Diaphragmatic Excursion-Posterior Lungs

POINTS TO REMEMBER:
1. First, ask the person to take "exhale and hold it" while you percuss down the left scapular line until the sound changes from resonant to dull.  Mark the area.  This estimates the level of the diaphragm separating the lungs from the abdominal viscera.  
2. Allow the patient to take a few normal breaths. Then, ask the person to "take a deep breath and hold it."  Continue percussing down from the first mark to the level where the sound changes to dull. Mark the area.
3. Measure the two marks. Repeat the same procedure on the right side.  It should be equal bilaterally and measure about 3-5 cm. in adults.  It may be up to 7-8 cm. in well-conditioned people.
4. Level of the diaphragm may be higher on the right side because of the liver.
5. Reason for Assessing Diaphragmatic Excursion-to determine the movement of diaphragm that occurs during inspiration.  Possible reasons for decreased descent include:  atelectasis of lower lobes, emphysema, pleural effusion, pain, abdominal changes such as tumors and extreme ascites.
6. Suggestion:  Hold your breath while you assess your patient.  When you run out of air, the patient surely has especially if the person has a respiratory problem. 

Click on the link below to watch a flash movie on percussion of the posterior lungs using the technique of diaphragmatic excursion