Lymphatic drainage- Upper limb and Lower limb, Lymph nodes and their location and function.

1. Lymphatic
Drainage
Dr. Usha (PT)
Assistant Professor

2. • When circulating blood reaches the capillaries, part of its
fluid content passes through them into the surrounding
tissue as tissue fluid. Most of this tissue fluid re-enters the
capillaries at their venous ends. Some of it is, however,
returned to the circulation through a separate set of
lymphatic vessels. These vessels begin as lymphatic
capillaries which drain into larger vessels.
• Along the course of these lymph vessels there are groups
of lymph nodes.

3. • Lymph vessels are difficult to see and special
techniques are required for their visualization.
• Lymph nodes are small bean-like structures that are
usually present in groups. These are not normally
palpable in the living subject.
• However, they often become enlarged in disease,
particularly by infection or by malignancy in the area
from which they receive lymph. They then become
palpable and examination of these nodes provides
valuable information regarding the presence and
spread of disease.

4. Lymph Nodes
In Upper Limb

5. Lymph Nodes In Upper Limb
– The main lymph nodes of the upper limb are the
axillary lymph nodes. These comprise anterior,
posterior, lateral, central and apical groups.
– Other nodes are:
1. The infraclavicular nodes
2. The deltopectoral node
3. The superficial cubital or supratrochlear nodes

6. 4. A few other deep lymph nodes lie in the following
regions.
i. Along the medial side of the brachial artery.
ii. At the bifurcation of the brachial artery (deep
cubital lymph node).
iii. Occasionally along the arteries of the forearm.

7. Axillary Lymph Nodes
– The axillary lymph nodes are scattered in the fibrofatty
tissue of the axilla. They are divided into five groups.
1. The nodes of the anterior (pectoral) group lie along the
lateral thoracic vessels, i.e. along the lower border of the
pectoralis minor. They receive lymph from the upper half
of the anterior wall of the trunk, and from the major part
of the breast.

9. 2. The nodes of the posterior (scapular) group lie along the
subscapular vessels, on the posterior fold of the axilla.
They receive lymph from the posterior wall of the upper
half of the trunk, and from the axillary tail of the breast.
3. The nodes of the lateral group lie along the upper part of
the humerus, medial to the axillary vein. They receive
lymph from the upper limb.

10. 4. The nodes of the central group lie in the fat of the upper
axilla. They receive lymph from the preceding groups and
drain into the apical group. They receive some direct
vessels from the floor of the axilla. The intercostobrachial
nerve is closely related to them.
5. The nodes of the apical or infraclavicular group lie deep to
the clavipectoral fascia, along the axillary vessels. They
receive lymph from the central group, from the upper part
of the breast, and from the thumb and its web. The
lymphatics from the thumb accompany the cephalic vein.

11. Infraclavicular Nodes
– The infraclavicular nodes lie in or on the clavipectoral
fascia along the cephalic vein. They drain the upper part
of the breast, and the thumb with its web.

13. Deltopectoral Node
– The deltopectoral node lies in the deltopectoral
groove along the cephalic vein. It is a displaced node of
the infraclavicular set, and drains similar structures.

14. Superficial Cubital Or
Supratrochlear Nodes
– The superficial cubital or supratrochlear nodes or
epitrochlear nodes lie just above the medial
epicondyle along the basilic vein. They drain the ulnar
side of the hand and forearm.

15. Lymphatics
Superficial lymphatics
– Superficial lymphatics are much more numerous than the
deep lymphatics. They collect lymph from the skin and
subcutaneous tissues. Most of them ultimately drain into
the axillary nodes, except for:
i. A few vessels from the medial side of the forearm which
drain into the superficial cubital nodes.
ii. A few vessels from the lateral side of the forearm which
drain into the deltopectoral or infraclavicular nodes.

16. • The dense palmar plexus drains mostly into the lymph
vessels onto the dorsum of the hand, where these continue
with the vessels of the forearm.
• Lymph vessels of the back of forearm and arm curve round
their medial and lateral surfaces and ascend up to reach
the floor of the axilla.
• Thus, there is a vertical area of lymph shed in the middle
of back of forearm and arm.

18. – Deep Lymphatics
• Deep lymphatics are much less numerous than the
superficial lymphatics. They drain structures lying deep to
the deep fascia.
• They run along the main blood vessels of the limb, and end
in the axillary nodes.
• Some of the lymph may pass through the deep lymph
nodes present along the axillary vein.

19. Clinical Anatomy
• Inflammation of lymph vessels is known as
lymphangitis, In acute lymphangitis, the vessels may
be seen through the skin as red, tender (painful to
touch) streaks.
• Inflammation of lymph nodes is called lymphadenitis.
It may be acute or chronic. The nodes enlarge and
become palpable and painful.

21. • Obstruction to lymph vessels can result in accumulation of
tissue fluid in areas of drainage. This is called
lymphoedema. This may be caused by carcinoma.
Infection with some parasites like filaria, or because of
surgical removal of lymph nodes.
• Pain along the medial side of upper arm is due to pressure
on the intercostobrachial nerve by enlarged central group
of axillary lymph nodes.

22. Lymph Nodes
In Lower Limb

23. – Most of the lymph from lower limb drains into the
inguinal lymph nodes, either mostly directly or partly
indirectly through the popliteal and anterior tibial
nodes.
– The deep structures of the gluteal region and the
upper part of the back of the thigh drain into the
internal iliac nodes along the gluteal vessels.

24. Classification
I. Lymph nodes
a) Superficial inguinal lymph nodes
b) Deep
• Deep inguinal lymph nodes
• Popliteal lymph nodes
• Anterior tibial lymph nodes
II. Lymphatics
a) Superficial
b) Deep

25. Superficial Inguinal Lymph
Nodes
– These are very important because they drain the skin and fasciae of
the lower limb; the perineum and the trunk below the umbilical
plane. They are divided into three sets.
• The superficial inguinal lymph nodes are variable in their number
and size.
• There arrangement is T- shaped, there being a lower vertical group
and an upper horizontal group.
• The upper nodes can be subdivided into the upper lateral and upper
medial groups.

26. 1. The lower vertical group is placed along both sides of the
terminal part of the great saphenous vein, and contains about
four or five nodes.
Lower vertical group drains lymph from most of the lower
limb.
They drain the skin and fasciae of the lower limb (great
saphenous territory), except the buttock and the short
saphenous territory. A few lymphatics, accompanying the
short saphenous vein, cross the leg, accompany the great
saphenous vein, and drain into this group of nodes.

28. 2. The upper lateral group is placed below the lateral part
of the inguinal ligament, and contains about two or three
nodes.
They drain the skin and fasciae of the upper part of the
lateral side of the thigh, the buttock, the flank and the
back below the umbilical plane.
Upper lateral group drains lymph from infra-umbilical
part of anterior abdominal wall and gluteal region.

29. 3. The upper medial group is placed below the medial
end of the inguinal ligament. One or two nodes may lie
above the inguinal ligament along the course of the
superficial epigastric vessels. The group contains two
to three nodes. They drain:
a. The anterior abdominal wall below the level of the umbilicus.
b. The perineum, including extemal genitalia, except the glans,
the anal canal below the pectinate line, the vagina below
hymen and the penile part of the male urethra.
c. The superolateral angle of the uterus, via the round ligament.

30. – Efferents from all superficial inguinal nodes pierce the
cribriform fascia, and terminate in the deep inguinal
nodes. A few may pass directly to the external iliac
nodes.

31. Deep Inguinal Lymph Nodes
– These are about four to five in number, and lie medial to the upper part of
the femoral vein. The most proximal node of this group; gland of Cloquet or
of Rosenmtiller, lies in the femoral canal. These nodes receive afferents from:
– 1 The superficial inguinal nodes.
– 2 The popliteal nodes.
– 3 Glans penis or clitoris.
– 4 The deep lymphatics of the lower limb accompanying the femoral vessels.
– Their efferents pass to the external iliac nodes.

32. Popliteal Lymph Nodes
– These nodes lie near the termination of the small saphenous
vein, deep to the deep fascia. One node lies between the
popliteal artery and the oblique popliteal ligament. They
receive afferents from:
1. The territory of the small saphenous vein.
2. The deep parts of the leg (through vessels running along the
anterior and posterior tibial vessels).
3. The knee joint.
– Their efferents run along the popliteal and femoral vessels, and
terminate in the deep inguinal nodes.

33. Anterior Tibial Lymph Nodes
– One inconstant node may lie along the upper part of
the anterior tibial artery. When present it collects
lymph from the anterior compartment of the leg, and
passes it on to the popliteal nodes.

34. Lymphatics
Superficial lymphatics
– These lymph vessels are larger and are more numerous
than the deep lymphatics. They run in the superficial
fascia and ultimately form two streams. The main stream
follows the great saphenous vein, and ends in the lower
vertical group of superficial inguinal lymph nodes.
– The accessory stream follows the small saphenous vein
and ends in the popliteal lymph nodes.

36. Deep Lymphatics
– These are smaller and fewer than the superficial
lymphatics, although they drain all structures lying deep to
the deep fascia. They run along the principal blood vessels,
and terminate mostly into the deep inguinal nodes, either
directly or indirectly through the popliteal nodes.
– The deep lymphatics from the gluteal region and from the
upper part of the back of the thigh accompany the gluteal
vessels and end in the internal iliac nodes.

37. Clinical Anatomy
– Elephantiasis: Lymphatic obstruction caused by the
parasite filaria is very common in the lower limb. This
results in great hypertrophy of the skin and of
subcutaneous tissue (elephantiasis).
– The commonest cause of a swelling in the inguinal area is
enlargement of the inguinal lymph nodes. This can be
caused by infection, or carcinoma, anywhere in the area
drained by these nodes

39. Thank you