Technique percussion

The patient is usually better to percutiebat when he is standing or sitting on a chair, putting on his knees, hands and relaxation and loosening of the muscles. Finger-plessimeter put to the body Palmar surface of the leaf and middle phalanx tight, but without much pressure. The rest of the fingers and the palm of the body unaffected. Finger-Malleus bent in interphalangeal joints so that the end phalanx becomes perpendicular to the Palmar surface. The rest of the fingers should slightly bend and relax. When applied percussion strike movements make only a brush at the wrist and middle finger in the metacarpophalangeal joints. When you hit the end joint of the finger-hammer is located perpendicular to the finger-plessimeter. Strike in the middle or end of the finger phalanx-plessimeter. The blows should be short, jerky (elastic) and identical force. It is better to produce simultaneously two shots, one after the other.
For the study of human body apply two methods percussion: comparative and topographical. Comparative percussion used to study the structures which are more or less constant ratio of air and dense tissue (lungs, stomach). In this method, P. compare the sound is obtained in symmetric plots the right and left halves of the chest or abdomen.
Topographic P. used to determine the size and shape of individual organs and borders between them. It is based on the fact that some organs contain air (light), others - airless (heart, liver and other). When P. they will give a different sound.
Precise definition of the limits of the authority depends on the strength of percussion blow. When examining the patient applied loud and soft percussion. A strong blow on the chest causing oscillation tissues area of 4-6 cm and a depth of 6-7 cm, weak - 2-3 cm and a depth of 3-4 see So loud P. applicable only as a comparative P. To determine the boundaries of the various bodies and their form is used P. quiet. B. N. Samples tapping on the body conducted pulp index finger of the right hand, loosening from the radial surface neighboring middle finger (click), and F. G. Yanovsky - pulp single finger (index or middle).
Percussion lungs. For the study of lung used percussion direct and indirect, comparative and topographic, loud and quiet. P. breast cells begin with comparative P. It is performed in a certain sequence. First, percussion compare over the tops, then left and right below her, and left srednesrochnoi line to the third intercostal space (below is located the heart). Finger-plessimeter put in intercostal space parallel to the edges and strictly symmetric points. When P. chest behind the finger-plessimeter over the shoulder blades put horizontally, between the shoulder blades vertically and lower blades again horizontally on intercostal space. Percussion-kick should be of medium force.
In pathological processes change the content of the air in the lungs causes changes of percussion sound. Inflammatory processes lead to the seal of the lung tissue. Over such sites percussion be stupid or dull (close to dull the sound). Percussion is stupid and above the fluid in the pleural cavity pleurisy or hydrothorax. When emphysema percussion over them may resemble the sound that is created when you hit the box (sound box). In the formation of smooth cavity in the lung (the abscess cavity), the accumulation of air in the pleural cavity percussion as a result of resonance is tympanic. Over a very large (diameter of 6-8 cm) and a smooth hollow in light percussion will also tympanic, but low, Recalling the sound when you hit the metal vessel (metallic sound). If a cavity is superficial and communicates with the bronchus narrow opening, P. there is a kind of quiet and rattling sound - noise cracked pot, with percussion patient with an open mouth tympanic sound over the cavity will be higher and shorter, and closed below and longer (the phenomenon of Wintrich). When P. patient during inhalation of tympanic sound over the cavity becomes higher and shorter, and during exhalation below and longer (the phenomenon ataxia). When the cavity ovate, containing air and liquid, P. patient with a change of position of a body can give tympanic sound different heights (the phenomenon Gerhardt). When you decrease the lightness of the lungs and lower elastic stresses the alveoli percussion becomes dull or accepts tympanic shade (voice) - pritulenko-tympanic sound.
Topographical percussion is used to determine the upper limits of the lungs, width tops (fields of Kreniga), lower bounds and mobility of the lower edge of the lungs. To determine pistoane tops above the collarbones (norm 3-3,5 cm) finger-plessimeter put parallel to the collarbone, and from the mid-move it up to the sternoclavicular-liners muscle. Back percuteret from the middle of the supraspinatus fossa (fossa supraspinata) towards the spinous process of VII cervical vertebra. To define fields of Kreniga finger-plessimeter put in the middle of the trapezius muscle perpendicular to its front edge and percuteret lateral and medial until the dull sound (width fields of Kreniga 5-6 cm).
Lower bounds of light is determined by okolovrusno, srednesrochnoi, axillary and blade lines. Finger-plessimeter put on intercostal space and move down until liver stupidity of the right and to the left tympanic sound (front and lateral). In pathological States of light and neighbouring organs of the position of the boundary of light can vary.

Percussion heart allows to determine its position, size and configuration. Changing the position of the heart may depend on the pathological changes in the lungs (atelectasis, fibrosis), chest (kyphoscoliosis) and pleura (effusion pleural cavity, pneumothorax), and abnormalities of the heart (dextrocardia). In other cases, the size and configuration of the heart can change only the development of a pathological process. Determine the right, the left and top border of the heart. At the heart projection on the front wall of the chest right border it is the right atrium, left - the left ventricle and the top - left atrial appendage, acting in the third intercostal space on 1,5-2 cm to the left of the sternum. As part of the front surface of the heart is covered with a light, define the boundaries corresponding to the true dimensions of the heart,the border of relative dullness and boundaries of the heart, naked light (border absolute stupidity). P. used to define the width of a vascular bundle (in II intercostal space), formed on the right of the ascending part of the aorta and the top Vena cava, while the left arch of the pulmonary artery. In norm the vascular bundle is not beyond the edge of the sternum (4-6 cm).
Percussion stomach carried out to determine its position. Delimit an area of low tympanic sound of the stomach from the field of high campanita guts. P. you can determine the offset of the stomach, both up and down, as well as reducing the size of the space Traub. For percussion stomach easier ways B. N. Obraztsov, and F. G. Yanovsky.
Percussion liver is used to determine its size and position (its borders can move both up and down). The upper limit of hepatic stupidity determine usually along three lines: okolovrusno, srednesrochnoi and peredatochnoi. She is and the bottom of the right lung. The bottom edge of a liver, in addition to these lines define additionally on the median line and on the left costal margin (in norm the share of the liver does not go beyond the left okolovrusno line). When abnormalities of the liver can be placed in the left hypochondrium, and spleen in the right. The gallbladder is normal with the help of P. not defined.
Percussion spleen is used for the definition of its position and size. It lies in the left hypochondrium, often in parallel X edge. Percussion is available only lower 2/3 of its surface adjacent to the chest wall. Emphysema of the lungs and the accumulation of gas in the stomach and splenic corner transverse colon P. spleen may become unmanageable.
P. can be used to determine the enlarged bladder, uterus (during pregnancy or fibromyoma), accumulation of fluid in the abdomen, pain in the bones. P. kidneys usually not performed, as they are located in the lower abdomen and covered the intestines, containing air.
Percussion children see the patient Survey (examination of children).