![]() Tenderness of the spine can indicate injury, inflammation or cancer, while costovertebral angle tenderness suggests a kidney infection. The normal spine is not tender to percussion, but if you hit someone hard it will hurt. ![]() Use direct percussion with the side of the fist, and moderate force. Percuss the spine and costovertebral angles Percuss over your stomach in the left upper quadrant and compare this more resonant percussion note to the others. Lung that has been replaced by air will be hyperresonant to percussion. Percuss over your liver, in the lower anterior right chest, to find a dull percussion note. Lung that has been filled with fluid or displaced by fluid or solid tissue will be dull to percussion. If you percuss over your own upper right anterior chest, you should find normal resonant lung. The right and left sides of the posterior chest should be symmetric. Tissue that is filled with air, like normal lung, is described as resonant to percussion. The examiner can both hear and feel differences based on the density of the underlying tissue. Percussion creates vibrations that are transmitted to the underlying tissue and reflected back again, like radar. Compare the right side to the left side at each level as you percuss down the posterior chest. ![]() Use indirect percussion, with one or more fingers of your non-dominant hand pressed firmly against the chest in the intercostal spaces. Pull the gown down slightly to examine the skin of the upper anterior chest as you listen to the upper lobes. Inspect the skinĪs you perform the chest exam, move the gown to the sides to inspect the skin of the posterior and lateral chest. Asymmetric expansion can be caused by weakness of the diaphragm (the muscle responsible for breathing) or by a lung problem that is limiting the intake of air. The hands should move equally because normal lungs should expand equally with inspiration. Place the hands on either side of the spine and watch as your patient breathes in. Rapid breathing, use of the muscles of the neck or abdomen to help with breathing and pulling in of the space between the ribs are all signs of respiratory distress. Normal breathing should be quiet at rest, without apparent effort. Image from Chapter 13 of Textbook of Physical Diagnosis: History and Examination, Eighth Edition, Copyright © 2021.
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