Human Anatomy Vol 1

UPPER LIMB

Fig. 7.8: lntravenous injection being given in the median cubital

vein

External

jugular vein

Clavicle

Cephalic vein

Fig. 7.9: A communicating vein helps in venous drainage from

upper limb

When circulating blood reaches the capillaries, part of

its fluid content passes through them into the

surrounding tissue as tissue fluid. Mrost 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 rsessels. These vessels begin as

lymphatic capillaries which drain into larger vessels.

Along the course of these ll*ph vessels there are

groups of lymph nodes.

Lymph vessels are difficult to see and special

techniques are required for their visualisation.

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.

It is, therefore, of importance for the medical student

to know something of the lymphatic drainage of the

different parts of the body.

Lymph Nodes

The main lymph nodes of the upper limb are the axillary

lymph nodes. These comprise anterior, posterior,

lateral, central and apical groups. These have been

described in Chapter 4 (see Fig.4.11). Other nodes are

as follows.

1 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.

2 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.

3 The superficial cubital or supratrochlear nodes lie just

above the medial epicondyle along the basilic vein.

They drain the ulnar side of the hand and forearm.

4 A few other deep lymph nodes lie in the following

regrons.

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.

lymphotics

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:

for removal of the breast (in carcinoma), the

axillary lymph nodes are also removed, and it

sometimes becomes necessary to remove a

segment of the axillary vein also. h these cases/

the communication between the cephalic vein and

the external jugular vein enlarges considerably

and helps in draining blood from the upper limb

(Fig.7.e).

In case of fiacture of the clavicle, the rupfure of

the communicating channel may lead to formation

of a large haematoma, i.e. collection of blood.

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