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Lump and Bump Examination

How to examine lumps and bumps for doctors, medical student finals, OSCEs and MRCP PACES

  • In a lump examination the inspection, palpation and other manouvres are often done in any order
  • The key is to ensure you have a clear idea of the various characteristics of the lump before presenting your findings
  • Not all of the ways of assessing a lump below are needed in every examination – for example, you do not need to auscultate a lump that is evidently a fibroadenoma
    • Cater your examination to the individual – this takes practise


Preparation (WIIPPPE)

  • Wash your hands
  • Introduce yourself
  • Identity of patient (confirm)
  • Permission (consent and explain examination)
  • Pain?
  • Privacy
  • Exposure



  • Anatomical location
    • Usually expressed in terms of distance from a bony prominence (e.g. 2cm superior to the angle of the right mandible) or a well-demarcated site (e.g. left antecubital fossa)
  • Relationship to surrounding structures
    • It may be possible to determine the anatomical plane from information given in the history or on examination (e.g. a subcutaneous lump lying superficial to a muscle will become more prominent when the underlying muscle is contracted, an intramuscular or submuscular lump will become less visible)



  • Size can be estimated but ideally should be measured using a tape measure or ruler
    • This ensures accuracy and allows objective assessment of any change in size
  • Size should be stated in at least two dimensions (and three where possible)
    • For example “I palpated a 3 by 5 by 5cm mass…”




Surface (appearance and colour)

  • Appearance
    • Is it smooth or rough; flat or raised; regular or irregular?
    • Is there any evidence of ulceration (skin breakdown) or necrosis (blackened, usually secondary to ischaemia)?
      • Normal skin often overlies deep lumps, while superficial swellings are more likely to result in a change in the overlying skin
  • Colour
    • The lump may be the colour of the overlying skin or may appear red and inflamed
    • Certain lumps are abnormally pigmented (e.g. melanoma)



  • This clinical feature describes a spectrum between hard and soft and can be considered under three categories: hard, firm (rubbery or spongy) or soft
    • Hard lumps suggest the possibility of cancer
    • Fluid-filled lumps may be tense (and thus quite hard), rubbery or spongy
    • Soft lumps are more likely to be benign (e.g. lipoma)
  • In terms of comparisons: hard is like your chin, firm is like your nose, soft is like your ear-lobe



  • Note whether the lump is pulsatile, suggesting a vascular origin
  • Try to determine whether the pulsation originates from the lump itself or whether it is transmitted from a nearby vessel
  • Intrinsic pulsation is indicated by a swelling that is pulsatile and expansile (e.g. an abdominal aortic aneurysm)


Video on neck lump examination


Compressibility and reducibility

  • Compressibility
    • Lumps that can be emptied by pressure but reappear spontaneously on release of pressure are compressible (e.g. saphena varix or varicose veins)
  • Reducibility
    • Lumps which disappear with pressure and do not return spontaneously (e.g. inguinal hernias) are reducible
  • Before attempting to compress or reduce a lump be sure to ask the patient if the area is tender
  • It is often helpful to ask the patient to demonstrate reducibility themselves (particularly true of hernias)



  • To test for fluctuation put your fingers on either side of the lump, opposite each other.  Press with one finger and feel whether the lump bounces against your other finger
  • This indicates a fluid- or fat-filled lump
  • If the lump is thought to contain fluid, this can sometimes be confirmed by eliciting a ‘fluid thrill
    • Tapping a large fluid-filled swelling causes a pressure wave which can be felt on the other side of the lump


Video on how to test for fluctuation



  • Observe first whether the lump moves spontaneously, on respiration or with muscular contraction
    • Certain lumps have a characteristic mobility (e.g. fibroadenoma). The mobility of other swellings may vary depending on anatomic site and other factors
  • Lesions that lie superficial to a muscle group should be tested for mobility with the underlying muscles both relaxed and contracted
    • If a previously mobile lump becomes fixed on contraction of the underlying muscles it is likely that the lesion has infiltrated the muscle layer
  • Mobility can also be reduced by ‘skin tethering’, which reflects an inflammatory or neoplastic process (e.g. in breast cancer)
    • Tethering can be demonstrated by gently moving the lump in two planes, looking carefully for wrinkling or pulling of the skin



  • Using a pen torch, shine a light across the lump – ideally in a dark room
  • A swelling containing clear fluid will glow when this test is performed, such as in:
    • Simple cyst
    • Hydrocele
    • Cystic hygroma
  • It is important to note, however, that lipomas (fat-filled lumps) will also transilluminate



  • Percussion is of limited value in assessing most lumps but may still provide important information
  • Gas-filled swellings (such as any involving the bowel) are resonant to percussion, while dullness to percussion is a feature of fluid-filled lesions and solid structures (e.g. retrosternal thyroid mass)


Auscultation (bruits, murmurs & bowel sounds)

  • Auscultation may confirm findings in the preceding examination. Typical findings include bruits/murmurs over vascular lesions or areas with an abnormally increased blood supply (e.g. enlarged thyroid) and bowel sounds heard over an inguinal hernia


Extra points

  • Examination should be completed with a specific examination of the lymph nodes which drain the site of the lump, followed by a general assessment of the patient, with particular attention being paid to eliciting signs of systemic infection or malignancy
  • Temperature, weight loss and lymphadenopathy are particularly relevant in this respect


Complete the examination

  • Thank the patient after finishing the examination
  • Make sure they are comfortable and happy getting dressed
  • Clean your hands with alcohol gel
  • In an exam hold your stethoscope behind your back, then turn to the examiner to present your findings…


Now click here to learn about the skin examination and here for the breast exam

Perfect revision for medical student finals, OSCES and PACES