Percussion is a technique of

clinical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the pat ...

Overview

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

s to assess the condition of the

thorax The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the c ...

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the to ...

. It is one of the four methods of clinical examination, together with

inspection An inspection is, most generally, an organized examination or formal evaluation exercise. In engineering activities inspection involves the measurements, tests, and gauges applied to certain characteristics in regard to an object or activity. ...

, palpation,

auscultation Auscultation (based on the Latin verb ''auscultare'' "to listen") is listening to the internal sounds of the body, usually using a stethoscope. Auscultation is performed for the purposes of examining the circulatory and respiratory systems (he ...

, 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 A Pleximeter is a device used in medical percussion, as part of a clinical examination, to absorb the energy generated by the strike from the plexor. During percussion the middle finger of examiner's hand is routinely used as pleximeter. The fin ...

) is placed firmly on the body over tissue. When percussing boney areas such as the

clavicle The clavicle, or collarbone, is a slender, S-shaped long bone approximately 6 inches (15 cm) long that serves as a strut between the shoulder blade and the sternum (breastbone). There are two clavicles, one on the left and one on the r ...

, the pleximeter can be omitted and the bone is tapped directly such as when percussing an apical cavitary lung lesion typical of

tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, ...

. 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

barrels A barrel or cask is a hollow cylindrical container with a bulging center, longer than it is wide. They are traditionally made of wooden staves and bound by wooden or metal hoops. The word vat is often used for large containers for liquids, u ...

liquor Liquor (or a spirit) is an alcoholic drink produced by distillation of grains, fruits, vegetables, or sugar, that have already gone through alcoholic fermentation. Other terms for liquor include: spirit drink, distilled beverage or h ...

, and Dr.

Leopold Auenbrugger Josef Leopold Auenbrugger or Avenbrugger (19 November 1722 – 17 May 1809), also known as Leopold von Auenbrugger, was an Austrian physician who invented percussion as a diagnostic technique. On the strength of this discovery, he is consi ...

is said to be the person who introduced the technique to modern medicine, although this method was used by

Avicenna Ibn Sina ( fa, ابن سینا; 980 – June 1037 CE), commonly known in the West as Avicenna (), was a Persian polymath who is regarded as one of the most significant physicians, astronomers, philosophers, and writers of the Islamic ...

about 1000 years before that for medical practice such as using percussion over the stomach to show how full it is, and to distinguish between

ascites Ascites is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. Symptoms may include increased abdominal size, increased weight, a ...

and

tympanites Tympany or tympanites (sometimes tympanism or tympania), also known as meteorism (especially in humans), is a medical condition in which excess gas accumulates in the gastrointestinal tract and causes abdominal distension. The term is from the ...

Of the thorax

It is used to diagnose

pneumothorax A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve i ...

emphysema Emphysema, or pulmonary emphysema, is a lower respiratory tract disease, characterised by air-filled spaces ( pneumatoses) in the lungs, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the alv ...

and other

disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

s. It can be used to assess the respiratory mobility of the thorax.

Of the abdomen

It is used to find whether any

organ Organ may refer to: Biology * Organ (biology), a part of an organism Musical instruments * Organ (music), a family of keyboard musical instruments characterized by sustained tone ** Electronic organ, an electronic keyboard instrument ** Hammond ...

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: * Tympanitic, drum-like sounds heard over air filled structures during the abdominal examination. * 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

with no contribution from the underlying area. Percussion may induce pain, this is often also noted as it can indicate underlying pathology.

References

{{DEFAULTSORT:Percussion (Medicine) Physical examination Audible medical signs