Order of Axillary Lymph Node Examination

Axillary lymph node examination should be performed in the following order: apical group, central group, pectoral group, subscapular group, and lateral (external) group. The examiner should stand in front of the patient with the four fingers (index through ring fingers) held together. Starting from the apex of the axilla, palpation should proceed gradually downward to the medial wall of the axilla, near the ribs. Next, the deep tissues along the inferior border of the pectoralis major muscle, the posterior axillary fold, and the lateral (external) wall of the axilla should be examined. Palpation should systematically assess the overlying skin for enlarged lymph nodes. If enlarged lymph nodes are palpable, their number, mobility, and whether they are matted or confluent should be documented.