Palpation:Use the ball of one hand and move the hand from one side of the posterior thorax to other. Note presence of swelling, masses, muscle tone, fremitus and crepitation. Fremitus is a vibration that can be felt by the hand through the chest wall. Ask the patient to speak in a normal tone of voice, repeating "99" or "1, 2, 3" while you palpate the chest. Increased vibration near the large bronchi is normal. In other areas, an increased fremitus is indicative of increased density of lung tissue which is seen in consolidation of lung, lobar pneunomia and pulmonary oedema. Decreased fremitus is normal in patient who has a soft voice. In other cases, it indicates obstruction of air flow into a portion of lung, pleural effusion, hemothorax, pneumothorax or a bronchial obstruction.
Crepitatoin is a tactile sensation or a coarse, crackling sound produced by the compression of skin with air in the underlying subentaneous tissue see in patients with aurgical emphysema or chest trauma (air leak into subcentarcons tissue).
Palpate the trachea to see it is located in a midline position in the neck. Tracheal deviation can occur on atilectasis, pneumonectomy, mediastinal mass, large pleural effusion, tension pneuthorax, unilateral emphysema and neck tumor