|Author: A. Chandrasekhar, MD
- Percuss the lung fields, alternating, from top to bottom and comparing sides.
- Percuss over the intercostal space and note the resonance and the feel of percussion.
- Keep the middle finger firmly over the chest wall along intercostal space and tap chest over distal interphalangeal joint with middle finger of the opposite hand.
- The movement of tapping should come from the wrist.
- Tap 2-3 times in a row.
- Do not leave the percussing finger on chest , otherwise you will dampen the sound.
- Stand on one side and with your flat of hand, tap the chest from top to bottom and from side to side to compare. I use this method as a screening step to identify the area of abnormality.
Percuss the chest all around. Stand back, have the patient cross arms to shoulder. This maneuver will wing the scapula and expose the posterior thorax. Then, have the patient keep their hands over head and percuss axilla. Then move to the front and percuss anterior chest , clavicles and supraclavicular space.
Movement of Diaphragm:
- Identify the lower limit of resonance during deep inspiration and deep expiration.
- This determines the range of movement of the diaphragm.
The lung is filled with air (99% of lung is air). Hence, percussion of it gives a resonance. This step helps identify areas of lung devoid of air.
- Appreciate the dullness of the left anterior chest due to heart and right lower chest due to liver.
- Note the hyper-resonance of the left lower anterior chest due to air filled stomach.
- Normally, the rest of the lung fields are resonant.
- Normal diaphragmatic excursion is 5-6 cm.