creaky joints artifact during auscultation

[Maynard]

I have very noisy, creaky joints in my fingers, and whenever I auscultate patients I find I often hear more of my joints than I do of the heart. To make matters worse, the sounds made by my joints resemble adventitious heart sounds. I’ve read and tried many different ways of dealing with this, but no way of gripping the stethoscope definitively solves it, except to just rest the stethoscope on the patient’s chest without touching it (not always feasible). Practice has made me better at working around it, but I still feel like I need a better way.

The one consistent workaround I’ve had is to use the in-house stethoscope, which magically doesn’t pick up finger sounds the way my much-more-expensive Littmann Cardio III does. Granted, it may not pick up heart sounds quite as well, but I still get a much better exam out of it. I’m wondering if there’s another high-end stethoscope that would solve the issue.

Has anyone else had this problem? If so, have you found a solution for it?

***(side note: I know from searching forums on this topic that some people will compare my creaky joints to noise from televisions or people talking in the room and say that I can learn to just tune it out with practice. I assure you, it’s not that simple. If you don’t have this problem (most don’t) then you most likely do not have a solution.)

[Guest JMPA]

palm or hold the tubing and not the bell

 

 

[MCHAD]

Are you sure it’s not your stethoscope?

[LT_Oneal_PAC]

2 hours ago, JMPA said:

palm or hold the tubing and not the bell

 

 

Agreed. I have this same problem. Do the above or sometimes I slide the steth under their jacket or whatever and hold in place through the clothes and it dampens the sound of my joints.

[wookie]

i have the same exact frustrating problem and nobody ive asked in person had this issue.

i usually just aim and only leave the tip of my index finger on the stethoscope as gently as possible without having it fall

[Maynard]

Palming doesn't eliminate the sounds for me. I have had some success with holding the tubing, but I have to hold the tubing a couple inches proximal to the diaphragm (if I hold the tubing where it goes over metal it still transmits). This gives me a very floppy hold on the stethoscope and, like resting the stethoscope on the patient without hands, it's not always feasible.

 

I don't think it's my particular stethoscope, given the brand and the fact that multiple attendings and preceptors have borrowed and used it without comment. However, I do think I could solve this problem by switching to another model. Part of my reason for posting this question was I that I was hoping someone else with the same problem had found a brand that eliminates the issue.

[Guest ral]

Curious as to whether or not the problem also occurs when auscultating abdomens.  

This might sound totally crazy but, try these few things:

1.  Auscultate something that doesn't make noise, such as your thigh.  

2.  You listen while someone else holds the stethescope bell against their own or a patient's chest.

3.  Have someone else listen while you hold the bell against yourself or a patient.  

Do you still hear the artifact sounds in the first two situations?  Does the other listener hear artifact sounds in number 3?

 

[camoman1234]

Have the patient hold it and tell them where to move it? :) Seriously, I have had this problem and hold the tubing which does help as well as listen to bare skin. I have a cardiology III and picks up every little noise.