Percussion (medicine)
Encyclopedia
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 four methods of clinical examination, together with inspection
, palpation
and auscultation
. It is done with the middle finger of one hand tapping on the middle finger of the other hand using a wrist action, which is placed firmly on the body over tissue, not bone. When percussing boney areas such as the clavicle
the stationary finger can be omitted and the bone is tapped directly such as when percussing an apical cavitary lung lesion typical of TB
.
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 initially used to distinguish between empty and filled barrels of liquor, and Dr. Leopold Auenbrugger
introduced the technique to medicine.
, emphysema
and other disease
s. It can be used to assess the respiratory mobility of the thorax.
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.
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
. It is one of the four methods of clinical examination, together with inspection
Inspection (medicine)
In medicine, inspection is the thorough and unhurried visualization of the client. This requires the use of the naked eye.During inspection, the examiner observes:External signs:...
, palpation
Palpation
Palpation is used as part of a physical examination in which an object is felt to determine its size, shape, firmness, or location...
and auscultation
Auscultation
Auscultation is the term for listening to the internal sounds of the body, usually using a stethoscope...
. It is done with the middle finger of one hand tapping on the middle finger of the other hand using a wrist action, which is placed firmly on the body over tissue, not bone. When percussing boney areas such as the clavicle
Clavicle
In human anatomy, the clavicle or collar bone is a long bone of short length that serves as a strut between the scapula and the sternum. It is the only long bone in body that lies horizontally...
the stationary finger can be omitted and the bone is tapped directly such as when percussing an apical cavitary lung lesion typical of TB
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
.
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 initially used to distinguish between empty and filled barrels of liquor, and Dr. Leopold Auenbrugger
Leopold Auenbrugger
Josef Leopold Auenbrugger or Leopold von Auenbrugg , Austrian physician who invented percussion as a diagnostic technique. On the strength of this discovery, he is considered one of the founders of modern medicine.-Biography:Auenbrugger was a native of Graz in Styria, an Austrian province...
introduced the technique to medicine.
Percussion of the thorax
It is used to diagnose pneumothoraxPneumothorax
Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...
, emphysema
Emphysema
Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath. In people with emphysema, the tissues necessary to support the physical shape and function of the lungs are destroyed. It is included in a group of diseases called chronic obstructive pulmonary...
and other disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
s. It can be used to assess the respiratory mobility of the thorax.
Percussion of the abdomen
It is used to find whether any organOrgan (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...
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.
Percussion notes
Based on the auditory and tactile perception, the notes heard can be categorized as- Tympanic or tympanitic, drum-like sounds heard over air filled structures during the abdominal examination.
- Hyperresonant (pneumothorax)
- Normal resonance/ Resonant
- Impaired resonance (mass, consolidation)
- Dull (consolidation)
- Stony dull (test)
See also
- Clinical examination
- Inspection (medicine)Inspection (medicine)In medicine, inspection is the thorough and unhurried visualization of the client. This requires the use of the naked eye.During inspection, the examiner observes:External signs:...
- PalpationPalpationPalpation is used as part of a physical examination in which an object is felt to determine its size, shape, firmness, or location...
- AuscultationAuscultationAuscultation is the term for listening to the internal sounds of the body, usually using a stethoscope...
- PleximeterPleximeterA Pleximeter is a device used in percussion to absorb the energy generated by the strike from the plexor.During percussion the middle finger of examiner's hand is routinely used as pleximeter. The finger of the examiner's left hand is firmly applied to the chest wall so as to displace any air...