This test is used to visually assess asymmetrical chest expansion, a potential sign of pleural effusions, thoracic wall trauma, deconditioning, etc.

Performing the Test

  1. Place both hands on chest
    • Posterior: Thumbs at approximately the 10th ribs with fingers resting parallel to ribs
    • Anterior: Thumbs resting parallel to costal margin
    • Hands should be placed medially and then slid medially to raise a fold of skin bilaterally between your thumb and patient's spine
  2. Ask patient to take a deep inspiration and then expiration
  3. Looking at the extent of skin unfolding, assess the range of expansion and symmetry

Evaluating the Result

  1. For evaluation of a pleural effusion, asymmetric chest expansion increases the likelihood ratio:
    • Asymmetric chest expansion: LR+ = 8.1 (95% CI = 5.2-12.7)
    • Absence of reduced tactile vocal fremitus: LR- = 0.21 (95% CI 0.12-0.37)
    • Dullness to conventional percussion: LR+ = 8.7 (95% CI, 2.2-33.8)


  1. Bickley LS. The thorax and lungs. In: Bickley LS, Szilagyi PG. Bates' Guide to Physical Examination and History Taking. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:283-321.
  2. Wong CL, Holroyd-Leduc J, Straus SE. The rational clinical examination: Does this patient have a pleural effusion? JAMA. 2009;301(3):309-317.