If you feel asymmetry, it may be abnormally decreased on one side or increased on the other. You may find one hand works better than the other, and you will need to switch from side to side at the same level. Have the patient say “toy boat” or “ninety-nine” over and over as you feel for asymmetry. Find what part of your hand is most sensitive to vibrations – often it is the portion of your hand that is most ticklish when you lightly stroke one palm with the other hand’s fingertips – and place this on the patient’s thorax. This is the palpable vibrations felt on the chest when patients speak.You may note asymmetric expansion if the patient has pneumonia, pleural effusion, collapsed lung, or other abnormality. Normally the chest wall will expand evenly with inspiration.
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