Physical examination maneuver

Physical Exam

Chest Wall Palpation

🎬
Video coming September 2026

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 helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Limited

Pleural Effusion

Decreased tactile (vocal) fremitus over the affected hemithorax
Rule in
HelpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Limited

Pulmonary Embolism

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

Rib Fracture

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

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. doi:10.1001/jama.2015.12735. PMID: 26547467.
  • 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.

Related Systems / Regions

MusculoskeletalThorax

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