A reasonable estimate of the degree and symmetry of thoracic cage excursion can be made. When examining the posterior chest place a hand with fingers extended on either side of the thorax in a lower lateral position. Point your thumbs towards the midline and try to keep them raised off the skin and steady. Ask the patient to breathe in deeply. Get a general sense of how much the hands and thumbs move away from each other and whether one side moves more than the other. Try to begin with the tips of your thumbs reasonably close to the midline as this makes it easier to see asymmetry of movement.
Palpating for vocal or tactile fremitus has little clinical utility. Its reported kappa value is 0.01 which indicates very poor inter-observer agreement.3
A thorough exploration for lymphadenopathy should be undertaken in both the cervical and axillary regions. All the regional subgroups should be assessed in a systematic fashion to avoid accidental omission.