Percussion - what kind of method is it? Percussion and palpation

Treatment of any disease begins with a primary general clinical examination necessary to obtain a general idea of the patient, the state of his health and to establish the connection between individual affected organs with pathologies of other organs in the body. The main methods of examination are: collection of anamnesis, examination of the patient, auscultation, percussion and palpation. These survey methods are informative, simple, accessible and absolutely harmless for the patient.

Percussion is a method that allows to detect abnormalities in the size and configuration of internal organs, to determine their location. It is a tapping on the surface of the body and an evaluation of the sounds that arise while the healthy and affected tissues sound differently. Closely associated with palpation - the method of consistent patient feeling.

The goals of percussion and palpation

Conducting percussion has two main goals:

- learn about changes in the organs, the air content in them and the presence or absence of dense elements;

- determine the boundaries, shape and size of the organs.

Feeling helps:

- determine the sensitivity of organs and tissues and their topography;

- assess the temperature of the skin, pulsation of vessels, intestinal motility;

- diagnose broncho-pulmonary pathologies;

- to reveal the shape and nature of deformation, neoplasms.

Types of percussion, palpation: methods of conducting

There are two main types of percussion:

- Direct percussion involves pinching one or more fingers on the patient's body surface.

- Mediated percussion is carried out with the help of an object attached to the body, on which tapping is performed.

There are several ways of direct percussion:

- Yanovsky FG's method, which consists in using the flesh of the end phalanx of the index finger or middle finger of the right hand;

- the way of Obraztsov VP, in which the index finger, which strikes, slides from the back of the third finger;

- Auenbrugger's method, which involves tapping with folded and half-bent fingers on the chest (rarely used today);

- sliding percussion is a method of conducting a survey using the flesh of several fingers, which allows very precisely to determine the boundaries of organs.

Mediated percussion can also be carried out in several ways:

- finger on the pleaser;

- a hammer at the pleometer;

- finger-finger method.

Mediated percussion is the most effective modern method of examination, because with the help of the plemetrix the resulting sound becomes louder and more distinct.

Depending on the depth of immersion of the fingers or hands , the tissues distinguish:

- Superficial palpation. This is a way of orienting, preliminary examination. Used to determine temperature, humidity, sensitivity and tissue density. Symmetrical superficial strokes help determine the nature of the surface, reveal any formations or seals in the skin, subcutaneous tissue, detect muscle tension in the limbs, back, abdomen. Surface palpation can be carried out with either one or two palms. The fingers are stretched, the pressure on the touching surface should not be.

- Deep palpation, used to assess the condition of organs and tissues located deep in the body.

To feel different muscles, joints and other areas, various options for deep palpation are used:

• To explore the muscles, bones under the muscle layer, articular gap, palpation is used with a deep immersion of the tip of one or more fingers.
• The organs of the abdominal cavity are examined with the help of deep sliding palpation.
• At research of a liver, a tumor of an abdominal cavity and at an ascites a balling or jerky palpation is used.
• To identify the accumulated fluid in the knee joint, the doctor can use the pricked pressure with several fingers.
• Investigate the uterus, ovaries, small pelvic tumors, wrist, knee and elbow joints will help bimanual palpation, carried out with both hands.

Intensity of percussion: percussion

The strength of a percussion stroke affects the distribution of vibrational movements along the surface and in depth, the intensity of the tone and the amount of air that is brought into the vibrational motion. Given all this percussion is divided into:

- deep (strong or loud);

- superficial (weak or silent).

Deep (strong) percussion provides the vibration of the tissues on the surface up to 5 cm, in depth - up to 6 cm. The acoustic sphere of surface (weak) percussion is half that of the strong one. Depending on the size of the affected area, the depth of the location and the purpose of the examination, the doctor may use either more or less strong percussion.

Percussion sounds: varieties

1. A clear, pulmonary sound is heard while tapping the chest directly above the lungs.
2. Femoral, or dull sound occurs when tapping over dense airless organs and tissues.
3. The tympanically formed sound is revealed during percussion of airborne organs, for example, larynx, trachea or intestine.

Clinical application of percussion

By design, there are two types of percussion:

- Comparative, which involves applying equal strength punches to the symmetric parts of the study area. It is often used for lung examination.

- Topographic, defining the boundaries and sizes of organs and projecting these boundaries onto the surface of the body. Topographical percussion requires superficial weak percussion and the use of a short stroke.

Percussion of the heart allows you to determine the magnitude, shape and position of the organ and vascular bundle itself. The heart is a muscular, airless, blood-filled organ, so when you tap the zone of absolute stupidity, the sound is blunt. Left and right it is covered with light - an organ containing air, and hence the sound in this area will be blunted. Usually percussion of the heart is carried out in a standing or sitting position with hands down, breathing should be calm at the same time.

Percussion of the liver, as a dense organ, gives a dull sound when tapping. Percutation follows from above, where the sound will be clear, and follow down until a dull sound appears. The change in sound is due to the fact that the liver is partially covered by a lung. Percussion of the liver must necessarily be carried out in a horizontal position. Topographical guidelines are ribs and conditional vertical lines of the chest. After percussion, palpation, or palpation of the organ, which allows you to determine changes in consistency, form and surface of the liver, painful places, allows you to localize the lower boundaries of the organ.

Determine the position of the lungs in the chest and in relation to other organs will help topographic percussion of the lungs. The norm of the percussion sound over the pulmonary tissue is a clear sound. It is in this area that the sound when tapping is the clearest in the whole body. Palpation of the chest allows you to determine its shape, painful areas, resistance and voice trembling. Feeling is done with both hands simultaneously. The revealed painful area is felt more carefully. If the chest in the definition of resistance is easily squeezed, then this is evidence of its susceptibility 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 pliable.

Features of percussion of children

Percussion in children, especially the first year of life, requires the doctor to be careful, since the organs of such patients are small, the walls of the chest are thin, and the skin is very tender.

When examining the lungs, special attention must be paid to the position of the child, in which the thorax will be located symmetrically. Mediated percussion is used in the examination of older children, for young children it is used directly. The back is tapping in the standing or sitting position with the legs crossed, the side surfaces of the chest - in the sitting position, with the hands stretched out in front or on the back of the head, and the chest - in the reclining position.

Percussion can only be quiet: finger-finger or direct. A high and clear percussion sound for young children is considered the norm. For the time of crying, it can change into tympanic.

Percussion: general rules

1. The room should be warm and quiet.
2. The position of the doctor is convenient.
3. The position of the patient depends on the age and severity of the condition. An adult can stand or sit still in the most relaxed position. The breastfeed in a vertical position should be kept, pressing it to itself, mum.
4. A naked body is percussionated.
5. The doctor's hands are warm, dry and clean.
6. The percussion blow should be light, of equal force, short, elastic.
7. The nail on the finger, conducting the percussion blows, should be short.

Palpation and percussion are medical methods of examining internal organs, allowing you to objectively assess their condition and position, requiring the doctor to be careful and attentive.