fossae
- Stand in front of the patient [Figures 93, 94].
- Palpate the medial aspect of the supraclavicular fossa while standing behind the patient.
- Look for: tumours, pain.
Figure 93
Figure 94