Palpation of the Chest, Palpation

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Palpation is used to determine five main clinical signs:
  1. the presence of lymphadenopathy:
    1. cervical and supraclavicular lymph nodes are particularly significant
  2. the position of the trachea:
    1. the trachea should be palpated deep in the supraclavicular notch to determine the position of the upper mediastinum
    2. the index finger is pressed deep in the suprasternal notch in the midline, if the trachea is not felt then the finger is inserted to one side or the other
  3. tracheal tug:
    1. the distance between the suprasternal notch and the cricoid cartilage is normally 2-3 fingers breadths
    2. a reduction in this distance, particularly on inspiration is a reliable sign of hyperinflation
  4. chest expansion:
    1. the examiner places the hands on either side of the chest over the upper and then lower zones
    2. observing the movement of the hands during respiration may demonstrate asymetrical expansion of the chest
  5. tactile vocal fremitus

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