Treatment of any disease begins with an initial general clinical examination necessary to obtain a general idea of the patient, his state of health and to establish a relationship between the individual affected organs and the pathologies of other organs in the body. The main examination methods are: medical history, examination of the patient, auscultation, percussion and palpation. These examination methods are informative, simple, accessible and completely harmless to the patient.
Percussion is a method that allows you to identify violations in the size and configuration of internal organs, to determine their location. It is a tapping on the surface of the body and an assessment of the sounds arising from this, since healthy and affected tissues sound differently. Closely associated with palpation - the method of sequentially feeling the patient.
Purpose of percussion and palpation
Performing percussion has two main goals:
- learn about changes in organs, about the air content in them and the presence or absence of dense elements;
- determine the boundaries, shape and size of organs.
Feeling helps:
- determine the sensitivity of organs and tissues and their topography;
- assess the temperature of the skin, pulsation of blood vessels, intestinal motility;
- diagnose broncho-pulmonary pathologies;
- identify the shape and nature of the deformation, neoplasm.
Types of percussion, palpation: methods of conducting
Two main types of percussion are distinguished:
- Direct percussion involves striking with one or more fingers on the surface of the patient's body.
- Indirect percussion is carried out with the help of any object attached to the body, on which taps are made.
There are several ways to directly percussion:
- the method of Yanovsky F. G., which consists in using the pulp of the terminal phalanx of the index or middle finger of the right hand;
- the method of V. Obraztsov, in which the index finger, which is striking, slides off the back of the third finger;
- the Aueenbrügger method, which involves tapping with folded and half-bent fingers on the chest (rarely used today);
- sliding percussion is a method of examination using the pulp of several fingers, which allows you to very accurately determine the boundaries of the organs.
Indirect percussion can also be performed in several ways:
- with a finger on a pessimeter;
- a hammer on a pessimeter;
- finger-finger method.
Indirect percussion is the most effective modern examination method, because with the help of a pessimeter the resulting sound becomes louder and more distinct.
Depending on the immersion depth of the fingers or hands in the tissue, there are:
- Superficial palpation. This is a method of indicative, preliminary examination. Used to determine temperature, humidity, sensitivity and tissue density. Symmetrical surface strokes help determine the nature of the surface, identify any formations or seals in the skin, subcutaneous tissue, detect muscle tension in the limbs, back, and stomach. Superficial palpation can be carried out with one or two palms. The fingers are extended, there should be no pressure on the palpable surface.
- Deep palpation, used to assess the condition of organs and tissues located deep in the body.
To feel various muscles, joints and other areas, various options for deep palpation are used:
- To study muscles, bones under the layer of muscles, joint space, palpation is used with deep immersion of the tip of one or several fingers.
- The abdominal organs are examined using deep sliding palpation.
- In the study of the liver, tumors of the abdominal cavity and ascites, a ballot or jerky palpation is used.
- To identify accumulated fluid in the knee joint, the doctor can use jerky pressure with a few fingers.
- Examining the uterus, ovaries, pelvic tumors, wrist, knee and elbow joints will help bimanual palpation performed with two hands.
Percussion Intensity: Types of Percussion
The strength of the percussion shock affects the distribution of vibrational movements over the surface and in depth, the intensity of the tone and the amount of air that is brought into vibrational movements.
Given all this, percussion is divided into:
- deep (strong or loud);
- superficial (weak or quiet).
Deep (strong) percussion provides tissue oscillation on the surface up to 5 cm, in depth - up to 6 cm. The acoustic sphere of superficial (weak) percussion is two times less than strong. Depending on the volume of the affected area, the depth of the location and the purpose of the examination, the doctor may use more or less strong percussion.
Percussion sounds: varieties
- A clear pulmonary sound is heard when tapping the chest directly above the surface of the lungs.
- A femoral, or dull, sound occurs when tapping over dense airless organs and tissues.
- A tympanically shaped sound is detected by percussion of air-containing organs, such as the larynx, trachea, or intestines.
The clinical use of percussion
According to the purpose, two types of percussion are distinguished:
- Comparative, which involves applying percussion strokes of equal strength to the symmetrical parts of the study area. Often used in lung examination.
- Topographic, defining the boundaries and sizes of organs and projecting these boundaries on the surface of the body. Topographic percussion requires superficial weak percussion and the use of a short stroke.
Percussion of the heart allows you to determine the size, shape and position of the organ itself and the vascular bundle. The heart is a muscular, airless organ filled with blood, therefore, when tapping the zone of absolute dullness, the sound is dull. Left and right, it is covered by the lungs - an organ containing air, which means that the sound in this area will be dulled. Usually, percussion of the heart is carried out in a standing or sitting position with hands down, while breathing should be calm.
Percussion of the liver, as a dense organ, gives a dull sound when tapped. Percussion should be from above, where the sound will be clear, and follow down until a dull sound appears. The change of sound is due to the fact that the liver is partially covered by the lung. Liver percussion must be carried out in a horizontal position. Topographic guides are the ribs and the conditional vertical lines of the chest. After percussion, palpation or palpation of the organ follows, which allows you to determine changes in the consistency, shape and surface of the liver, painful places, allows you to localize the lower borders of the organ.
Topographic percussion of the lungs will help determine the position of the lungs in the chest and in relation to other organs. The norm of percussion sound over the lung tissue is clear sound. It is in this area that the sound during tapping is the clearest in the whole body. Palpation of the chest allows you to determine its shape, painful places, resistance and vocal trembling. Feeling is done with two hands at the same time. The revealed painful area is felt more thoroughly. If the chest, when determining resistance, is easily compressed, then this is evidence of its ductility and elasticity, which is considered the norm. You can squeeze both front and back, symmetrically placing your hands, and from the sides, where the chest is more supple.
Features percussion children
Percussion in children, especially the first year of life, requires care from the doctor, since the organs of such patients are small, the walls of the chest are thin, and the skin is very soft.
When examining the lungs, special attention must be paid to the position of the child, in which the chest will be located symmetrically. Mediated percussion is used in the examination of older children, while for small children it is used directly. The back is tapped in a standing or sitting position with legs crossed, the lateral surfaces of the chest are in a sitting position, with arms extended in front of you or folded on the back of the head, and the chest is in a lying position.
Percussion can only be quiet: finger-finger or direct. High and clear percussion sound for young children is considered the norm. While crying, he can change to tympanic.
Percussion: general rules
- The room should be warm and quiet.
- The position of the doctor is comfortable.
- The position of the patient depends on the age and severity of the condition. An adult person can stand or sit calmly in the most relaxed position. The baby must be held upright by pressing him to her mother.
- The naked body is percussed.
- The doctor’s hands are warm, dry and clean.
- A percussion strike should be light, of equal strength, short, elastic.
- The fingernail for percussion strokes should be short.
Palpation and percussion are medical methods for examining internal organs that allow you to objectively assess their condition and position, requiring the doctor to be careful and attentive.