Lymph node examination !

Exam technique

How the nodes of the neck, armpits and groin are felt, and which features make an enlarged node worrying.

Updated 2026-11-01

See it in 3D: Neck lymph nodes · Superficial inguinal nodes · Cubital nodes · Sternocleidomastoid · Clavicle

What it is

The lymph node exam goes through every palpable group in a fixed order and describes size, consistency, tenderness, mobility and whether nodes are matted together. Most enlarged nodes are reactive to a nearby infection, but some features (hard, fixed, painless, persistent, supraclavicular) point to cancer or tuberculosis. Knowing what each group drains sends the search for the cause to the right place.

Landmark anatomy

Sternocleidomastoid splits the neck into anterior and posterior triangles: it is the landmark for the cervical groups.
The clavicle and the edge of sternocleidomastoid frame the supraclavicular fossa.
The thoracic duct drains into the left venous angle: that is why the left supraclavicular node receives abdominal lymph.
The testes drain to the para-aortic (lumbar) nodes, not the inguinal nodes, because they descend from the abdomen.

Technique, step by step

Seat the patient with the neck slightly flexed forward and towards the side being examined, to relax the muscles.
Palpate with the pads of the index and middle fingers in gentle circles, comparing both sides.
Head and neck, in this order: preauricular, posterior auricular, occipital, tonsillar (angle of the jaw), submandibular and submental.
Then: superficial cervical (over sternocleidomastoid), posterior cervical (behind the muscle), deep cervical chain and supraclavicular.
Feel the supraclavicular nodes from behind, in the angle between clavicle and sternocleidomastoid, while the patient coughs or does a Valsalva.
Axillae: with the patient's arm supported and relaxed, feel the central (up to the apex), anterior, posterior and lateral walls and the apex.
Epitrochlear: with the elbow flexed, in the groove above the medial epicondyle.
Inguinal: with the patient lying down, the horizontal group below the inguinal ligament and the vertical group along the great saphenous vein.
For each node record: site, size in centimetres, consistency, tenderness, mobility, matting and overlying skin changes.
If a node is enlarged, examine the area it drains and look for liver and spleen enlargement.

Node groups: where to feel them and what they drain

Group	Where to feel it	What it drains
Preauricular	In front of the tragus	Eyelids, conjunctiva, temporal scalp
Posterior auricular and occipital	Over the mastoid and at the skull base	Scalp
Submental and submandibular	Under the chin and below the jaw edge	Lips, floor of mouth, tongue, cheeks
Tonsillar and anterior cervical	Angle of the jaw and in front of sternocleidomastoid	Tonsils, pharynx, thyroid
Posterior cervical	Behind sternocleidomastoid	Scalp, neck; enlarge in mononucleosis
Left supraclavicular (Virchow)	Left clavicle–sternocleidomastoid angle	Abdomen and thorax via the thoracic duct
Right supraclavicular	Right clavicle–sternocleidomastoid angle	Lung, mediastinum, oesophagus
Axillary	Walls and apex of the axilla	Arm, breast, chest wall
Epitrochlear	Above the medial epicondyle	Ulnar side of the forearm and hand
Superficial inguinal	Below the inguinal ligament and over the saphenous vein	Leg, external genitalia, perineum, lower anal canal; not the testes

Abnormal findings

Worrying features: hard or rock-hard, painless, fixed to deep tissue, nodes matted together and progressive growth.
Size: over 1 cm at most sites (over 2 cm in the groin); any palpable supraclavicular node is suspicious.
Persistence over four weeks without a cause, age over 40, fever, night sweats or weight loss raise suspicion.
Left supraclavicular (Virchow): suggests abdominal cancer, above all gastric. Right supraclavicular: lung, mediastinal or oesophageal cancer.
A soft, mobile, tender node of rapid onset is usually reactive to an infection in the area it drains.
Generalised lymphadenopathy (two or more regions): mononucleosis, HIV, tuberculosis, lymphomas, leukaemias and autoimmune disease.
In Colombia, tuberculous lymphadenitis (scrofula) should be considered with matted cervical nodes, sometimes with a sinus.

Common errors

Pressing too hard or using the fingertips: nodes slip away and are missed.
Mistaking normal structures for nodes: the submandibular gland, the transverse process of the atlas, a cervical rib or the carotid pulse.
Forgetting the supraclavicular or epitrochlear nodes, or examining only the side that worries the patient.
Not measuring or recording: without size and date, growth cannot be judged.

Test yourself

Think of the answer, then tap the question to see it.

What does a palpable left supraclavicular node (Virchow node) suggest?

An abdominal cancer, especially gastric, because that region receives lymph from the thoracic duct. Any palpable supraclavicular node is suspicious.

Which node features point to malignancy?

Hard, painless, fixed, matted with others, over 1 cm (2 cm in the groin), growing or persisting over four weeks, especially with systemic symptoms or age over 40.

Where does the testis drain?

To the para-aortic (lumbar) nodes, not the inguinal nodes, because the testis descends from the lumbar region during development.

What area do the epitrochlear nodes drain?

The ulnar side of the forearm and hand (ring and little fingers).

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Swollen lymph nodes: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); Lymphadenopathy - Cardiology - Merck Manual Professional Edition (Merck Manuals, 2026).

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Representative model, for educational purposes only.