Percussion Show
Percussion is an assessment technique which produces sounds by the examiner tapping on the patient's chest wall. Just as lightly tapping on a container with your hands produces various sounds, so tapping on the chest wall produces sounds based on the amount of air in the lungs. Percussion sets the chest wall and underlying tissues into motion, producing audible sounds and palpable vibrations. Percussion helps to determine whether the underlying tissues are filled with air, fluid, or solid material.  Work from the top part of the chest downward, comparing sounds heard on both the right and left sides of the chest. Visualize the structures underneath as you proceed. Look at the following diagram that shows percussion notes on the posterior chest:
Instant Feedback: The normal sound expected on percussion throughout most of the lung fields is resonance. © RnCeus.com
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multiple elements of objective assessments to aid diagnosis and inform treatment. Percussion plays a key role in such an examination, when performed in conjunction with other techniques such as auscultation, palpation and imaging[1] . Percussion produces audible sounds which can be interpreted by a skilled examiner to discern fluid, air or solid material
within the chest cavity [2]. Technique[edit | edit source]Place your non-dominant middle and index fingers directly onto the patient’s skin, with your distal interphalangeal joints held firmly against the patient’s chest. Using your dominant middle finger, tap the middle finger of your non-dominant hand (firmly placed on the patient’s chest) at
the level of the distal interphalangeal joint. This is best performed by a quick flick of the wrist to achieve a solid strike on the finger [3]. Sequence[edit | edit source]With the patient in an upright seated position, with the scapulae protracted; percuss on the posterior chest wall; either side of the mid-clavicular line in the interspaces at 5cm intervals. Ensure you percuss from side to side and top to bottom (omitting areas covered by the scapulae). Repeat for the anterior chest. Percussion sounds should be categorized as follows: normal, dull, or hyperresonant. Location and quality of percussive sounds should be noted and recorded as part of the objective respiratory examination[3] Clinical Presentations[edit | edit source]Normal[edit | edit source]Percussion over normal, healthy lung tissue should produce a resonant note.[3] Flat or Dull[edit | edit source]Dull percussive sounds are indicative of abnormal lung density. Hyperresonant[edit | edit source]Hyperresonance on percussion indicates too much air is present within the lung tissue. Video Link[edit | edit source][5] References[edit | edit source]
Which part of the hand is best suited for palpating vibrations?Vibration is best palpated with the ulnar surface of the hand, because this surface is sensitive to vibrations and it rests on the skin surface during percussion. The fingertips are rich in sensory nerve endings and so are best suited for fine tactile discrimination.
Which part of your hand is best for detecting vibration sensations?The metacarpophalangeal joints (base of fingers on the palmar surface) (Figure 1.9) or ulnar surface of hands/fingers (Figure 1.10) are the most sensitive to movement discrimination (vibration and pulsatility).
Which part of Examiners hand is best for palpating vibration of abdomen?You are planning to palpate the abdomen of your patient. Which part of the examiner's hand is best for palpating vibration? The ulnar surface of the hand and bases of the fingers can best feel vibratory sensations such as thrills and fremitus.
What is the most commonly used method of percussion?There are three approaches to percussion, but the most widely used is indirect percussion, which is the application of a mediated force using parts of both of your hands.
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Which part of the hand is best suited for palpating vibrations produced during percussion
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