Tenderness may occur with metastatic bone deposits or cervical spondylosis. When assessing vertebral tenderness, start with light pressure over the cervical and thoracic spines. If no tenderness is found, progress to heavier percussion by tapping your fist onto the back of your hand, over each area in turn (figure 31a–e).

Percuss (see above) and palpate for evidence of liver enlargement (figure 32) from metastases, in known or suspected pulmonary malignancy.