Looking from above (standing behind the patient), over the shoulders or the upper part of the chest.If standing or sitting is not possible for the patient, inspect the chest in Iying down position, patient lies absolutely straight in the bed in supine position) inspect from the
- Top.
- Foot end of the bed.
- The sides in profile.
- Head end.
- Back (try to turn the patient to any one side).
The following are the points to note :
- Any deformity, fullness or depression (i.e. shape of the chest), apical impulse etc.
- Back (winging of the scapula, drooping of the shoulder, kyphoscoliosis, gibbus. skin changes).
- Whether both the sides of the chest arc moving simultaneously and symmetrically.
- Classically winged scapula is found in paralysis of nerve to serratus anterior (C 6 ,7) and sometimes in facio-scapulo-humeral muscular dystrophy.
- Assessment of the expansion of the upper lobes is better achieved by inspection
- From behind the patient, looking down at the clavicles during moderate respiration.
- Equal on both sides - normal
- Reduced movement on one side - pleural disease ,pulmonary disease
- Bilaterally reduced movement - in emphysema.
