Expansion of the Chest Wall (costal = 4 to 6cm normal).
Antero-posterior and transverse.

Fremitus
  • Tactile (vocal)
    Is the transmission of voice vibrations, is a palpable vibration. Normally symmetrical. Ask the patient to repeat 'ninety-nine', '1,2,3' or 'e-e-e'.
  • Rhoncal
    Coarse vibrations (noisy respiration). More apparent in inspiration and less localized. Corresponds to ronchi on Auscultation. Produced by exudate on the trachea or bronchi.
    Palpation Methods
    1) With the palmar aspect of the hand.
    2) With the pulps of the fingertips (Grancher).
    3) With the ulnar aspect of the hand (Eichorst).
  • Pleural Friction Fremitus
    Is a palpable rub. 'Grating' in quality. 2 phases, less localized.
    Crepitation