Systemics Final OP

10 mins written, 3 mins special test and pulse, 12 minutes OP

Pulse
Common carotid: side of neck, below angle of mandible
Axillary: palm along humerus (facing lat), finger pads to axilla line
Brachial: medial side of biceps brachii. Flex bicep, relax, push it out of the way.
Anywhere along med line of bicep or where we locate close to cubital fossa (medial
side)
Radial:  distal end of radius. Anterior/ lateral surface OR in anatomical snuff box
Ulnar: From medial side, push FCU tendon out of the way. Feel for pulse on distal/ ant
surface of shaft of ulna. Lateral to FCU tendon, sink in to feel pulse. Lateral to pisiform/
hook of hamate
Femoral: ASIS down along/ inf inguinal ligament. Go just medial of sartorius & sink in to
"squishy" area (pectineus here). Use Inner hand w/ finger pads below inguinal lig;
reinforce with other hand
Popliteal: btw hamstrings tendons w/ flex knee in supine. face fingers on back of thigh,
w/ hamstrings, pads toward popliteal fossa in prone
Posterior tibial: behind medial malleolus
Anterior tibial/ Dorsal pedis: from dorsum of the foot, along metatarsal 1. Terminates
btw 1st & 2nd toe

Special tests (All test Bilaterally)

Buergers Test (Rubor Test)
 Patient is supine while examiner elevates leg 45 degrees for at least 3 minutes
 Positive: foot turns white or prominent veins collapse = poor arterial flow
 The patient is then asked to sit in a relaxed position
 Positive:1-2 minutes for the color in the foot to be restored and the prominent
veins to refill
 Expected findings: double positive for patient with buergers

Capillary Refill Test

 Therapist compresses the nail bed, colour should return within 3 seconds
 Positive: Longer than 3 seconds = arterial insufficiency is suspected
 Expected findings: positive for patient with Raynaud’s

Allen Test
 Opens and closes hand several times then squeezes hand tightly in a fist
 Therapist places thumb and index finger over radial and ulnar arteries
compressing them
 Patient opens hand while pressure is maintained over arteries
 Pressure is released from one artery, watch for flushing
 Test the other artery by doing the test again but releasing opposite artery
 Expected findings: No positive, determines which artery is main blood supply to
hand, failure to for hand to flush may indicate and issue with that pathway
Greater Saphenous vein Competency
 Standing
 Palpate along varicose vein distal to knee and then at the spot more proximal
along vein, at least 20 cms higher 
 Percuss vein proximally and feel for the pulse in distal hand
 Positive: backflow of blood pulsing at the distal point  
 Expected Findings: positive for patient with varicose veins

Homans Sign
 Supine 
 Wrap fingers around muscle belly of gastrocs, patient dorsi-flexes the ankle while
therapist squeezes muscle belly
 Positive: severe pain on pressure (Testing isn’t absolute)
 Expected Findings: negative

Tactile or Vocal Fremitus

 Palpable vibrations transmitted through the chest wall when the patient speaks
 Hands are placed lightly on chest wall, and the patient repeats “99”
 Normal = uniform vibration
 Presence of secretions = increased fremitus/vibrations. Positive for COPD/
chronic bronchitis
 Trapped air = decreased or absent fremitus/vibrations. Positive for asthma and
emphysema
 Expected Findings: increased vibration for chronic bronchitis or decreased
vibration for emphysema/asthma

Percussion
 Assesses whether the lung is air filled or solid 
 Place fingers of one hand flat against the chest wall along the intercostal space 
 With the tip of the middle finger on the other hand, tap on top of the middle finger
that is on the patient, flat along the chest wall
 Perform at the anterior and posterior chest wall
 Hollow or resonant sound= normal
 Dull/flat sound = Positive for solid matter such as tumor or solidification
 Hyper-resonant or tympanic = Positive increased amount of air (as in
emphysema)
 Expected Findings: positive for hyper-resonant in emphysema/asthma
Sinusitis

History questions
1. Are you talking any decongestion/anti-inflammatory meds?
2. Do you have any allergies?
3. Are you experiencing any tooth pain?
4. How do you blow your nose?
5. What side do you sleep on?

Assessments
1. Length assessment for SCM/scalene/temporalis/masseter. Activation of latent TP
shows induced headache from these muscles
2. ROM testing of C-spine. find baseline of ROM
3. Shoulder check/4 corners: compare ROMs of unaffected side and affected side
4. VAT: checking for vertebral artery insufficiency

Expected findings:
1. Shortness of muscle on affected side/ Bilateral
2. Decreased C-spine ROM
3. Decreased ROM of affected side
4. Negative for VAT, no nystagmus or dysarthria

Goals:
1. Decrease congestion of (sinus) with fingertip tapotement
2. Increase (range) of C-spine with muscle stripping of scalene, SCM, levator
scapulae
3. Decrease HT of SCM with GTO release

CI/Precautions:
1. Congestion meds
2. Dermatological disorders

Homecare
 Stretch: pain-free, 30-60 seconds, twice a day, everyday until next visit
 Strengthening: isometric, 60% resistance, 6-10sec/set, 3-5 sets/day, everyday
until next visit
 Hydro: facial steam. Around 40 degrees, 5 mins each time, 5 times a day with 1-
2 hours in between each, every day for a week
Tension headache

History Questions
1. Frequency, quality, location of pain?
2. Is there any visual/digestive disturbances?
3. Do you have any hypertension?
4. Are you on any medications (NSAIDS)?
5. Is the pain worse in the AM vs PM?

Assessments
1. Compression decompression test, test for compression at the nerve root
2. Spurling’s test, test for facet joint irritation
3. Length assessment for muscle, activation of latent TP shows induced headache
from the muscles
4. ROM testing of C-spine. find baseline of ROM

Expected findings
1. Reproduction of neurological symptoms during compression and reduced
symptoms during decompression
2. Pain local in the neck
3. Shortness of muscle on affected side/ Bilateral
4. Decreased C-spine ROM

Goals
1. Decrease trigger point to UT, SCM, elevator scapula with TPR
2. Decrease HT of suboccipital with GTO release
3. Increase AROM of C/S with traction

CI/Precautions:
1. Meds
2. Hypertension
3. Dermatological disorders

Homecare
 Stretch: pain-free, 30-60 seconds, twice a day, everyday until next visit
 Strengthening: isometric, 60% resistance, 6-10sec/set, 3-5 sets/day, everyday
until next visit
 Hydro: Heat pack to shoulder/neck. 40 degrees, 5-20 mins each time, 2 times a
day, am and pm, every day for a week
Migraine

History Questions
1. Is there any visual/digestive disturbances?
2. Do you have any hypertension?
3. How is your hormones/menstrual cycles?
4. Are you on any medications (NSAIDS)?
5. Is the pain worse in the AM vs PM?

Assessments
1. Compression decompression test, test for compression at the nerve root
2. Spurling’s test, test for facet joint irritation
3. Length assessment for muscle, activation of latent TP shows induced headache
from the muscles
4. ROM testing of C-spine. find baseline of ROM

Expected findings
1. Reproduction of neurological symptoms during compression and reduced
symptoms during decompression
2. Pain local in the neck
3. Shortness of muscle on affected side/ Bilateral
4. Decreased C-spine ROM

Goals
1. Decrease trigger point to UT, SCM, elevator scapula with TPR
2. Decrease HT of suboccipital with GTO release
3. Increase ROM of joint with traction
4. Increase muscle length with pin and stretch

CI/Precautions:
1. Meds
2. Hypertension
3. Photophobia/phonophobia
4. Dermatological disorders

Homecare
 Stretch: pain-free, 30-60 seconds, twice a day, everyday until next visit
 Strengthening: isometric, 60% resistance, 6-10sec/set, 3-5 sets/day, everyday
until next visit
 Hydro: Derivation (40 degrees) feet and retrostasis (0 degree) neck, 20 mins
max, 1-2 time/day, everyday for a week
Constipation

History Questions
1. Are you experiencing any bloating or flatulence in the stomach?
2. Do you have any food allergies?
3. Are you taking any codeine, opiates, antidepressant meds?
4. Have you made any recent changes to your lifestyle

Assessments
1. Rebound tenderness test, to test for appendicitis
2. Pinch an inch test, to test for peritonitis
3. Crunch test, to differentiate between muscle mass or intra-abdominal mass
4. Thomas test, to test for hip flexors

Expected Findings
1. Negative, no fever and nausea
2. Negative, no pain on release
3. Mass disappears, positive for intra-abdominal mass
4. Positive for tight hip flexors

Goals
1. Increase motility of colon with directional kneading
2. Decrease HT to glut max with muscle stripping
3. Decrease HT of iliopsoas with GTO bowing
4. Decrease TP to glut max or iliopsoas with trigger point release

CI/Precautions:
1. Meds
2. No hot hydro if hypertension
3. No cool abdominal wash with diarrhea
4. Diabetic appliances
5. Dermatological disorders

Homecare
 Stretch: pain-free, 30-60 seconds, twice a day, everyday until next visit
 Strengthening: isometric, 60% resistance, 6-10sec/set, 3-5 sets/day, everyday
until next visit
 Hydro: Cool abdominal washes at 5-7am, 20 degrees, 5-10mins, every day until
proper bowel movement
Thromboangiitis Obliterans/Buerger’s Disease

History Questions
1. Are you currently on any vasodilators or blood thinner meds?
2. Do you have hypertension?
3. Are you experience any Numbness, tingling, weakness?
4. Do you smoke?

Assessments
1. Buergers test/rubor test, to test for prominent veins collapse and time for
prominent veins to refill
2. Pulse check in arms and leg, to test for circulation

Expected Findings
1. Double positive, foot turns white from elevation and takes 1 minute for color in
foot to be restored
2. Positive, pulse loss for posterior tibial and dorsal pedis

Goals
Case dependent, work around buerger’s
1. Decrease TP with trigger point release
2. Decrease HT with muscle striping and GTO release
3. Increase muscle length with pin and stretch
4. Increase ROM of joint with traction

CI/Precautions:
1. Do not treat distal to line of demarcation
2. Dermatological disorders

Homecare
 Stretch: pain-free, 30-60 seconds, twice a day, everyday until next visit
 Strengthening: concentric contraction, 60% resistance, 8-12 reps/set, 3-5
sets/day, everyday until next visit
 Hydro: Reflex heating, Heat proximally to site on affected side and same area on
opposite limb to increase circulation. 40 degrees, 5-20 mins each time, 2 times a
day, am and pm, every day for a week
Raynaud’s Disease

History Questions
1. Are you currently on any decongestion meds?
2. How frequent are the “attacks”?
3. Is the symptom bilateral or unilateral?
4. Are you sensitive to cold?

Assessments
1. Capillary refill test, to test for sufficiency of artery
2. Myotome testing, integrity of nerve roots
3. Pulse check in arms and leg, to test for circulation

Expected Findings
1. Positive, takes more than 3 seconds to refill
2. Negative, functional nerve roots
3. Diminished/absence of pulse

Goals
1. Decrease fascial restriction at wrist joint with fascial techniques
2. Decrease TP with trigger point release
3. Decrease HT with muscle striping and GTO release
4. Increase muscle length with pin and stretch
5. Increase ROM of joint with traction

CI/Precautions:
1. Decongestion meds
2. No deep techniques
3. Avoid extremes of temperature
4. Dermatological disorders

Homecare
 Stretch: pain-free, 30-60 seconds, twice a day, everyday until next visit
 Strengthening: concentric contraction, 60% resistance, 8-12 reps/set, 3-5
sets/day, everyday until next visit
 Hydro: mild contrast, 37 degrees warm, 28 degrees cool, on wrist, 3mins heat,
30sec cool, 3 times, 2 times a day, everyday for a week
Varicose Veins

History Questions
1. Are you taking oral contraceptives?
2. Do you smoke?
3. Do you have a family history of varicose veins?

Assessments
1. Great saphenous vein competency test, to test for valve integrity
2. Homans sign, to test for Deep vein thrombosis

Expected Findings
1. Positive, backflow of blood pulsing at distal point
2. Negative, no pain on pressure

Goals
Case dependent, work around varicose veins
1. Decrease TP with trigger point release
2. Decrease HT with muscle striping and GTO release
3. Increase muscle length with pin and stretch
4. Increase ROM of joint with traction

CI/Precautions:
1. No direct pressure/treatment over varicose veins
2. Oral contraceptive, blood thinners, decongestion meds
3. Skin fragility
4. Dermatological disorders

Homecare
 Stretch: pain-free, 30-60 seconds, twice a day, everyday until next visit
 Strengthening: concentric contraction, 60% resistance, 8-12 reps/set, 3-5
sets/day, everyday until next visit
 Remex: ankle pumping. 5 sec of PF and DF, 10-15 times, 2 times a day (1am,
1pm), every day for a week
 Hydro: mild contrast, 37 degrees warm, 18 degrees cool, posterior leg, 5 mins
each, 3 times, twice a day, everyday for a week
Chronic Bronchitis

History Questions
1. Are you on any anti-inflammatory, decongestion, bronchodilator meds?
2. Are you experience dyspnea/ shortness of breath?
3. Do you smoke
4. How is the serverity, quantity, quality of your cough?

Assessments
1. Vocal fremitus, to test for presence of secretion and trapped air
2. Percussion, to test for lung density

Expected Findings
1. Increased fremitus/vibration, presence of secretion from chronic bronchitis
2. Resonant sound

Goals
1. Removal of secretion with tapotement
2. Decrease hypertonicity to pecs, scalene, SCM, levator scapula, intercostals,
suboccipital, splenii with muscle stripping or GTO release
3. Decrease trigger point to pecs, scalene, SCM, levator scapula, intercostals,
suboccipital, splenii with trigger point release
4. Reduce fascial restriction with fascial techniques

CI/Precautions:
1. No joint paly to rib hypermobility and subluxation
2. No tapotement to floating ribs
3. Dermatological disorders

Homecare
 Stretch: pain-free, 30-60 seconds, twice a day, everyday until next visit
 Strengthening: concentric contraction, 60% resistance, 8-12 reps/set, 3-5
sets/day, everyday until next visit
 Hydro: facial steam. Around 40 degrees, 5 mins each time, 5 times a day with 1-
2 hours in between each, every day for a week
Asthma

History Questions
1. Do you have a family history of asthma?
2. Are you on any anti-inflammatory, decongestion, bronchodilator meds?
3. Have you used your inhaler before coming in today?

Assessments
1. Vocal fremitus, to test for presence of secretion and trapped air
2. Percussion, to test for lung density

Expected Findings
1. Decreased fremitus/vibration, presence of trapped air from asthma
2. Hyper-resonant sound

Goals
1. Decrease hypertonicity to pecs, scalene, SCM, levator scapula, intercostals,
suboccipital, splenii with muscle stripping or GTO release
2. Decrease trigger point to pecs, scalene, SCM, levator scapula, intercostals,
suboccipital, splenii with trigger point release
3. Reduce fascial restriction with fascial techniques

CI/Precautions:
1. No joint paly to rib hypermobility and subluxation
2. Dermatological disorders

Homecare
 Stretch: pain-free, 30-60 seconds, twice a day, everyday until next visit
 Strengthening: concentric contraction, 60% resistance, 8-12 reps/set, 3-5
sets/day, everyday until next visit
 Hydro: facial steam. Around 40 degrees, 5 mins each time, 5 times a day with 1-
2 hours in between each, every day for a week