Standing or sitting
If you wish to palpate on the skin, provide a private room for assessment. Ask the patient if he/she is willing to uncover the appropriate part of the rib area ñ removing the shirt for men and wearing a halter top, bathing suit, etc. for women. While the skin can not be viewed with clothes covering the area, these structures usually can be palpated over clothing.
Anterior to the patient.
(Guide the patient to drape appropriately.) Please stand. May I touch your ribs (add for women, in the areas outside your halter top) and also the attachment of some ribs to the breastbone (or bone in the front of your chest)? (or point to the areas).
Guide the patient to drape appropriately. Place your fingers on the palpable ribs and follow them from the area of the transverse process posteriorly to the costal cartilage anteriorly in areas where palpation is appropriate. Palpation over the breasts is not appropriate for general palpation but may be needed when specific pathology is suspected. Patient modesty is assured at all times. In a relaxed position, from the transverse process, the rib follows an inferior course to attach to the costal cartilage on the anterolateral trunk. The costal cartilage follows a superior course to attach to the sternum or to another costal cartilage.
The costal cartilages of right and left rib 7 can be followed with palpation to the xiphisternum, the junction of the xiphoid process and the sternum.
The xiphoid process is the smallest and most inferior portion of the sternum. It is inferior to the palpable xiphisternum and may or may not be palpable. This location is important to note, as pressure on the xiphoid process must be avoided during cardiopulmonary resuscitation. Excessive pressure on this process can result in the xiphoid process puncturing the liver.
The costal cartilages of right and left rib 7 can be followed with palpation to the xiphisternum, the junction of the xiphoid process and the sternum.
The xiphoid process is the smallest and most inferior portion of the sternum. It is inferior to the palpable xiphisternum and may or may not be palpable. This location is important to note, as pressure on the xiphoid process must be avoided during cardiopulmonary resuscitation. Excessive pressure on this process can result in the xiphoid process puncturing the liver.
VH - Skeleton of the trunk, neck and head
On one side, pectoralis major, minor, subclavius