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Patient crosses arms and places hands on opposite shoulders. Begin by inspecting posterior thorax for contour, symmetry, deformities, and skin condition. Palpate chest wall for pain, tenderness, lesions, or abnormalities found during inspection. Assess lung expansion by placing thumbs close to spine at T10 level, spread fingers across lateral thorax, and ask patient to inhale and exhale deeply. Watch thumbs for movement divergence and feel for range and symmetry. Systematically palpate for tactile fremitus by asking patient to say "ninety-nine" as you touch their chest.
