Physical examination maneuver

Physical Exam

Chest Wall Palpation

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How to Perform

Begin by carefully palpating the area of pain or other concern. Palpate the ribs, costochondral and costosternal junctions, sternum, intercostal spaces, and chest wall muscles as clinically indicated. Compare paired structures bilaterally. Note any focal tenderness, mass, swelling, or crepitus, including whether focal pressure reproduces the patient's chest pain.

How to Interpret

Showing 4 of 5 findings

Acute Coronary Syndrome

Chest pain reproduced by palpation
Rule in
Not helpful
Rule out
Somewhat helpful
Evidence:Moderate

Pleural Effusion

Decreased tactile (vocal) fremitus over the affected hemithorax
Rule in
Helpful
Rule out
Somewhat helpful
Evidence:Moderate

Pulmonary Embolism

Chest pain reproduced by palpation
Rule in
Not helpful
Rule out
Not helpful
Evidence:Moderate

Rib Fracture

Localized chest-wall tenderness after blunt trauma
Rule in
Not helpfulDerived CI
Rule out
—
Evidence:Moderate

Related Bedside Tests

🎬Video coming soon
Abdomen Palpation
Rule in:VHExtrahepatic Biliary Obstruction, VHIntussusception, VHPyloric Stenosis +32 more
Rule out:VHHepatocellular Jaundice, HAppendicitis, SHDiverticulitis +32 more
Cardiac AuscultationMembers
Sign in
Cardiac Auscultation
Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy +37 more
Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy, VHRight-sided Valvular Lesion +37 more
🎬Video coming soon
Jugular Venous Pressure
Rule in:VHShock, HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure +14 more
Rule out:HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure, SHPulmonary Hypertension +14 more
🎬Video coming soon
Lung Auscultation
Rule in:VHChronic Obstructive Pulmonary Disease, VHPneumothorax, HMainstem Bronchus Intubation +29 more
Rule out:VHChronic Obstructive Pulmonary Disease, HPleural Effusion, SHInterstitial Lung Disease +28 more
Heart RateMembers
Sign in
Heart Rate
Rule in:SHAtrial Fibrillation, SHDecompensation, SHHypothyroidism +15 more
Rule out:HDecompensation, SHAtrial Fibrillation, SHPostoperative Complication +15 more
Oxygen SaturationMembers
Sign in
Oxygen Saturation
aka Pulse oximetry
Rule in:HMortality, SHPneumonia, MHCardiac Tamponade +8 more
Rule out:ICCardiac Tamponade, NHHepatopulmonary Syndrome, NHMortality +8 more

Related Systems / Regions

MusculoskeletalThorax

Related Diagnoses

Acute Coronary SyndromePleural EffusionPulmonary EmbolismRib Fracture

Related Chief Complaints

Arm PainChest HeavinessChest PainChest PressureChest TightnessChest TraumaChest Wall PainDiaphoresisEpigastric PainExertional Chest PainFatigueIndigestionJaw PainLightheadednessNauseaNeck PainPain Radiating to the ArmPain with CoughingPain Worse with BreathingPalpitationsRib PainSense of Impending DoomShortness of BreathShoulder PainSweatingSyncopeVomiting

References

  • Fanaroff AC, Rymer JA, Goldstein SA, Simel DL, Newby LK. Does this patient with chest pain have acute coronary syndrome? The rational clinical examination systematic review. JAMA. 2015;314(18):1955-1965. PMID 26547467. doi:10.1001/jama.2015.12735.
  • Kalani N, Habibzadeh SR, Ghahremanizadeh R, Tavakolian A, Hatami N, Barazandehpour S, Abiri S. Diagnostic accuracy of physical examination and history taking in traumatic rib fracture; a single center experience. Bull Emerg Trauma. 2020;8(2):111-114. PMID: 32420396.
  • Le Gal G, Testuz A, Righini M, Bounameaux H, Perrier A. Reproduction of chest pain by palpation: diagnostic accuracy in suspected pulmonary embolism. BMJ. 2005;330(7489):452-453. PMID: 15684025.
  • Kalantri S, Joshi R, Lokhande T, Singh A, Morgan M, Colford JM Jr, Pai M. Accuracy and reliability of physical signs in the diagnosis of pleural effusion. Respir Med. 2007;101(3):431-438. doi:10.1016/j.rmed.2006.07.014. PMID: 16965906. Tabulated in: Wong CL, Holroyd-Leduc J, Straus SE. Does this patient have a pleural effusion? JAMA. 2009;301(3):309-317. doi:10.1001/jama.2008.937. PMID: 19155458.
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 9, 2026.