Zieman’s Test (Three Finger Test) : Procedure, Examination of Inguinal Hernia
Procedure
- The examiner places his index finger on the deep inguinal ring and middle finger on the superficial inguinal ring, ring finger over saphenous opening. The patient is asked to cough or to hold the nose and blow. If the impulse is felt on the index finger, it is indirect hernia.
Index finger on the deep inguinal ring
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Middle finger on the superficial inguinal ring
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Ring finger over saphenous opening
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Ask the patient to cough
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Impulse felt on the index finger
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Indirect hernia
Use
Zieman’s Test (Three Finger Test) is used to differentiate type of hernia.
A hernia is an abnormal protrusion of the whole or a part of a viscus through an opening in the wall of the cavity in which it is contained which occurs as a result of an area of anatomical weakness or disruption of the fibromuscular tissues of the body wall.
1. Inguinal hernia is defined as the protrusion of the abdominal content through the superficial inguinal ring.
- Indirect hernia : Inguinal hernia is indirect when abdominal content comes out through deep inguinal ring (internal ring) into the inguinal canal along with the cord.
- Direct hernia : Inguinal hernia is direct when herniation of abdominal content occurs through the posterior wall of the inguinal canal via Hesselbach’s triangle.
2. Femoral hernia is defined as the protrusion of the abdominal content through the femoral canal.
Rules of hernia examination
- Never forget to examine the opposite side of body.
- Never forget to do per rectal examination (PR).
- Never forget to examine urethra.
- Never forget to check abdominal muscular tone.
- Never forget to do examination in appropriate manner & conditions.
Differential diagnosis should be considered during examination of any type of swelling in pelvic or inguinal region.
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