The examiner can determine the degree of symmetry of chest excursion by placing his or her hands flat against the patient's back with the thumbs parallel to the midline at approximately the level of the 10th ribs and pulling the underlying skin slightly toward the midline. The patient is asked to inhale deeply, and the movement of the examiner's hands is noted. The hand movement should be symmetric. Localized pulmonary disease may cause one side of the chest to move less than the opposite side. The placement of the examiner's hands is shown in Figure 13-11.
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