[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Skin, head and neck](https://durgical.com/en/clinical-exam/#a-head_neck) › Lymph node examination

[Clinical exam](https://durgical.com/en/clinical-exam/) · [Skin, head and neck](https://durgical.com/en/clinical-exam/#a-head_neck)

# 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](https://durgical.com/en/anatomy/lymph-nodes-of-neck/) · [Superficial inguinal nodes](https://durgical.com/en/anatomy/superficial-inguinal-nodes/) · [Cubital nodes](https://durgical.com/en/anatomy/cubital-nodes/) · [Sternocleidomastoid](https://durgical.com/en/anatomy/sternocleidomastoid-muscle/) · [Clavicle](https://durgical.com/en/anatomy/clavicle/)

## Key points

- Neck order: preauricular, posterior auricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior, deep and supraclavicular.
- Worrying node: hard, painless, fixed, matted, over 1 cm (2 cm in the groin) or persisting over four weeks.
- Any palpable supraclavicular node is suspicious; Virchow node (left) suggests gastric or abdominal cancer.
- The testes drain to para-aortic, not inguinal, nodes.
- Enlarged posterior cervical nodes with pharyngitis and fatigue suggest mononucleosis.

## 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.

## Memory aid

'Hard, still and silent' (rock-hard, fixed and painless) is the node you never let go.

## 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).

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/lymph-node-examination/)

## See it in 3D

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

- [Neck lymph nodes](https://durgical.com/en/anatomy/lymph-nodes-of-neck/)
- [Superficial inguinal nodes](https://durgical.com/en/anatomy/superficial-inguinal-nodes/)
- [Cubital nodes](https://durgical.com/en/anatomy/cubital-nodes/)
- [Sternocleidomastoid](https://durgical.com/en/anatomy/sternocleidomastoid-muscle/)
- [Clavicle](https://durgical.com/en/anatomy/clavicle/)

## Related

- [Thyroid examination](https://durgical.com/en/clinical-exam/thyroid-examination/)
- [Mouth and pharynx examination](https://durgical.com/en/clinical-exam/mouth-and-pharynx-examination/)
- [Clinical breast examination](https://durgical.com/en/clinical-exam/clinical-breast-examination/)
- [Palpation of the liver and spleen](https://durgical.com/en/clinical-exam/palpation-of-the-liver-and-spleen/)
- [The ABCDE of pigmented lesions](https://durgical.com/en/clinical-exam/the-abcde-of-pigmented-lesions/)
- [Fever, infection and sepsis: the bedside signs](https://durgical.com/en/clinical-exam/fever-infection-and-sepsis-the-bedside-signs/)

## Related conditions

- [Cervical lymphadenopathy](https://durgical.com/en/conditions/cervical-lymphadenopathy/)
- [Infectious mononucleosis](https://durgical.com/en/conditions/infectious-mononucleosis/)
- [Hodgkin lymphoma](https://durgical.com/en/conditions/hodgkin-lymphoma/)
- [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)
- [Tuberculosis](https://durgical.com/en/conditions/tuberculosis/)
- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)
- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Gastric cancer](https://durgical.com/en/conditions/gastric-cancer/)
- [Streptococcal pharyngitis](https://durgical.com/en/conditions/streptococcal-pharyngitis/)

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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](https://medlineplus.gov/ency/article/003097.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Lymphadenopathy - Cardiology - Merck Manual Professional Edition](https://www.merckmanuals.com/professional/cardiovascular-disorders/lymphatic-disorders/lymphadenopathy) (Merck Manuals, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/clinical-exam/lymph-node-examination/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/lymph-node-examination/