The positions in which the percussion note on the two sides should be compared are as follows:
• Anterior chest wall (Fig. 4.17): (a) clavicle; (b) infraclavicular region; (c) second to sixth intercostal spaces.
■ Lateral chest wall (Fig. 4.17): fourth to seventh intercostal spaces.
• Posterior chesi wall (Fig. 4.18): (a) trapezius, percussing downwards over the lung apex; (b) above the level of spine of scapula: (c) at intervals of 4—5 cm from below the level of spine of scapula down to the eleventh rib.
The lung apices are percussed by placing the left middle finger across ihe anlerior border of the trapezius muscle, overlapping the supraclavicular fossa, and directing the percussion downwards (Fig. 4.19). Percussion over the
clavicle may be of value in detecting lesions of the upper lobe using the same technique of percussion of the chest wall because direct percussion of the clavicle may cause pain. The correct situation for percussion is within the medial third of the clavicle just lateral to its expanded medial end. Percussion more laterally will merely elicit the dullness produced by the muscle masses of the shoulder.
Tidal percussion. A crude impression of the range of diaphragmatic movement can be obtained by measuring the
distance between the lower border of pulmonary resonance at the back of the chest in full inspiration and forced expiration, but this procedure is of little practical value.
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