Hand Surgery Source

Lymph Node Elbow

Test, Exam and Signs

Historical Overview

  • In 1932, Rouviere first described the involvement of elbow or epitrochlear lymph nodes in Hodgkin disease.1  

Description

  • The lymph node elbow test checks for Hodgkin disease or non-Hodgkin lymphoma in the elbow.
  • In rare cases, T cell lymphoma deposits may also be found in muscle or tendon of the forearm.2

Pathophysiology

  • The lymph node elbow test can help diagnose a viral infection, Hodgkin disease, non-Hodgkin lymphoma or cutaneous melanoma.3
  • Lymph nodes in the axilla may temporarily swell and become tender after a collagenase injection for Dupuytren’s disease.4

Instructions

  1. Obtain an accurate and complete patient history, including any family history of cancer. Ask the patient to rate on a scale from 1 to 10 how much pain s/he usually experiences in the affected elbow.
  2. Check for a deposit or mass on the lymph node near the elbow.
  3. Measure the size of any visible mass. If it exceeds 5 cm, it could be potentially malignant.
  4. Examine the contralateral elbow.

Variations

  • Check for swelling and changes in range of motion (ROM) of the elbow.
  • Also check for swelling in the forearm.2

Related Signs and Tests

  • Mass tenderness
  • ROM, active
  • Lymph node biopsy
  • Color-Doppler ultrasound3
  • Magnetic resonance imaging (MRI) with contrast5
Presentation Photos and Related Diagrams
Axillary Sentinel Node Biopsy
  • Imaging after injection for a sentinel node biopsy of patient with a subungual melanoma left long finger. Note uptake in left axilla.
    Imaging after injection for a sentinel node biopsy of patient with a subungual melanoma left long finger. Note uptake in left axilla.
Definition of Positive Result
  • A positive result occurs when a lymph node is palpable at the elbow. 
Definition of Negative Result
  • A negative result when a lymph node is not palpable at the elbow. 
Comments and Pearls
  • In cases of Hodgkin disease involving the elbow, patients may be treated with radiation therapy.7
  • Operative treatments for cutaneous melanoma may include lymphadenectomy.3 
  • When a patient experiences musculoskeletal symptoms without a distinct rheumatic pattern, it is important to rule out malignancies. If there is a presence of high lactic dehydrogenase (LDH) or alpha-HBDH levels and raised erythrocyte (ESR) or C-reactive protein (CRP) value, more tests for cancer should be done.6
Diagnoses Associated with Tests, Exams and Signs
References
  1. Yardimci VH, Yardimci AH. An unusual first manifestation of Hodgkin Lymphoma: epitrochlear lymph node involvement: a case report and brief review of literature. J Investig Med High Impact Case Report 2017;5(2) Epub. PMID: 28508005
  2. Ellstein J, Xeller C, Fromowitz F, et al. Soft tissue T cell lymphoma of the forearm: A case report. J Hand Surg Am 1984;9(3):346-50. PMID: 6609953
  3. Catalano O, Nunziata A, Saturnino PP, et al. Epitrochlear lymph nodes: Anatomy, clinical aspects, and sonography features. Pictorial essay. J Ultrasound 2010;13(4):168-74. PMID: 23397026
  4. Hurst LC, Badalamente MA, Hentz VR, et al. Injectable collagenase clostridium histolyticum for Dupuytren’s contracture. N Engl J Med 2009;361(10):968-79. PMID: 19726771
  5. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012
  6. Trapani S, Grisolia F, Simonini G, et al. Incidence of occult cancer in children presenting with musculoskeletal symptoms: a 10-year survey in a paediatric rheumatology unit. Semin Arthritis Rheum 2000;29(6):348-59. PMID: 10924020
  7. Chang BK, Backstrand KH, Ng AK, et al. Significance of epitrochlear lymph node involvement in Hodgkin disease. Cancer 2001;91(7):1213-8. PMID: 11283919