Expansion of the chest is tested with the palms of your hands resting symmetrically, first superiorly, then on the middle and finally on the lower chest, wall with the thumbs pointing towards the midline (figure 17a–c). This is to pick up possible asymmetry of expansion; this is highly suggestive of underlying pulmonary disease.
When examining the back of the chest, sit the patient upright, on a chair or a bed, so that you can sit or stand behind them (figure 25). The procedure follows the same order described above: inspection, palpation, percussion and auscultation, using identical techniques. Again examine equivalent sites on the two sides consecutively.
Start with expansion (figure 26a–c), followed by course percussion (figure 27a–d).
On percussion posteriorly, ask the patient to move their elbows forward, this rotates the scapulae anteriorly (figure 28a–m). Tactile vocal fremitus is assessed superiorly and inferiorly (figure 29a–d).
Listen at first in the apices and then in the upper, middle and lower zones, and anteriorly within the axillae (figure 30a–m).