Palpation is an assessment technique in which the examiner uses the surface of the fingers and hands to feel for abnormalities. Assessment data that can be obtained through palpation includes identifying chest movement symmetry, chest skeletal abnormalities, tenderness, skin temperature changes, swelling, and masses.
To assess the symmetry of chest expansion during breathing, stand behind the person, and place your hands with fingers spread apart beneath his or her arms, on the sides of the chest, about 2 inches below the axilla. Your fingers should be pointing toward the anterior chest - this will let you feel the chest rising and falling on inspiration and expiration. Ask the person to breathe out completely observe your hands and thumbs to see that they have moved equally on both sides.
After checking for symmetrical chest expansion, feel for tactile fremitus. Fremitus refers to vibratory tremors that can be felt through the chest by palpation. To assess for tactile fremitus, ask the patient to say 99 or blue moon. While the patient is speaking, palpate the chest from one side to the other. Tactile fremitus is normally found over the mainstem bronchi near the clavicles in the front or between the scapulae in the back. As you move your hands downward and outward, fremitus should decrease. Decreased fremitus in areas where fremitus is normally expected indicates obstruction, pnemothorax, or emphysema. Increased fremitus may indicate compression or consolidation of lung tissue, as occurs in pneumonia.
Normal findings on palpation include: