Physical Exam

Chest Wall Palpation

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Video coming September 2026

How to Perform

Palpate the chest wall systematically with the fingers, comparing the two sides. Assess the ribs, the costochondral and costosternal junctions, the sternum, the intercostal spaces, and the overlying muscles, noting any tenderness, masses, swelling, or crepitus. Where chest pain is present, attempt to reproduce it with focal pressure.

How to Interpret

Acute Coronary Syndrome

Chest pain fully reproduced by focal palpation of the chest wall

Rule in

—

Rule out

Somewhat helpful

Evidence:Limited

Rib Fracture

Localized tenderness (or a palpable step or grating) over a rib on chest-wall palpation after trauma

Rule in

Not helpful

Rule out

Not helpful

Evidence:Limited

References

Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL. The rational clinical examination. Is this patient having a myocardial infarction? JAMA. 1998;280(14):1256-1263. PMID 9786377. doi:10.1001/jama.280.14.1256.
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.
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.