Lymph nodes and vessels of the upper limb

In this note, we are going to discuss the main groups of lymph nodes of the upper limb and the lymphatic drainage pathways from various tissues in this region.

Lymph nodes and vessels of the upper limb

Lymphatic vessels

The lymphatic vessels of the upper limb are divided into two groups: superficial and deep.

The superficial vessels are located above the superficial fascia and collect lymph from the skin and subcutaneous tissue.

Superficial lymphatic vessels anterior surface

Superficial lymphatic vessels posterior surface

They are grouped into three main categories:

The lateral group, which drains lymph from the 1st and 2nd fingers, the radial side of the 3rd finger, and the lateral side of the hand, forearm, and arm. These vessels follow the path of the cephalic vein.

The medial group, which drains lymph from the ulnar side of the 3rd finger, the 4th and 5th fingers, and the medial side of the hand, forearm, and arm. These vessels follow the path of the basilic vein.

The central (or middle) group, which drains lymph from the palmar surface of the hand and the anterior forearm. These vessels follow the path of the median antebrachial vein and join the lateral and medial groups.

The deep lymphatic vessels are located beneath the superficial fascia and collect lymph from the muscles, bones, joints, fasciae, and nerves of the upper limb. These vessels accompany the major arteries and veins of the upper limb.

Lymph Nodes

The lymphatic vessels of both the superficial and deep groups form numerous anastomoses, creating an extensive network for lymphatic drainage. This lymph is directed to several groups of regional lymph nodes.

Let’s take a closer look at them.

Cubital nodes are located in the cubital fossa and can be either superficial or deep. They receive lymph from the medial and anterior surfaces of the hand and forearm.

The lymph is then directed to the axillary nodes.

Brachial nodes can also be divided into superficial and deep nodes.

The superficial brachial nodes are found along the course of the superficial veins. The deep brachial nodes follow the neurovascular bundle of the arm. These nodes collect lymph from the tissues of the arm.

Axillary nodes form the largest group of lymph nodes in the upper limb.

They are located within the adipose tissue of the axillary region. These nodes are further divided into numerous subgroups, which will be discussed in more detail.

Lateral (or humeral) axillary nodes collect lymph from the lateral group of superficial vessels and the deep lymphatic vessels.

Medial (or pectoral) axillary nodes receive lymph from the breast and the serratus anterior muscle.

Subscapular (or posterior) axillary nodes collect lymph from the muscles of the posterior wall of the axillary cavity and intermuscular spaces.

Inferior axillary nodes drain lymph from the medial group of superficial vessels.
Central axillary nodes are located at the center of the axillary region. They receive lymph from the breast, muscles, intermuscular spaces, and underlying lymphatic vessels.

Interpectoral axillary nodes are found between the pectoralis major and pectoralis minor muscles. They collect lymph from adjacent structures.

Apical axillary nodes are located within the clavipectoral triangle at the apex of the axillary space. They receive lymph from all other axillary node subgroups.

The lymph from the apical axillary nodes drains into the subclavian trunk,

which subsequently drains into either the right lymphatic duct

or the thoracic duct, depending on the side.

Occasionally, the subclavian trunk drains directly into the corresponding venous angle.

Golosary