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Lymph Node Elbow

Exams 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

Additional Information

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 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
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