HOME
ListMoto - Percussion (medicine)


--- Advertisement ---



Percussion is a method of tapping on a surface to determine the underlying structure, and is used in clinical examinations to assess the condition of the thorax or abdomen. It is one of the five methods of clinical examination, together with inspection, palpation, auscultation, and inquiry. It is done with the middle finger of one hand tapping on the middle finger of the other hand using a wrist action. The nonstriking finger (known as the pleximeter) is placed firmly on the body over tissue. When percussing boney areas such as the clavicle the pleximeter can be omitted and the bone is tapped directly such as when percussing an apical cavitary lung lesion typical of TB.[1] There are two types of percussion: direct, which uses only one or two fingers, and indirect, which uses the middle/flexor finger. There are four types of percussion sounds: resonant, hyper-resonant, stony dull or dull. A dull sound indicates the presence of a solid mass under the surface. A more resonant sound indicates hollow, air-containing structures. As well as producing different notes which can be heard they also produce different sensations in the pleximeter finger. Percussion was at first used to distinguish between empty and filled barrels of liquor, and Dr. Leopold Auenbrugger
Leopold Auenbrugger
is said to be the person who introduced the technique to modern medicine although this method was used by Avicenna
Avicenna
about 1000 years before that for medical practice such as using percussion over the stomach to show how full it is and to distinguish between ascites and tympanites.[2]

Contents

1 Of the thorax 2 Of the abdomen 3 Notes 4 References

Of the thorax[edit] It is used to diagnose pneumothorax, emphysema and other diseases. It can be used to assess the respiratory mobility of the thorax. Of the abdomen[edit] It is used to find whether any organ is enlarged and similar (assessing for organomegaly). It is based on the principle of setting tissue and spaces in between at vibration. The sound thus generated is used to determine if the tissue is healthy or pathological. Notes[edit] Based on the auditory and tactile perception, the notes heard can be categorized as:[3]

Tympanitic, drum-like sounds heard over air filled structures during the abdominal examination.[4] Hyperresonant (pneumothorax) said to sound similar to percussion of puffed up cheeks. Normal resonance/ Resonant the sound produced by percussing a normal chest. Impaired resonance (mass, consolidation) lower than normal percussion sounds. Dull (consolidation) similar to percussion of a mass such as a liver. Stony dull the sounds produced on percussion from the pleximeter with no contribution from the underlying area.

Percussion may induce pain, this is often also noted as it can indicate underlying pathology. References[edit]

^ Owen Epstein, G. David Perkin, John Cookson, David P. de Bono. Pocket Guide to Clinical Examination, Third Edition. Mosby, 2004. ISBN 0-7234-3230-9 ^ https://archive.org/stream/AvicennasCanonOfMedicine/9670940-Canon-of-Medicine_djvu.txt ^ "Percussion notes". LifeHugger. Archived from the original on 2011-07-13. Retrieved 2009-10-07.  ^ "University of California, San Diego". 

v t e

Medical examination and history taking

Medical history

Chief complaint History of the present illness Systems review Nursing assessment Allergies

Medications

Past medical history

Surgical history

Family history Social history Psychiatric history Progress notes Mnemonics

SAMPLE OPQRST SOAP COASTMAP

Physical examination

General/IPPA

Inspection Auscultation Palpation Percussion

Vital signs

Temperature Heart rate Blood pressure Respiratory rate

HEENT

Oral mucosa TM Eyes (Ophthalmoscopy, Swinging-flashlight test) Hearing (Weber, Rinne)

Respiratory

Respiratory sounds Cyanosis Clubbing

Cardiovascular

Precordial examination Peripheral vascular examination Heart sounds

Other

Jugular venous pressure Abdominojugular test Carotid bruit Ankle-brachial pressure index

Abdominal

Digestive

Liver span Rectal Murphy's sign Bowel sounds

Urinary

Murphy's punch sign

Extremities/Joint

Back (Straight leg raise) Knee (McMurray test) Hip Wrist
Wrist
(Tinel sign, Phalen maneuver) Shoulder
Shoulder
(Adson's sign) GALS screen

Neurological

Mental state

Mini–mental state examination

Cranial nerve examination Upper limb neurological examination

Neonatal

Apgar score Ballard Maturational Assessment

Gynecological

Well-woman examination Vaginal examination Breast examination Cervical motion tenderness

Assessment and plan

Medical diagnosis Differential diagnosis

v t e

Symptoms and signs relating to the respiratory system (R04–R07, 786)

Medical examination and history taking

Auscultation

Stethoscope Respiratory sounds

Stridor Wheeze Crackles Rhonchi Stertor Squawk Pleural friction rub Fremitus Bronchophony Terminal secretions

Elicited findings

Percussion Pectoriloquy Whispered pectoriloquy Egophony

Breathing

Rate

Apnea

Prematurity

Dyspnea Hyperventilation Hypoventilation Hyperpnea Tachypnea Hypopnea Bradypnea

Pattern

Agonal respiration Biot's respiration Cheyne–Stokes respiration Kussmaul breathing Ataxic respiration

Other

Respiratory distress Respiratory arrest Orthopnea/Platypnea Trepopnea Aerophagia Asphyxia Breath holding Mouth breathing Snoring

Other

Chest pain

In children Precordial catch syndrome Pleurisy

Nail clubbing Cyanosis Cough Sputum Hemoptysis Epistaxis Silhouette sign Post-nasal drip Hiccup COPD

Hoover's sign

asthma

Curschmann's spirals Charcot–Leyden crystals

chronic bronchitis

Reid index

sarcoidosis

Kveim test

pulmonary embolism

Hampton hump Westermark sign

pulmonary edema

Kerley lines

Hamman's

.