Hear my fingers when auscultating with stethoscope--help!

[Ruban]

Hi all,
I have a very nice stethoscope (Littmann Cardiology III), but I have a problem with it: when auscultating with the stethoscope, I hear what I think are the joints of my fingers in addition to whatever I am listening to. Basically, it seems that the stethoscope is transmitting the tiny noises of my PIP and DIP through the stethoscope, which is annoying b/c it can mimic adventitious sounds!

Anyone else have this problem? Is there a good solution? It is really annoying!

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[Dr JPH]

How are you holding it?

Are you moving that much that you can hear your fingers?

Im a bit confused.

 

[fang]

Hi all,
I have a very nice stethoscope (Littmann Cardiology III), but I have a problem with it: when auscultating with the stethoscope, I hear what I think are the joints of my fingers in addition to whatever I am listening to. Basically, it seems that the stethoscope is transmitting the tiny noises of my PIP and DIP through the stethoscope, which is annoying b/c it can mimic adventitious sounds!

Anyone else have this problem? Is there a good solution? It is really annoying!

This happens to me too. It doesn't matter how I hold it-- with the tips of my fingers, wedged between my index and middle finger, etc. I can hear the creaks in my fingers and sometimes elbow. I've just tried to tune them out (they don't really sound like anything realted to the lung exam, and and with the heart you can listen for several beats). Also, when I auscltate when someone is lying down I let go for a few seconds.

Anyone else have any tricks for this?

 

[Ruban]

This happens to me too. It doesn't matter how I hold it-- with the tips of my fingers, wedged between my index and middle finger, etc. I can hear the creaks in my fingers and sometimes elbow. I've just tried to tune them out (they don't really sound like anything realted to the lung exam, and and with the heart you can listen for several beats). Also, when I auscltate when someone is lying down I let go for a few seconds.

Anyone else have any tricks for this?

YES! Finally someone who knows what I'm talking about! I too have tried lots of different positions.

I hope you and I aren't predisposed to premature osteoarthritis 2/2 defective synovial fluid or something

 

[dpmd]

The only time I experience this phenomenon is when I am using a high end steth (they are too sensitive). With my single tube $12 nursing steth I hear only what I am trying to listen to and I haven't had a problem with missing abnormalities. You could always try positioning the patient so you can let go while you listen. Otherwise you are just going to have to practice enough with it that you start to block out the sounds you are making.

 

[Purifyer]

I get it too. Extremely annoying and scary when you are a newbie. I actually haven't noticed it for a long time though. I remember I changed the way I held my steth (but I can't remember how I changed it - maybe a lighter grip as well as holding the steth alot closer to the the ... diaphragm/bell thing.) edit - I think the sound may be caused in part by your DIP/PIP/MCP being too tense

Maybe, when you know what you are listening for, you just stop paying attention to the joint creaking sounds.

PS. I hope I don't start paying attention to them again because of this thread... haha.

 

[deleted87716]

Learning to "tune out" extraneous sounds when auscultating just takes a little time and practice. Keep at it...you'll eventually be able to tell the important stuff from the background noise with no problem.

 

[AlternateSome1]

I have a lot of finger crepitus too. Just palm the stethescope when you press it against the patient, that way you don't have to worry about your finger movements.

 

[Segadnab]

Hold it by the pivot joint...where the bell and the rubber meet then use leverage to adjust the pressure you want to apply....Works great for me...so well I can differentiate a I from a II.....just kidding.

 

[ericdamiansean]

Hold it by the pivot joint...where the bell and the rubber meet then use leverage to adjust the pressure you want to apply....Works great for me...so well I can differentiate a I from a II.....just kidding.

I use a cardio, and I know exactly what the OP is saying, worse is when you're taking BP and at that moment, you knock onto the metal and you think that's the systolic..

About holding it at the pivot joint, sometimes, I even get transmitted sounds from the rubber too..

So far, my tricks are to palm it hard, or to concentrate real hard and shut down all other noises around me..

 

[Adcadet]

Yup, I hear my joints. I think I hold the scope differently and tune it out. Some people will literally lay they steth on a patient who's laying down and take the hand off, but that only works some of the time.

 

[Ruban]

Thanks for all the replies thus far, folks. To summarize, it seems that the major solutions people are using are:

-Palm the stethoscope rather than holding it with your fingers.
-Hold the stethoscope at the pivot joint
-Let go of the stethoscope when auscultating a supine patient
-Use a cheap stethoscope that is less sensitive

Good tips so far! Anyone have other suggestions? It seems like this is a fairly common problem.

 

[deleted87716]

Use a cheap stethoscope that is less sensitive

Actually, because of their lightweight construction, cheaper stethoscopes are likely to transmit more extraneous noises.

 

[abc56]

hahah i DEFINITELY have the creaky joint problem too!! i thought i was developing a mean case of osteoarthritis but i guess not....

i find that holding the stethoscope at the pivot works really well

sometimes if you just let the stethoscope rest on the patients body without touching it (it looks weird and only works if theyre lying down) that works really well too. actually when youre pronouncing a death and ausculatating the heart/lungs, you are supposed to do that just to be SURE there arent any sounds. creepy but true....

 

[SBlanc]

Yay! I had this problem too starting out but was always too embarrassed to ask anyone else about it... My solution has been (like previous posters said) to hold the rubber tubing right near the metal part, rather than touching the metal itself. Also, not using force (in other words, just resting the diaphragm on the patient gently but so that it makes complete contact) reduces the chance the fingers will move. I stopped noticing it after a while and now I never hear it.

Also remind yourself that it's OK to take a long time to listen and make sure you hear what you think you hear. At first I would try to go fast b/c I was nervous, but I find that patients often prefer you to take your time.

 

[Hard24Get]

I hae a cardiology III as well and I find holding the stethoscope against the chest between my fingertips or using one finger works well.

This is like seeing your own eyelashes in the microscope. It goes away.

 

[adrenalinejunkie]

Hi all,
I have a very nice stethoscope (Littmann Cardiology III), but I have a problem with it: when auscultating with the stethoscope, I hear what I think are the joints of my fingers in addition to whatever I am listening to. Basically, it seems that the stethoscope is transmitting the tiny noises of my PIP and DIP through the stethoscope, which is annoying b/c it can mimic adventitious sounds!

Anyone else have this problem? Is there a good solution? It is really annoying!

I know this is an old post, but as a first year medical student, it's super reassuring to know that it's not just me!

 

[073116]

I also have this problem. I hear my spleen and liver working shush sounds. Mostly spleen. Need to re position myself and breath in slowly so that spleen will get quieter.

 

[Crayola227]

you hear your spleen? do you also get spleen pain? (not medical advice, I'm being facetious)

 

[OrthoTraumaMD]

you hear your spleen? do you also get spleen pain? (not medical advice, I'm being facetious)

Sent from my iPhone using SDN mobile

 

[Matthew9Thirtyfive]

Sent from my iPhone using SDN mobile

Necro bump was worth it for that video.

 

[Crayola227]

to be fair, while it's extremely uncommon to "hear" the spleen, there are rare times where abnormal findings with the spleen (hearing increased blood flow, enlarged, tender) can be a sign of something more serious (cancer, etc) and worth investigating

as a medical student I would highly question if I were indeed "hearing" a "loud" spleen