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April 9, 1997

Diagnostician's DigitA Repercussion of Percussion

Author Affiliations

From Northwestern Memorial Hospital, Northwestern University Medical School, Chicago, III.

JAMA. 1997;277(14):1168. doi:10.1001/jama.1997.03540380082038

Percussion, described by Dr Leopold Auenbrugger in 1761, has long been a tool used by the physician as a technique in the art of physical diagnosis.1 One method, bimanual indirect or mediate, is done by placing the left long finger on the body surface to be percussed to serve as a pleximeter. The area about the distal interphalangeal joint is struck a sharp blow with the tip of the flexed right long finger, the plexor.2

An octogenarian physician, a practicing internist, graduated from medical school in 1936 and has been using the art of digital percussion for more than 62 years, including his time as a medical student. The posttraumatic hyperpigmentation with central hypopigmentation and atrophic changes are a result of innumerable repetitions of the technique of bimanual indirect percussion. The physician first noticed the lesion more than 5 years ago. A similar lesion does not exist on