Percussion

Percussion

It is a diagnostic technique in which the examiner taps on the body surface to produce sounds that provide clues about the underlying structures.

Percussion

This technique helps assess: Size, Consistency, & Presence of fluids or air in body organs.

Percussion

Tapping the body surface to elicit sounds or vibrations.

Percussion

Helps determine the underlying structures.

Percussion Purpose

Assess organ size, shape, and density.

Percussion Purpose

Detect fluid accumulation, masses, or air in body cavities.

Percussion Purpose

Evaluate pain or tenderness in specific areas.

Direct Percussion (Immediate Percussion)

The examiner directly taps the body with the fingertips.

Direct Percussion (Immediate Percussion)

Commonly used in assessing the sinuses. Examples: frontal sinuses and maxillary sinuses.

Indirect Percussion (Mediate Percussion)

Involves placing a non-dominant hand’s middle finger (pleximeter) on the body surface.

Indirect Percussion (Mediate Percussion)

Striking it with the dominant hand’s middle finger (plexor).

Indirect Percussion (Mediate Percussion)

Commonly used for assessing Thorax & Abdomen.

Blunt Percussion

Performed by using a closed fist to gently strike the body surface.

Blunt Percussion

Used to assess tenderness over organs such as Kidneys (e.g., Costovertebral Angle Tenderness - CVA test).

Percussion Sound: Resonance

Characteristics: Low-pitched, hollow

Percussion Sound: Resonance

Common Locations: Normal lung tissue

Percussion Sound: Resonance

Clinical Significance: Normal finding in healthy lungs

Percussion Sound: Hyperresonance

Characteristics: Lower-pitched, booming

Percussion Sound: Hyperresonance

Common Locations: Overinflated lungs (e.g., emphysema)

Percussion Sound: Hyperresonance

Clinical Significance: Abnormal, suggests trapped air

Percussion Sound: Tympany

Characteristics: High-pitched, drum-like

Percussion Sound: Tympany

Common Locations: Over the stomach and intestines

Percussion Sound: Tympany

Clinical Significance: Normal over the stomach; abnormal in the lungs (pneumothorax)

Percussion Sound: Dullness

Characteristics: Soft, thud-like

Percussion Sound: Dullness

Common Locations: Over solid organs (liver, spleen)

Percussion Sound: Dullness

Clinical Significance: Normal over dense organs; abnormal if detected over lungs (e.g., pneumonia, pleural effusion)

Percussion Sound: Flatness

Characteristics: Very soft, high-pitched

Percussion Sound: Flatness

Common Locations: Over bones or muscles

Percussion Sound: Flatness

Clinical Significance: Normal over bones; abnormal if found in unexpected areas (e.g., massive pleural effusion)

Thoracic Percussion (Lungs and Pleura)

Purpose: Used to assess lung fields and detect fluid or air abnormalities.

Thoracic Percussion (Lungs and Pleura) Normal Findings

Resonance over lung tissue

Thoracic Percussion (Lungs and Pleura) Abnormal Findings

Dullness → Pneumonia, pleural effusion, lung consolidation

Abnormal Findings

Hyperresonance → Emphysema, pneumothorax

Abdominal Percussion

Purpose: Used to assess the presence of gas, fluid, or solid masses in the abdomen

Abdominal Percussion Normal Findings

Tympany over the stomach and intestines (indicates air presence)

Abdominal Percussion Normal Findings

Dullness over the liver and spleen

Abdominal Percussion Abnormal Findings

Excessive Tympany → Intestinal obstruction

Abdominal Percussion Abnormal Findings

Dullness in unexpected areas → Fluid accumulation (ascites) or masses

Kidney Percussion (Costovertebral Angle Tenderness Test - CVA Test)

Purpose: Used to assess for kidney tenderness (indicative of kidney infection or inflammation)

Kidney Percussion (Costovertebral Angle Tenderness Test - CVA Test)

Clinical Significance: Positive CVA tenderness may indicate pyelonephritis or renal stones

Patient Positioning

Goal: Ensure the patient is in a comfortable position

Patient Positioning For Thoracic Percussion

Have the patient sit upright

Patient Positioning For Abdominal Percussion

The patient should be in a supine position

Steps for Indirect Percussion

Place the middle finger of the non-dominant hand flat on the surface

Steps for Indirect Percussion

Keep other fingers lifted to prevent dampening of sound

Steps for Indirect Percussion

Use the dominant hand’s middle finger to strike the distal interphalangeal joint of the stationary finger

Steps for Indirect Percussion

Deliver quick, sharp, and relaxed taps

Steps for Blunt Percussion (Kidney Assessment)

Place one hand over the patient’s costovertebral angle (lower back)

Steps for Blunt Percussion (Kidney Assessment)

Use the other hand to strike with a closed fist

Steps for Blunt Percussion (Kidney Assessment)

Observe the patient’s response for tenderness or pain

How to Correct: Apply moderate, controlled force

Common Mistake Using too much or too little force

Common Mistake: Keeping other fingers in contact with the skin

How to Correct: Keep non-striking fingers lifted to avoid sound dampening

Common Mistake: Striking with a tense hand

How to Correct: Keep the wrist relaxed for better sound quality

Common Mistake: Incorrect placement of the pleximeter finger

How to Correct: Ensure firm contact with the body surface for accurate sounds

Common Mistake: Failing to compare symmetrical areas

How to Correct: Always compare sounds bilaterally