Chest palpation: expansion and tactile fremitus !

Exam technique

The hands check whether both sides of the chest expand equally and whether the voice vibrates equally over both lungs.

Updated 2026-11-01

See it in 3D: Ribs (back part) · Trachea · Pleura

What it is

Palpation confirms symmetric expansion and tests tactile fremitus, the vibration of the voice felt on the chest wall. Fremitus increases when the lung is solid with an open bronchus, and decreases when air or fluid lies between lung and wall or the bronchus is blocked. Palpation also finds tenderness, subcutaneous crepitus and the position of the trachea.

Landmark anatomy

The voice makes the larynx vibrate; the vibration travels down the trachea, bronchi and lung tissue to the wall.
Solid tissue carries vibration better than air; pleural fluid or air damps it and moves the lung away from the hand.
The lower ribs move outward and upward on inspiration (bucket-handle movement), which spreads the thumbs.

Technique, step by step

With the patient seated, first palpate any painful areas, deformities or masses reported or seen.
Posterior expansion: thumbs at the tenth rib, parallel and near the spine, hands spread over the sides.
Ask for a deep breath and watch both thumbs move apart the same distance.
Repeat in front, thumbs along the costal margins, and at the apices with hands over the infraclavicular areas.
Fremitus: place the ulnar edge or palm of the hand on the chest and ask the patient to say 'ninety-nine' firmly.
Move over symmetric points from apex to base, behind, at the sides and in front, comparing one side with the other.
Palpate the trachea at the suprasternal notch to confirm it is midline.

Abnormal findings

Reduced expansion on one side: effusion, pneumothorax, atelectasis, large consolidation, one-sided fibrosis or pain.
Reduced expansion on both sides: emphysema, diffuse fibrosis, obesity, neuromuscular disease.
Increased, localized fremitus: pneumonic consolidation.
Absent fremitus: large effusion, pneumothorax or blocked bronchus.
Tracheal deviation: toward an atelectasis; away from a massive effusion or a tension pneumothorax.

Common errors

Comparing points that are not symmetric, or palpating over the scapula, where fremitus is felt poorly.
Letting the patient speak too softly: fremitus is not felt and seems reduced everywhere.
Forgetting that fremitus is normally a little stronger at the right apex and weaker with a thick chest wall or a soft deep voice.

Test yourself

Think of the answer, then tap the question to see it.

What tactile fremitus is expected in lobar pneumonia with consolidation?

Increased, because solid lung with an open bronchus carries the voice vibration better.

Why is fremitus reduced in pleural effusion?

The fluid separates the lung from the wall and damps the vibration before it reaches the examiner's hand.

Where are the thumbs placed to test posterior expansion?

At the level of the tenth rib, parallel and near the spine; they should move apart equally on deep inspiration.

Which way does the trachea shift in a large lobar atelectasis?

Toward the side of the atelectasis, because the volume loss pulls the mediastinum.

Add to my cards (4)

See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Pleural effusion: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2024); Community-acquired pneumonia in adults: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2024).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.