Percussion (medicine)

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Percussion (medicine)
MeSHD010474
MedlinePlus002281

Percussion is a technique of

clinical examination
.

Overview

Percussion is a method of tapping on a surface to determine the underlying structures, and is used in

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 tuberculosis.[1]

There are two types of percussion: direct, which uses only one or two fingers; and indirect, which uses only the middle/flexor finger. Broadly classifying, 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

tympanites.[2]

Of the thorax

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

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

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

  1. ISBN 0-7234-3230-9
  2. ^ Cibeles Jolivette Gonzalez. "Avicenna's Canon Of Medicine". Retrieved 17 April 2018 – via Internet Archive.
  3. ^ "Percussion notes". LifeHugger. Archived from the original on 2011-07-13. Retrieved 2009-10-07.
  4. ^ "University of California, San Diego".
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