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PubMed1982

Auscultatory percussion of the head.

Eighty-nine consecutive patients with suspected intracranial masses were examined by auscultatory percussion in a blind study to assess the sensitivity of the procedure. Each patient underwent computed tomography (CT) of the brain as part of his medical care, and the results were compared with those of auscultatory percussion. Fifty-one of the patients had abnormal CT scans, of whom 44 (86%) had abnormal (positive) findings on auscultatory percussion; seven (13%) yielded false-negative results. Each of the patients with subdural haematomas had distinctly positive findings by auscultatory percussion. Of the 38 patients with normal CT scans, 11 had strokes with hemiparesis, and each had positive findings in the contralateral hemisphere by auscultatory percussion. The remaining 27 patients with normal CT scans were healthy; 25 had normal findings on auscultatory percussion, two (7%) gave false-positive results. Twenty subjects were studied with phonoscopy. Auscultatory percussion is easy to perform and is clinically useful.

Adult↗
PubMed1986

Effect of manual percussion on tracheobronchial clearance in patients with chronic airflow obstruction and excessive tracheobronchial secretion.

The effect of manual percussion of the thorax in nine patients with stable chronic airflow obstruction and excessive tracheobronchial secretion has been studied. Tracheobronchial clearance was measured over 50 minutes on three different days. On the first day manual percussion was applied for 10 minutes. In the period when percussion was applied the mucus clearance was slightly but significantly greater than in the periods when no percussion was applied. On the second day manual percussion was applied in combination with postural drainage, coughing, and breathing exercises for 20 minutes. This resulted in a much greater clearance than on the first day. On the third day postural drainage, coughing, and breathing exercises, but no manual percussion, were carried out for 20 minutes. There was no significant difference between the clearance of days 2 and 3. From this study it is apparent that manual percussion is a relatively ineffective procedure in patients with stable chronic airflow obstruction, but may be useful when the patient is not able to cough and cannot assume the appropriate position for postural drainage.

Aged↗
PubMed2003

Comparison of the caudal lung borders determined by percussion and ultrasonography in horses with recurrent airway obstruction.

The aim of the study was to evaluate the diagnostic value of thoracic percussion and ultrasonography with the help of distance measurements and statistical methods in the determination of the caudal lung border in horses with recurrent airway obstruction (RAO). Examinations were performed on 11 healthy, warm-blooded horses of different breeds, age and grade of disease. First, the caudal lung border was determined by the traditional indirect percussion method in the 10th, 12th, 14th and 16th intercostal spaces at the end of inspiration and expiration on both sides of the thorax. To apply standardised measurements, a fix point was chosen as described earlier by the same authors for healthy horses. The distance between this point and the caudal lung border was measured with a tape-measure. Percussion was followed by ultrasonographic determination of the caudal lung border. Measurements were performed in the same way as described for the percussion technique. Mean values and standard errors of absolute values of differences between percussion and ultrasonographic measurements were the following, in centimetres (10th, 12th, 14th and 16th intercostal spaces). Left side expiration: 1.4, 0.4; 0.8, 0.2; 0.9, 0.2; 0.8, 0.4; left side inspiration: 0.8, 0.3; 1.5, 0.3; 1.4, 0.3; 1.1, 0.3; right side expiration: 2.1, 1.0; 2.1, 0.5; 1.6, 0.5; 0.8, 0.1; right side inspiration: 1.5, 0.7; 1.2, 0.6; 0.8, 0.2; 0.8, 0.3, respectively. Ultrasonography proved to be reliable in determining the caudal lung borders in horses with RAO. Results of the percussion examination did not differ significantly from those of the ultrasound method which was used as a reference technique. The differences between inspiration and expiration were greater in horses with RAO than in healthy horses in a previous study. Based on these results, percussion can be used as an integrated part of the physical examination in diagnosing caudal shift of the caudal lung border of horses suffering from RAO.

Airway Obstruction↗
PubMed2000

Percussion of Traube's space--a useful index of splenic enlargement.

OBJECTIVE: To evaluate the sensitivity and specificity of palpation and percussion for splenic enlargement, as the accuracy of many of the clinical maneuvers we perform remains largely unstudied. METHODS: One hundred cases were selected at random from medical wards, and splenic enlargement was assessed by palpation and percussion of the Traube's space (Barkuns method), which was confirmed by the ultrasonography of the abdomen. The results of the various tests were tabulated and assessed statistically. RESULTS: 1) Performance of Traube's space percussion shows 24 true positive and 48 true negative cases, the test thus had an overall sensitivity of 67% and specificity of 75%. It was also found that the BMI of the false negative cases was significantly higher (29.43 Kg/m2). 2) Palpation as a diagnostic maneuver had a high specificity of 96.87% along with high false negative rate with overall low sensitivity of 44.44%. 3) Interpolation of findings of Traube's space percussion and palpation showed that maximum clinical utility could be achieved when both percussion and palpation were positive. CONCLUSION: Percussion of the Traube's space is a useful clinical screening test for splenomegaly, with a sensitivity of 67% and specificity of 75%, as compared to palpation (sensitivity of 44.44% and specificity of 96.87%). And maximum clinical utility is achieved when both percussion and palpation are combined.

Adult↗
PubMed1992

Accuracy of percussion of the left cardiac border.

UNLABELLED: The purpose of this study was to determine the accuracy of percussion of the left cardiac border. Sixty-six adult patients were studied. The left cardiac border as determined by percussion and marked with a calibrated lead marker was compared with that obtained by a chest X-ray. The error in locating the left cardiac border by percussion ranged from underestimating by 5.0 cm to overestimating by 5.5 cm. The mean absolute error was 1.6 cm (SD = 1.6 cm). In 74% (49/66) and 85% (56/66) of the patients the percussed border was within 1.0 and 2.0 cm, respectively, of that established by X-ray. In 24 of the 66 cases, a second examiner also independently percussed the left cardiac border. The differences between the location determined by the two observers ranged from 0 to 4 cm with a mean difference of 1.2 cm (SD = 1.0 cm). CONCLUSION: Percussion can accurately locate the left cardiac border in the adult patient and is a reproducible technique.

Adult↗
PubMed1999

Getting a feel for percussion.

When Auenbrugger introduced percussion it was direct or immediate percussion of the chest. Corvisart was the first to recognise that percussion not merely gave a sound but also a sensation to the percussing fingers. When Piorry introduced mediate percussion the sensation was more readily appreciable. However, there were many astute clinicians who ignored the sensation and these included Stokes, Hope, Latham and Gerhard. To this day some popular handbooks of physical signs do not mention this valuable component of percussion.

History, 18th Century↗
PubMedDate not supplied

Accuracy and reliability of palpation and percussion for detecting hepatomegaly: a rural hospital-based study.

BACKGROUND: Palpation and percussion are standard bedside techniques used to diagnose hepatomegaly. Ultrasonography is a noninvasive and accurate method for measurement of liver size, but many patients in developing countries have limited access to it. We compared the accuracy of palpation and percussion in a rural population in central India, using ultrasonography as a reference standard. METHODS: The study design was a blinded, cross-sectional analysis of a hospital-based case series. Three physicians, blind to clinical data and to each other's results, independently used palpation and percussion to detect hepatomegaly. Diagnostic accuracy was measured by computing sensitivity, specificity, and likelihood ratio values. Inter-physician agreement was assessed using the kappa statistic. RESULTS: Of the 180 study patients, 36 (20%) had enlarged liver on ultrasonography. The likelihood ratios for findings at both palpation (2.2, 3.0, and 2.5 for the three physicians, respectively) and percussion (1.1 for all three physicians) as predictors of true hepatomegaly were low. The kappa values for inter-observer agreement between three physicians for the presence of hepatomegaly at palpation (=0.44-0.53) and percussion (=0.17-0.33) were low, indicating poor reliability of these techniques. CONCLUSION: Clinical assessment of hepatomegaly by palpation and percussion lacks both accuracy and reliability.

Adult↗
PubMed1993

Accuracy and reproducibility of precordial percussion and palpation for detecting increased left ventricular end-diastolic volume and mass. A comparison of physical findings and ultrafast computed tomography of the heart.

OBJECTIVE: To assess the accuracy and reproducibility of indirect definitive precordial percussion in detecting increased left ventricular end-diastolic volume (LVEDV), left ventricular mass (LVM), and left ventricular end-diastolic wall thickness (LVEDWT), and to compare it with palpation of the apical impulse. DESIGN: Descriptive study. SETTING: Hospitals and clinics of a university medical center. PATIENTS: Convenience sample of 103 patients (62 men and 41 women) referred for ultrafast computed tomography (CT) of the heart. INTERVENTIONS: Percussion dullness distance from the midsternal line in the left fourth through sixth intercostal spaces, distance of the apical impulse from the midsternal line, and apical impulse diameter in the left lateral decubitus position were measured on all patients. Measurements of LVEDV, LVM, and LVEDWT were taken using ultrafast CT of the heart. Investigators performing the physical diagnostic maneuvers were blinded to the clinical history and CT results, and investigators performing the CT scans were blinded to physical findings. RESULTS: Percussion dullness distance in the left fifth intercostal space was the best discriminator of LVEDV (receiver operating characteristic [ROC] area, 0.680; 95% confidence interval [CI], 0.547 to 0.813), and dullness distance in the left sixth intercostal space was the best discriminator of LVM and LVEDWT (ROC areas, 0.831, 95% CI, 0.674 to 0.988; and 0.849, 95% CI, 0.651 to 0.999, respectively). A percussion dullness distance of greater than 10.5 cm in the left fifth intercostal space detected increased LVEDV or LVM with a sensitivity of 91.3% (95% CI, 70.5% to 98.5%) and a specificity of 30.3% (95% CI, 19.9% to 43.0%). There was moderate concordance between investigators for percussion dullness distance (kappa, 0.57; 95% CI, 0.18 to 0.96). In patients in whom an impulse was palpated, an apical impulse diameter of greater than 3.0 cm in the left lateral decubitus detected increased LVEDV or LVM with a sensitivity of 100% (95% CI, 77.1% to 100%) and a specificity of 40% (95% CI, 23.2% to 59.3%). However, an impulse was palpable in only 53% of cases and showed only slight interobserver reproducibility (kappa, 0.18; 95% CI, 0.0 to 0.58). CONCLUSION: Indirect definitive percussion of the precordium is a sensitive and moderately reproducible maneuver for excluding cardiomegaly due to increased LVEDV or LVM. Although measurement of apical impulse diameter was also sensitive in excluding cardiomegaly, lack of a palpable impulse in many patients and low precision between physicians may limit its utility in clinical practice.

Cardiomegaly↗
PubMed1991

Evaluation of chest percussion in the treatment of patients with copious sputum production.

The effect of manual chest percussion was studied in nine patients with copious sputum production. Treatment consisting of postural drainage (PD) and the forced expiration technique (FET) produced sputum at the rate of 0.831 g min-1. When percussion was included in the treatment regimen, the rate of sputum production was significantly greater (P less than 0.05), being 1.231 g min-1 for fast percussion and 1.040 g min-1 for slow percussion. Pulmonary function and oxygen saturation were unaffected by any of the treatment regimens. This study demonstrates that manual chest percussion is a useful adjunct to PD and FET in the treatment of patients with copious sputum production.

Adult↗
PubMed1994

A modified fluid percussion device.

This report examines a modified fluid percussion device with specific improvements made to address deficiencies found in previously reported devices. These improvements include the use of a cylindrical saline reservoir made of stainless steel, placement of the reservoir in a 15-degree head-up position for the easy release of air bubbles, placement of the fluid flushing outlet and the pressure transducer close to the piston on the same plane, with both perpendicular to the direction of the piston, and adjustable reservoir volume to vary the waveform of the pressure pulse, and a metallic central injury screw secured to the animal's skull over the exposed dura. Using this device, midline fluid percussion (MFP) and lateral fluid percussion (LFP) injuries were performed in 70 rats. Histopathologic findings included diffuse axonal injury in the MFP model and cortical contusion in the LFP model. Survival rate was 41.4% in MFP animals and 100% in LFM animals when the device settings were 178 mm3 of the cylindrical reservoir and 50 degrees-60 degrees in height of the pendulum. Our results suggest that this modified fluid percussion device may offer significant improvements over previously reported fluid percussion models for use in experimental head injury.

Animals↗
PubMed1979

Non-penetrative percussion stunning of sheep and calves.

Attempts were made to stun lambs, adult sheep and calves by a non-penetrative percussive method. Using an adapted Cash pistol, with a concave padded impact head, impulses were produced which effectively stunned 96% of lambs but induced brain haemorrhages in up to 7% of the animals. The signs and duration of an effective percussive stun were observed and recorded. Calves were readily stunned by percussive methods but brain haemorrhages frequently occurred. Impulses sufficiently large to stun adult sheep, with a non-penetrating impact head, were produced from an adapted Hantover pneumatic cattle stunner. Comparative trials, using electrical and percussive stunners, demonstrated a significant decrease in the prevalence of blood splash in lambs stunned by percussion.

Abattoirs↗
PubMed1991

[Reflex response of the masseter muscle after percussion of the chin and electrical stimulation of the upper lip in patients with central motor disorders].

In 23 patients with central motor disorders (spastic hemiparesis, pseudobulbar syndrome and parkinsonism) reflex responses in both masseters were evoked during their relaxation and contraction by percussion with a reflex hammer on the chin and by electric stimulation of the upper lip. For recording of the reflex responses the electromyographic method was used. On the side of the spastic hemiparesis, as compared with the finding on the non-paretic side, the author found changes in the short-, medium and late-latency excitation and inhibition segments of the reflex response. In patients with parkinsonism the medium-latency portion of the reflex response after percussion of the chin from above as well as from below was satisfactory. The late latency excitation response after percussion of the chin from below was greater than its corresponding part evoked by percussion of the chin from above. In patients with the pseudobulbar syndrome the inhibitory parts of the reflex responses after percussion of the chin were weak. The results of the examination provided thus more detailed information on disorders of supranuclear control of masseter muscles.

Cerebrovascular Disorders↗
PubMed1989

Contour maps of auscultatory percussion in healthy subjects and patients with large intrapulmonary lesions.

Auscultatory percussion of the chest is a clinical examination method that has been purported to detect intrapulmonary masses by their effect on transmission of the percussion note to the posterior chest. Recent findings from this laboratory suggested that the sound of sternal percussion may actually travel through the chest cage and not the lung parenchyma. To investigate this possibility further, we recorded the sound produced by sternal percussion at 63 evenly spaced points over the posterior chest wall of 3 healthy subjects and 4 patients with large, discrete intrathoracic lesions in the right upper lobe (2 patients), left lower lobe, and left upper lobe (1 patient each). We constructed 3-dimensional contour maps of the indices of sound amplitude and frequency to view graphically the pattern of distribution of the sound. Examination of the maps revealed areas of increased amplitude in the zones of projection of some osseous structures, especially the scapulae, both in the healthy subjects and patients. No disturbances in the pattern reflecting the presence of mediastinal structures or intrathoracic lesions were found despite the existence of deeply situated lung masses as large as 10 cm in diameter. These findings support the argument that the sound of sternal percussion travels to the posterior chest predominantly through chest wall structures.

Auscultation↗
PubMed1998

Respiratory and cardiovascular responses to manual chest percussion in normal subjects.

The respiratory and cardiovascular responses to manual chest percussion were studied in seven naive healthy subjects. Percussion during quiet breathing, percussion with thoracic expansion exercises (TEE) and TEE alone were applied to subjects in side-lying. Inspired volume, oxygen consumption, oxygen saturation, heart rate and blood pressure were measured before, during and after each technique. Significant increases in inspired volume and heart rate occurred with all three techniques (p < 0.01). Oxygen consumption increased with all three techniques however only the increases during percussion with TEE, and TEE alone were significant (p < 0.01). Oxygen saturation increased with percussion with TEE and TEE alone (p < 0.01). No significant changes in blood pressure were observed.

Journal Article↗
PubMed1994

Combined fluid percussion brain injury and entorhinal cortical lesion: a model for assessing the interaction between neuroexcitation and deafferentation.

Laboratory studies suggest that excessive neuroexcitation and deafferentation contribute to long-term morbidity following human head injury. Because no current animal model of traumatic brain injury (TBI) has been shown to combine excessive neuroexcitation and significant levels of deafferentation, we developed a rat model combining the neuroexcitation of fluid percussion TBI with subsequent entorhinal cortical (EC) deafferentation. In this paradigm, moderate fluid percussion TBI was induced in each rat, followed 24 h later by bilateral EC lesion (BEC). Six conditions were examined: (1) fluid percussion TBI followed 24 h later by bilateral EC lesion (TBEC), (2) fluid percussion TBI (TBI), (3) bilateral EC lesion (BEC), (4) sham fluid percussion TBI (SHAM), (5) TBI followed 24 h later by unilateral EC lesion (TUEC), and (6) unilateral EC lesion (UEC). The first four groups were assessed for motor (with beam-balance and beam-walk testing) and cognitive deficits (with the Morris water maze) and hippocampal morphology (with immunocytochemistry and electron microscopy). The TUEC and UEC groups were assessed for cognitive deficits alone. Motor deficits were greater in the TBEC injury than in TBI or sham alone; however, no significant difference was observed between the TBEC and BEC conditions in motor performance. Cognitive deficits were of a greater magnitude in the combined TBEC injury model relative to each individual insult. These cognitive deficits appeared to be additive for the two experimental injuries, BEC deafferentation producing deficits intermediate between TBI and TBEC insults. Morphologic analysis of the dentate gyrus molecular layer at 15 days after TBEC showed that the distribution of synaptophysin-positive presynaptic terminals was distinct from that observed after either TBI or BEC alone. Specifically, the laminar pattern of presynaptic rearrangement induced by BEC lesion did not occur after TBEC injury. The present results show that axonal injury and its attendant deafferentation, when coupled with traumatically induced neuroexcitation, produce an enhancement of the morbidity associated with TBI. Moreover, they indicate that this model can effectively be used to study the interaction between neuroexcitation and synaptic plasticity.

Animals↗
PubMed2000

[Study of the fluid-percussion graded model of experimental brain injury in rats].

OBJECTIVE: To study the histopathological aspects of the fluid-percussion graded model of experimental brain injury in rats and the relationship between the fluid-percussion graded model and the clinical grades of brain injury. METHODS: The graded model of rats was set up by using the device of the improved fluid-percussion model, then we observed the changes of brain tissue of rats. RESULTS: The fluid-percussion graded model of experimental brain injury could be pathologically graded. CONCLUSION: The pathological grade of the fluid-percussion graded model can be used to evaluate the degree of brain injury in clinic and in experiments.

Animals↗
PubMed2000

[Expression of c-fos mRNA following moderate lateral fluid percussion brain injury in rats].

This experiment was designed to study the expression of c-fos mRNA in brain following moderate lateral fluid percussion brain injury in rats and to observe the temporal pattern of its expressions following percussion. Male Sprague-Dawley rats were divided into normal control, sham operation control and injury groups. The rats of the injury group were subjected to moderate lateral fluid percussion injury (0.2 MPa). The injury group was then subdivided into 5 min, 15 min, 30 min, 1 h, 2 h groups according to the time elapsed after injury. The expression of c-fos mRNA was studied with reverse transcription polymerase chain reaction(RT-PCR) semi-quantitatively. c-fos mRNA in cortex and brain stem was expressed weakly in control groups. After 5 min of percussion, the expression of c-fos mRNA increased progressively and remained elevated up to 2 h after brain injury. This result suggested that the induction and expression of the c-fos mRNA in cortex and brain stem after fluid percussion brain injury were increased rapidly. The temporal pattern of induction in cortex was similar to that in brain stem.

Animals↗
PubMed1989

Splenic enlargement and Traube's space: how useful is percussion?

PURPOSE: The utility of Traube's space percussion in the bedside assessment of splenic enlargement was evaluated. The influence of meals and obesity on this sign were also assessed, because both are believed to interfere with the results of abdominal percussion. PATIENTS AND METHODS: The inpatient population of a tertiary care hospital was studied where cases and controls were selected according to the results of abdominal ultrasonographic examinations. RESULTS: Traube's space percussion exhibited a sensitivity of 0.62 (95% confidence interval [CI], 0.51 to 0.71) and a specificity of 0.72 (95% CI, 0.65 to 0.80) when classifying tympanitic examinations as negative. False-positive examinations were reduced by assessing patients more than two hours after mealtime. Obese patients were a source of false-negative examinations. CONCLUSION: Traube's space percussion compares favorably with other commonly used clinical maneuvers and diagnostic tests. When performed alone in a selected patient population, it adds useful clinical information but is not sufficiently sensitive or specific to obviate the need for further diagnostic testing.

Adult↗