Percussion (Clinical Exam)

The percussion It is a maneuver that is carried out when examining a patient in order to identify changes in the tissues when evaluating their loudness.

Together with inspection, palpation and auscultation, they correspond to the steps to be carried out during the physical examination performed on a patient.

Technique for Percussion

Is technique it is carried out on the skin. To do this, it is necessary to place an extended finger on the area to be struck, usually the middle finger, and then make small taps with the tip of the middle finger of the other hand.

When performing the maneuver, different types of sounds will be obtained. When hitting solid tissues such as bones, the sound is high-pitched, solid tissues have a different tone (matte), liquids somewhat more serious and air corresponds to the lowest tone (tympanic).

Any region of the body can be percussed, however this maneuver is most useful in the thorax, abdomen and lumbar region.

Chest percussion

When examining the chest, percussion is an important part of the evaluation of the lungs. When you percuss, the sound generated is heard. In general conditions the lungs emit a serious sound, due to their contents of air, which must be equal throughout all intercostal spaces.

When there is the replacement of the air in the lungs by fluid, as occurs in infections such as pneumonia or the pleural effusions, the percussion shows a change in the sound that allows to identify these conditions and even to establish their location with certain precision.

Another region to percuss is the supraclavicular hollow, a depression that is located just above the superior border of the sternum, between the prominence of the insertion of the sternocleidomastoid muscles. The percussion in that area must provide a sound compatible with air content, when obtaining sharper or dull sounds at that level, a thyroid growth known as submerged goiter.

Abdominal percussion

The abdomen is an area where percussion is very helpful. Thanks to this maneuver you can decide conditions like the increase in the size of viscera such as the liver and spleen, as well as conditions such as colon distention by accumulation of gases, wave presence of free fluid in the abdominal cavity (ascites).

Lumbar percussion

At the lumbar level, a modified percussion called percussion fist is usually performed. In it, the examiner places an outstretched hand over the area where the kidney is located (just under the ribs on each side of the spine) and with the other hand makes gentle strokes.

This maneuver does not seek to evaluate the sound but rather the reaction of the patient. When there is an infection of the kidneys, known as pyelonephritis, the maneuver is very painful and the patient usually moves forward.

Photos: Fotolia - Gabriel Blaj / Grib_nick

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