This test is used to visually assess asymmetrical chest expansion, a potential sign of pleural effusions, thoracic wall trauma, deconditioning, etc.
Performing the Test
Place both hands on chest
Posterior: Thumbs at approximately the 10th ribs with fingers resting parallel to ribs
Anterior: Thumbs resting parallel to costal margin
Hands should be placed medially and then slid medially to raise a fold of skin bilaterally between your thumb and patient's spine
Ask patient to take a deep inspiration and then expiration
Looking at the extent of skin unfolding, assess the range of expansion and symmetry
Evaluating the Result
For evaluation of a pleural effusion, asymmetric chest expansion increases the likelihood ratio:
Asymmetric chest expansion: LR+ = 8.1 (95% CI = 5.2-12.7)
Absence of reduced tactile vocal fremitus: LR- = 0.21 (95% CI 0.12-0.37)
Dullness to conventional percussion: LR+ = 8.7 (95% CI, 2.2-33.8)
References
Bickley LS. The thorax and lungs. In: Bickley LS, Szilagyi PG. Bates' Guide to Physical Examination and History Taking. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:283-321.
Wong CL, Holroyd-Leduc J, Straus SE. The rational clinical examination: Does this patient have a pleural effusion? JAMA. 2009;301(3):309-317.