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Clinical Breast Examination: Proficiency and Risk Managemen

A Continuing Education Program of the California Department of Health Services

January 2005

Palpation of the Axillary Nodes

(Figure 4a)Axillary nodes are palpated at deep pressure using a circular

motion with the pads of the three middle fingers of theexamining hand, in all four aspects of the axilla. Note thatthis pattern resembles a diamond.

Findings

Shotty nodes are usually small and less than 1cm, soft, mobile and of little clinical significance. Nodes

that suggest inflammation or infection, or are fixed, matted or persistent, should be considered a

suspicious finding. Note the size, shape, firmness and mobility. Appropriate follow-up may include

mammography, ultrasound or other tests as indicated by history and clinical findings.

ReferencesBates, B. (1995). Physical Examination and History Taking 6th Edition. Philadelphia, JB Lippincott

Gray, Henry. (2000). Gray’s Anatomy In Chapter: Lymphatics of the Upper Extremity, 15th Edition. New York, Barnes& NoblePublishers.

Harris, J; Lippman, M; Morrow, M & Hellman, S. (1996). Diseases of the Breast. In Chapter 1: Breast Development & Anatomy,

Philadelphia, Lippincott-Raven

Figure 4b #3Continue by palpatingthe subscapular nodes.Sweep back up andreturn to the axilla withthe palm facing laterally,feeling inside the muscleof the posterior axillaryfold.

Figure 4b #4Check the lateralnodes with the palmof the hand facingthe humeral head.

Figure 4b #1Start palpating thecentral nodes deepin the apex of theaxilla. The hand isstraight up, deepin the underarm.

Figure 4b #2Proceeding down themid-axillary chestwall,lift the tissue with theexamining hand andgently move the pads of the fingers medially andinside the border of thepectoral muscle and the

pectoral node chain.

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Figure 4a

Figure 4b