Stigmata of Chronic Obstructive Pulmonary Disease (Stanford Medicine 25) 

1. Tripod position ........... Allows the scalene muscle (an accessory muscle of the neck) to yank the rib cage & aid in its expansion. Also, sitting forwards pushes the abdominal contents upwards, increasing the curvature of the diaphragm and improving its effectiveness. The tripod position optimizes the mechanics of respiration by taking advantage of the accessory muscles of the neck and upper chest to get more air into the lungs. With the position of the arms secure, contraction of the pectoralis results in elevation of the anterior wall of the chest. The tripod position may be seen in cases of pericarditis as well since leaning forward tends to alleviate the chest pain of pericarditis. 2. Dahl’s sign (or thinker’s sign) ........... Dermatitis (hyperpigmentation & hyperkeratosis or thickening) on the thighs from prolonged resting of the palms on the thighs while in the tripod position. COPD patients tend to sit forwards with their arms resting on their thighs (tripod position), leading to chronic erythema of the skin at the points of contact. Over time, hemosiderin released from RBCs trapped in the skin causes a brown discoloration of said skin. 3. Flaring of the ala nasi 4. Pursed-lip breathing - Lips pursed during exhalation in order to prolong the expiratory phase and reduce air trapping. 5. Hollowing (cupping) of the supraclavicular fossa 6. Hollowing of the subclavicular fossa 7. Sternocleidomastoid muscle (SCM) hypertrophy 8. Inspiratory descent of the trachea 9. Descent of the laryngeal prominence (Adam’s Apple) during inspiration caused by the flattened diaphragm pulling on the taut pericardial sac &, thus, the trachea during contraction. 10. Prominent sternal angle of Louis 11. Exaggerated thoracic kyphosis 12. Increased anteroposterior diameter of the chest (barrel chest) 13. Harrison's sulcus ........... Hourglass appearance of the lower thoracic cage (subcostal grooves forming on the patient’s sides) as the diaphragm pulls the rib cage in as it contracts during inspiration. 14. Obtuse subcostal angle - a normal subcostal angle is acute (< 90°). 15. Hoover’s sign ........... Narrowing of the subcostal angle (which should normally widen) upon inhalation due to the inward pull on the rib cage by the flattened diaphragm as it contracts in a horizontal fashion.

the signs that he talked about in the video are stooped posture or tripod position dahl's sign which is dermatitis of thighs because of resting your hands on the thighs too long for maintaining stooped posture alar flaring pursed lips while exhaling hypertrophy of the sternocleidomastoid muscle tracheal decent with inspiration cupping of supra clavicular fossae very prominent angle of louis barrel chest thoracic kyphosis subcoastal angle widening hour glass apperance of lower throacic cage (harrisons sulcus) hoovers sign (narrowing of sub coastal angle with each diapragmatic contraction)

Wow probably the most informative video on COPD

You keep us maintain our hope on getting proper clinical education. Many thanks to your efforts.

Thanks for clearing up the reasoning behind the tracheal tug maneuvre could not find it anywhere

You have fantastic clinical education videos, and the physician in these videos explains things well. My suggestion is to either illustrate these signs with a real patient, or pause the video and show these signs when mentioned

these videos are great hope more are made

I love this Doc.

Excellent video. Thanks!

That was a good video doc! thanks.

Best explanation till date ❤️

priceless teaching

Excellent video thank you so much!

Thank you for helping us

I love you DOCTOR!!!!

U guys are amazing!

Wonderful . I like it .

thank you for this video!

Awesomely informative. Thanks for posting these valuable videos for all to learn.

suggestion ; when doctor tels example sing harrison sulcus its important to put image at the sides of the video

greattt video thank you

Thank you

Superb

Thank you🤍🤍🤍

i would like to learn more that it is a obstructive disease

Tracheal tug and inspiratory tracheal descent is so confusing can u plz explain it more ...

Why is there supraclavicular and infraclavicular hollowing in emphysema??

thx good video is good to learn this i have been a send hand smoker sense i was born , i have trade smokering but it did not like the feeling that the nikitin gave so i said that not for me. thx

Which books can we find these in? Or is just many years of experience and reading.

Can these elevations on the patient be classified as keloids?

I have all these. Quite obviously too. I'm a 5'5" woman and will be 58 next month. I can slowly walk about 10 yds without oxygen, and maybe 50 yds slowly with oxygen. I'm on 2lts oxygen for min 16 hours a day. I weigh about 98lb (never weighed more than about 115lb). I found out I had COPD about 10 years ago. I'd love to know how long I've got left?

Nice video, but why not demonstrate with an actual COPD patient?

Too bad I can't understand I'm from Romania with this severe mixed chronic bronchitis disease

Can any one please summarize all the signs of obstructive pulmonary disease

lol fuck up on my typeing sorry

I'm just here for the hot guy lol

Nakamay log kuch ata ni ha

What happened to his chest?