Epitrochlear And Brachial

■ Peripheral edema

Assessment of the peripheral vascular system relies primarily on inspection of the arms and legs, palpation of the pulses, and a search for edema. See Chapter 3 for a method of integrating these techniques into your examination of the limbs. Additional techniques may be useful when you suspect an abnormality.

H Arms_

Inspect both arms from the fingertips to the shoulders. Note: ■ Their size, symmetry, and any swelling

■ The venous pattern

■ The color of the skin and nail beds and the texture of the skin

Lymphedema of arm and hand may follow axillary node dissection and radiation therapy.

Prominent veins in an edematous arm suggest venous obstruction.

Palpate the radial pulse with the pads of your fingers on the flexor surface of the wrist laterally. Partially flexing the patient's wrist may help you feel this pulse. Compare the pulses in both arms.

Brachial Pulse PictureVintage Physical Exam
(Source of photo above: Marks R: Skin Disease in Old Age. Philadelphia, JB Lippincott, 1987)

In Raynaud's disease, wrist pulses are typically normal but spasm of more distal arteries causes episodes

There are several systems for grading the amplitude of the arterial pulses. One system is to use a scale of 0 to 4, as below; however, you should check to see what scale is used in your institution.

4+ Bounding

3+ Increased

2+ Brisk, expected

1+ Diminished, weaker than expected

0 Absent, unable to palpate of sharply demarcated pallor of the fingers (see Table 14-1, Painful Peripheral Vascular Disorders and Their Mimics, pp. 460-461).

Note that if an artery is widely dilated, it is aneurysmal.

Bounding carotid, radial, and femoral pulses in aortic insufficiency; asymmetric diminished pulses in arterial occlusion from atherosclerosis or embolism

If you suspect arterial insufficiency, feel for the brachial pulse. Flex the patient's elbow slightly, and with the thumb of your opposite hand palpate the artery just medial to the biceps tendon at the antecubital crease. The brachial artery can also be felt higher in the arm in the groove between the biceps and triceps muscles.

Epitrochlear

Medial aspect of left arm

Feel for one or more epitrochlear nodes. With the patient's elbow flexed to about 90° and the forearm supported by your hand, reach around behind the arm and feel in the groove between the biceps and triceps muscles, about 3 cm above the medial epicondyle. If a node is present, note its size, consistency, and tenderness.

Epitrochlear nodes are difficult or impossible to identify in most normal people.

Medial aspect of left arm

Epitrochlear Nodes
An enlarged epitrochlear node may be secondary to a lesion in its drainage area or may be associated with generalized lymphadenopathy.

H Legs_

The patient should be lying down and draped so that the external genitalia are covered and the legs fully exposed. A good examination is impossible through stockings or socks!

Inspect both legs from the groin and buttocks to the feet. Note:

■ Their size, symmetry, and any swelling

■ The venous pattern and any venous enlargement

■ Any pigmentation, rashes, scars, or ulcers

■ The color and texture of the skin, the color of the nail beds, and the distribution of hair on the lower legs, feet, and toes.

Palpate the superficial inguinal nodes, including both the horizontal and the vertical groups. Note their size, consistency, and discreteness, and note any tenderness. Nontender, discrete inguinal nodes up to 1 cm or even 2 cm in diameter are frequently palpable in normal people.

Horizontal

=emoral artery

group

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Responses

  • mattalic button
    Where are the epitrochlear lymph node?
    7 years ago
  • Clotilde
    Where swollen epitrochlear lymph node comes and how it can be felt?
    7 years ago
  • ellis
    Where is the epitrochlear lymph node in the elbow?
    7 years ago
  • geremia
    Where is epitrochlear and brachial node?
    3 years ago
  • Judy
    Are epitrochial nodes deep in the groove between bicoes and triceps?
    3 years ago
  • frank
    Are epitrochlear noes on triceps?
    3 years ago
  • Lemlem
    Which area of the arm drains to the epitrochlear nodes?
    3 years ago
  • tom
    How to check elbow lymph nodes?
    3 years ago
  • Carrie
    Where and how to palpate the epitroclear lymphnodes/in the arms?
    3 years ago
  • ELIA
    Is any lymph node is present in tricep region of arm?
    3 years ago
  • HANA
    How to check epitrochlear nodes?
    3 years ago
  • amiee
    What is epitrochlear brachal?
    3 years ago
  • mae
    Where to assess for epitrochlear nodes?
    2 years ago
  • alida
    Where are the lymph nodes outside elbow area?
    2 years ago
  • clarence
    Can epitrochlear lymph nodes cause wrist swrlling?
    2 years ago
  • hugo lajunen
    How does the epitrochlear node feel when swollen?
    2 years ago
  • karri
    How do you assess the epitrochlear node?
    2 years ago
  • keiran gibson
    Why is my supratrochlear node swollen?
    2 years ago
  • Luigia Baresi
    How to palpate epitrochlear artery?
    2 years ago
  • colomba
    How to check epitrochlear lymph node?
    2 years ago
  • ren nadel
    Where are elbow lymph nodes located?
    11 months ago
  • Valentin Kes
    How tofind epitroclia nodes in arms?
    3 months ago

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