Tactile Fremitus

Healthy lungs produce a tactile and vibratory sensation which is palpable. This vibratory sensation is called fremitus and is assessed by physicians to detect if there are any abnormalities in the lungs of the person.

What is Tactile Fremitus?

The tactile fremitus is a test used to detect and assess if there are any abnormalities present in the lungs of an individual. It is also known as tactile vocal fremitus. It is one of the many palpation tests which involve the use of the hands to detect the presence of abnormalities in the body and to evaluate them.

How is the Tactile Fremitus Test performed?

The Tactile Fremitus test involves the following steps:
• The bony regions of the hand are placed firmly on either side of the chest region. This may be the dorsal portion of the fingers or the ulnar portion of the palm. These areas of the hand are used as they are more sensitive to picking up the vibrations.
• The patient is asked to speak the words “Ninety-Nine” or “Blue Moon”.
• This is repeated till the entire back region of the thorax region is assessed.
• The physician will check the movement of his hands and fingers to see if they have moved in a symmetrical manner on both sides of the chest cavity being examined.
• The fremitus is strongly felt over the main bronchial regions. In the front of the chest, it is found the strongest near the clavicles and in the back of the chest, it is found the strongest between the scapulae.
• The tremor or vibrations produced by the fremitus should decrease as the physician’s hands move down and out. The vocal resonance, intensity, and quality of pitch of the fremitus are assessed.

Tactile Fremitus Test Video

Normal Findings of the Tactile Fremitus Test

For a healthy individual, the findings after palpation will be normal and this will include:
• Regular chest size
• Regular chest shape
• Warm skin
• Absence of tender or swollen areas
• Symmetrical chest expansion when palpated on both sides
• The vibratory tremor or the tactile fremitus will be felt over the main bronchial region in the front of the chest and between the scapulae at the back.

Abnormal Findings of the Tactile Fremitus Test

If the fremitus is less in areas where it is normally expected, it indicates the presence of an obstruction, emphysema or pneumothorax. If it is more in areas where it is expected to be less or decreasing, it indicates compression, or lung tissue consolidation, maybe even pneumonia.

Pathological Conditions

There are some abnormal conditions which may be indicated by the palpation. If the fremitus is increased or decreased where the condition should be the opposite, it could be indicative of the following:

Pleural Effusion

When fluid collects in the space between the lungs and the chest wall, this creates a pleural effusion. The lungs get displaced upwards and this reduces the fremitus over this area. It creates a dull or flat vibration. The breath sounds will be lower.

Lung consolidation

This happens when the parenchyma of the lungs becomes filled with fluid or tissue and gets engorged. This usually results in pneumonia. The engorgement of the fluid or tissue in the parenchyma alters the transmission of sound and this increases the fremitus over the area. The breath sounds will be louder.

Pneumothorax

This condition is caused when the air entering into the lungs causes them to partially or totally collapse. The pressure in the thorax turns from negative to neutral and the lung collapses.

Frequently Asked Questions

How does the physician assess tactile fremitus?

This is done by assessing the intensity of the vibration which is felt on the chest wall or by listening via a stethoscope when certain words are spoken.

Are there other forms of fremitus?

Yes, there are other forms of fremitus. Vocal fremitus occurs when the vocal cords vibrate when a person speaks. Hepatic fremitus is when the liver is seriously inflamed and rubs against the peritoneum, thereby creating a vibration. Dental fremitus occurs when the teeth move.

What is atelectasis?

This condition occurs when there is a drastic reduction of air in the lung of the individual. This condition will cause a decrease in the tactile fremitus.

Is the tactile fremitus testing enough to detect abnormalities?

While the tactile fremitus test can be used to identify the bigger obstructions, certain conditions such as a chest abscess or atelectasis need to be confirmed through a chest radiography or using a CT scan.

The fremitus refers to the vibratory sensation produced by the lungs. Tactile fremitus is the assessment of these sensations to detect and evaluate the presence of any abnormalities in the lungs and related areas of the person.