Superficial lymphatic vessels
These vessels (vasa lymphatica superficialia) are located in the subcutaneous adipose tissue. They originate from dense lymphatic networks of the palmar and dorsal surfaces of the hand. Confluent, they form 8–10 major trunks that collect lymph from adjacent skin areas along their course.
Depending on the topography, two main groups are distinguished:
- Medial group: Vessels ascend along the basilic vein (v. basilica). Reaching the cubital fossa, 1–2 vessels penetrate into the cubital lymph nodes. From there, efferent pathways proceed to the deep vessels of the arm. The remaining vessels of the medial group continue along the medial surface of the arm and drain directly into the axillary nodes.
- Lateral group: These pathways accompany the cephalic vein (v. cephalica). Having ascended to the upper third of the arm, they penetrate deep into the tissues — into the axillary cavity, where they also terminate in the axillary lymph nodes (nodi lymphoidei axillares).
Deep lymphatic vessels
The main task of the deep network is drainage of lymph from bones, joints, and muscles. In the fingers, these vessels run along the lateral surfaces near the blood arteries. Passing to the hand, they anastomose and form the palmar lymphatic plexus, the projection of which coincides with the arterial arch.
In the forearm, lymph drains through vessels accompanying the major arteries:
- Along the ulnar artery (a. ulnaris): vessels are interrupted in the upper third of the forearm or the cubital fossa, draining into the cubital nodes (nodi lymphoidei cubitales). Lymph from the dorsum of the forearm also arrives here via pathways running with the posterior interosseous artery.
- Along the radial artery (a. radialis): pathways likewise reach the cubital fossa and terminate in the cubital nodes.
The efferent vessels of the cubital nodes merge into a single large trunk, which ascends along the arm along the brachial artery (a. brachialis). At the border of the middle and lower thirds of the arm, this trunk enters a humeral lymph node. Further, two vessels depart from it, reaching the lateral axillary nodes (nodi lymphoidei axillares laterales).
Formation of lymphatic trunks
The axillary nodes are a critical relay station. The efferent vessels of all groups of axillary nodes unite and form the axillary lymphatic plexus (plexus lymphaticus axillaris). It is located along the course of the vein of the same name and the subclavian vein.
The efferent pathways of this plexus form major subclavian trunks — right and left (trunci subclavii dexter et sinister), through which lymph leaves the upper extremity.
Regional lymph drainage: mammary gland
The axillary nodes receive lymph not only from the upper extremity but also from the mammary gland, where a complex drainage system exists (superficial and deep networks with cross-anastomoses).
In addition to the main pathway to the axillary nodes, drainage is distributed by quadrants:
- From medial regions: vessels pierce the intercostal spaces and pass into the parasternal nodes (nodi lymphoidei parasternales).
- From upper and lateral regions: lymph goes to the paramammary (paramammarii, along the a. thoracica lateralis) and interpectoral (interpectorales, 3–4 nodes subcutaneously or between the pectoral muscles) nodes.
- Supraclavicular pathway: vessels course around the clavicle anteriorly and head to the supraclavicular and jugulo-omohyoid nodes.
Adjacent lymph nodes of the head and neck
Although these nodes belong to another region, for completeness of the lymphatic system, boundary groups are often considered:
- Occipital nodes (nodi lymphoidei occipitales): 2 to 6 nodes, lie in the subcutaneous tissue near the superior nuchal line.
- Mastoid nodes (nodi lymphoidei mastoidei): 2–4 nodes posterior to the auricle, where the sternocleidomastoid muscle attaches.
- Parotid nodes (nodi lymphoidei parotidei): divided into deep and superficial (the latter usually 2–4, located anterior to the ear on the gland capsule).
Briefly: answers to topical questions
What topographical groups are the axillary lymph nodes subdivided into?
The axillary lymph nodes (nodi lymphoidei axillares) are subdivided into superficial and deep. Five main topographical groups are distinguished:
- pectoral (pectorales);
- subscapular (subscapulares);
- lateral (laterales);
- central (centrales);
- apical (apicales).
Where do the right and left subclavian lymphatic trunks empty?
The right and left subclavian lymphatic trunks (trunci subclavii dexter et sinister) empty into major lymphatic ducts or directly into the venous angles.
- Right subclavian trunk (truncus subclavius dexter) — drains into the right lymphatic duct (ductus lymphaticus dexter) or directly into the right venous angle.
- Left subclavian trunk (truncus subclavius sinister) — drains into the thoracic duct (ductus thoracicus) or directly into the left venous angle.
Which lymph nodes of the upper extremity are superficial?
The superficial lymph nodes of the upper extremity include superficial cubital and superficial axillary nodes.
- Superficial cubital lymph nodes (nodi lymphoidei cubitales superficiales) — are located in the subcutaneous tissue of the cubital fossa at the level of the medial epicondyle, medial to the basilic vein (v. basilica).
- Superficial axillary lymph nodes (nodi lymphoidei axillares superficiales) — are located in the tissue of the axillary fossa; lateral superficial lymphatic vessels running parallel to the cephalic vein (v. cephalica) drain into them.
Class and exam questions
Where do the superficial lymphatic vessels of the arm drain?
The medial group of vessels drains into the cubital and axillary lymph nodes, while the lateral group heads directly to the axillary nodes.
How does lymph drain from deep tissues of the hand?
The vessels of the fingers run along their lateral surfaces and form the palmar lymphatic plexus in the hand. From there, lymph ascends to the forearm along the radial and ulnar arteries.
Where are the subclavian lymphatic trunks formed?
They are formed by the efferent vessels of the axillary lymphatic plexus, which in turn collects lymph from all axillary nodes.
What else to study on this topic
- Topography and classification of axillary lymph nodes
- Anastomoses of lymphatic networks of the right and left mammary glands
- Formation of the palmar lymphatic plexus
- Course of efferent vessels of cubital lymph nodes
- Connection of upper extremity lymph drainage with fasciae (Fascia brachii, Fascia antebrachii)
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