Palpation has four potential uses:
■ Identification of tender areas
■ Assessment of observed abnormalities
■ Further assessment of chest expansion. Place your thumbs along each costal margin, your hands along the lateral rib cage. As you position your hands, slide them medially a bit to raise loose skin folds between your thumbs. Ask the patient to inhale deeply. Observe how far your thumbs diverge as the thorax expands, and feel for the extent and symmetry of respiratory movement.
Tender pectoral muscles or costal cartilages tend to corroborate, but do not prove, that chest pain has a musculoskeletal origin.
■ Assessment of tactile fremitus. Compare both sides of the chest, using the ball or ulnar surface of your hand. Fremitus is usually decreased or absent over the precordium. When examining a woman, gently displace the breasts as necessary.
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