- Place flat portion of one hand in infraclavicular region and the other below
costal margin. Note the contribution of intercostals and diaphragm in expanding the
chest. Make a similar assessment of the other side.
- Infracostal Movement:
Apply both your palms along infracostal region and note the symmetrical downward
displacement of hands with deep inspiration. There is symmetrical outward movement of
epigastrium with inspiration. In diaphragmatic paralysis there will be ipsilateral
inspiratory retraction of epigastrium (Paradoxical movement). This results in
see-saw movement of epigastrium during respiration.
- Tidal Percussion:
Percuss diaphragmatic position with deep inspiration and expiration and assess the depth
Diaphragm assumes 80% function for inspiration in supine position. Hence if the diaphragm
is paralyzed, significant compromise occurs and patients become very short of breath.