Respiratory System Examination: Percussion

1. Purpose

• Assess underlying lung and pleural conditions by evaluating the sound quality produced when tapping different chest areas.

2. Areas to Percuss

• Perform percussion systematically on both sides, always comparing corresponding regions:

  • Supraclavicular

  • Infraclavicular

  • Mammary

  • Inframammary

  • Axillary

  • Infraaxillary

  • Suprascapular

  • Interscapular

  • Infrascapular

3. Percussion Technique

Patient Positioning

• Posterior percussion: Patient should sit upright with arms folded across the chest to move scapulae laterally.

• Anterior and lateral percussion: Arms rest comfortably at the sides.

Performing Percussion

• Place the middle finger (pleximeter) of your non-dominant hand firmly over the intercostal space (not over ribs).

• With the tip of the middle finger (plexor) of your dominant hand, sharply strike the distal phalanx of the pleximeter finger with a quick, wrist-driven movement.

• Lift the plexor finger immediately after striking to avoid dampening the sound.

• Move from top to bottom, percussing side-to-side at each level for comparison.

• Avoid percussing over bones (clavicle, ribs, scapula) as this produces dull, non-representative notes.

4. Types of Percussion Notes and Interpretation

• Resonant: Normal lung tissue.

• Impaired (Dull): Suggests consolidation, lung collapse, fibrosis, tumor, or pleural thickening.

• Stony Dull: Suggestive of pleural effusion.

• Hyperresonant: Indicates pneumothorax or emphysema.

5. Special Percussion Techniques

• Liver Dullness: Percuss downwards in the right midclavicular line to find the upper border of liver dullness; helps assess the right lung base.

• Tidal Percussion: Differentiate between lung and abdominal dullness during deep inspiration and expiration, especially useful at the bases.

6. Documentation Example

Percussion:
Resonant note heard in all areas (supraclavicular, infraclavicular, mammary, inframammary, axillary, infraaxillary, suprascapular, interscapular, infrascapular) bilaterally.
Liver dullness present at the 6th intercostal space in the right midclavicular line.
No areas of stony dullness or hyperresonance detected.

7. Key Points to Remember

• Always compare corresponding areas on both sides.

• Percuss in all specified regions to avoid missing localized pathology.

• Document abnormal findings with precise anatomical location.

• Use special techniques (liver dullness, tidal percussion) when indicated for comprehensive assessment.