Hyperresonance can be a normal lung sound in small children or children with thin chest walls when percussing because of the round anatomical shape of their thorax. Hyperresonance is also low-pitched but is more of a booming sound in terms of sound quality and has a longer duration than resonance. For example, findings may include “resonance anteriorly in all lobes of the lungs.” However, it may be more of a dull or flat sound if a client has adipose tissue or a muscular chest, because this increased density modifies the sound. Resonance is the normal sound heard when percussing the lungs because they are filled with air rather than dense tissue.

Resonance is a low-pitched sound that is hollow in terms of sound quality with a moderate duration. See Figure 1.9 for the expected location of percussion sounds and Table 1.2 for an explanation of the types of percussion sounds heard including resonance, hyperresonance, tympany, dullness, and flatness.įigure 1.9: Expected location of percussion sounds This skill requires lots of practice, so start by practicing the technique on a table or your own leg.Īs a nurse, you need to become familiar with the expected percussion sounds so that you can identify what is normal and what is abnormal. To optimize this motion, the wrist of your dominant hand should be relaxed and loose with your forearm parallel to the person’s body. The motion should be firm and quick with a very short duration. The pleximeter finger of your dominant hand should be at a 90-degree angle to the surface of the body.

Dominant hand: Flex (bend) the pleximeter finger of your dominant hand and with the tip of your finger, tap twice on the distal interphalangeal joint of your non dominant hand.Ensure that only your interphalangeal joint is touching the body (and not the rest of the hand) and that the finger is fully extended. Non-dominant hand: With your hand parallel to the body, place the distal interphalangeal joint of the pleximeter (middle) finger of your non-dominant hand firmly on the body region to percuss.The steps of this technique are as follows: Indirect percussion is often used to assess the lungs and the abdomen (e.g., bowels, bladder, liver). See Figure 1.8 demonstrating the technique of indirect percussion.įigure 1.8: Indirect percussion technique There are three approaches to percussion, but the most widely used is indirect percussion, which is the application of a mediated force using parts of both of your hands. Percussion can also help reveal the presence of masses, particularly if they are close to the surface of the body. Fluid filled (e.g., bladder and stomach).For example, the percussion sounds can tell you if the organ is: This concept also applies to the body.Įach body part that you percuss provides information about the consistency as well as the size and borders of the underlying structure.

As you tap these surfaces, you can hear that each surface elicits a different sound based on the object’s consistency. Try tapping different surfaces with your fingertips and compare the sounds: a firm hard surface like a wood desk or table, a thick textbook, a window, or even a drum. Percussion involves tapping the body to elicit sounds and determining whether the sounds are appropriate for a particular organ or area of the body.

Hyperresonant lung sounds