MSK Flashcards
Salter-Harris Fractures involvement
all types involve the physis (epiphyseal plate)
for one and 5, only the physis is injured
2-4 - metaphysis and/or epiphysis is fractured
- M, E, ME: 2: Metaphysis, 3:Epiphysis, 4: M & E
Salter-Harris Fractures type I
physis is widened, distorted, or displaced by traction or shear force
Salter-Harris Fractures type V
physis is crushed or compressed by axial copression
Salter-Harris Fractures type II
Metaphysis fractured
Salter-Harris Fractures type III
epiphysis fractured
Salter-Harris Fractures type IV
Metaphysis and Epiphysis fractured
what is the Salter-Harris system used for?
classify fractures in CHILDREN ONLY
What is a Jefferson’s fracture?
cervical spine;
caused by heavy object falling directly on the head or hitting head while diving.
at least two fractures of c1
What is a Hangman’s fracture?
cervical spine;
occurs often in MVA or hangings
B/L pedicle fracture with anterior displacement of C2
What is a Clay shoveler’s fracture?
cervical spine;
result of flexion injury in the lower cervical spine in which the spinous process is broken or fractured
What is a Chance fracture?
Thoracolumbar spine;
horizontal fracture of a vertebra, usually result of a MVA where the seat belt immobilizes pelvis but upper body is thrust forward
What is a burst/compression fracture?
thoracolumbar spine;
collapse or compression of vertebral body, usually caused by fall from a height
What is spondylolysis?
defect in pars interarticularis, appears as a collar on the “Scottie dog”
best seen in oblique view
What is spondylolisthesis?
bilateral pars interarticularis defect causing misaligned vertebrae causing forward slip, usually L5-S1
What is a bucket handle fracture?
pelvis;
fracture through ischiopubic rami on one side and fracture of SI joint on other side
What is a malgaine fracture?
pelvis;
fracture through ischiopubic rami and SI joint on same side
What is an avulsion fracture?
pelvis;
a small piece of bone is separated from the origin or insertion site of a tendon
how is imaging usually done if there is a suspected AC joint separation?
shoulder XR taken with pt holding weights; 3 grades
clavicular fracture most frequently occurs ____ (proximal, distal, middle)
middle third of the bone
What should you look for on imaging for a radial head fracture?
difficult to see; look for ant and post fat pad signs
What is a Monteggia fracture-dislocation (night stick)?
caused by receiving a blow when protecting oneself; dislocation of radial head and fracture of ulna
What is a Galaezzi fracture-dislocation?
caused by falling on outstretched hand and dislocating the distal radio-ulnar joint and fracturing the distal radius
Mnemnonic for elbow fractures
policeman Radii Galeazzi tried to hit thief Ulna Monteggia for stealing his bike. Ulna Monteggia blocked the blow to his forearm and tripped policeman Radii Galeazzi who fell on his outstretched hand
What is a Colles’ fracture?
wrist;
distal radial fracture posteriorly displaced
What is a Smith’s fracture?
wrist;
distal radial fracture anteriorly displaced
What is the most common fractured carpal bone? What are signs of fracturing this bone and what complications may arise?
scaphoid fracture
pain in anatomical snuffbox
may give rise to avascular necrosis
What is “gamekeeper’s thumb”/”Skiers thumb”?
a hand fracture;
fracture of the base of the proximal phalanx of the thumb
What is a Bennett’s fracture?
fracture through the base of the first (thumb) metacarpal
What is a Boxer’s fracture?
fracture of the 5th metacarpal
What is a “Bar Room/Brawler’s” fracture?
fracture of the 3rd metacarpal
What is a subcapital fracture?
fracture under the head of the femur; can lead to avascular necrosis
Common mechanism of injury for hip dislocation
common MVA injury to have impact on knee when hip is flexed (sitting) which causes femoral head to be displaced posteriorly (90% hip dislocations are posterior)
What is a spiral fracture?
common femoral, tibia, or fibular shaft fracture
What is a tibial plateau fracture?
impact most common on lateral side
What is a march fracture?
stress on the second or third metatarsal
What is a jones fracture?
common fracture seen in athletes at the base of the fifth metatarsal
Indications for a bone scan with normal L spine XR?
osteomyelitis
bony neoplasm or metastases
occult vertebral fracture
how do bone scans work?
radiographic tracer uptakes in areas with high bone turnover
advantages and disadvantages of bone scans
sensitive for bony neoplasm and infection
disadvantage: non specific
false pos for osteoarthritis in older pts
false neg for diffuse bony mets, multiple myeloma
what types of joint pain pathologies have a unilateral pattern?
infectious
crystalline
trauma
HIP: AVN + SCFE
what types of joint pain pathologies have a paired pattern?
RA
enteropathogenic
psoriatic
what types of joint pain pathologies have a paired and wandering pattern?
post strep (inc ASO)
what types of joint pain pathologies have a mixed/asymmetric pattern?
OA
reactive arthritis
concern for AVN of femur/hip
onset of pain in one hip that does not improve
esp ppl on chronic steroid therapy (more likely to throw small microemboli)
what is the most common muscualr dystrophy of children?
duchenne’s MD
what is the most common dystrophy in adults?
myotonic dystrophy
etiology/presentation/prognosis of Duchenne’s muscular dystrophy
sex linked, males
muscle replaced by fat/pseudohypertrophy of calves (gowers sign+)
usu death by 20
presentation myotonic dystrophy
presents in adolescence with facial atrophy
what is osteomyelitis
pyogenic infiltration of staph; spreads through the blood (concern with open fractures)
brodies abscess: walled off area of bacteria
sinus tracts develop, squamous carcinoma common at sinus tracts
recurs
what is tubercular osteomyelitis
blood bourne TB
destructic
thoracic and lumbar spine
common causes of osteoporosis
primary: menopausal, reduction of bone mass/matrix and demineralization
secondary: dz; advanced hyperthyroid, PTH dz
what is osteomalacia
demineralization of bone
what is osteochondroma
most common benign bone tumor
exostoses with cartilagenous covering; chondrosarcoma is a risk with multiple lesions
what is paget’s/osteitis deformans?
paramyxovirus; lytic mixed with sclerotic areas
esp skull, bowing of femur/tibia, OA
pathologic fracture common
what is an osteoma?
benign; normal bone exostosis on skill; if multiple then gardeners yndrome (intestinal polyps and sarcomas)
what is an osteroid osteoma?
benign tumor of osteoblasts in vertebrae and long bones; young adults
what is osteosarcoma
primary bone cancer, adolescent males, familiarl
secondary to pagets in elderly
destructive, mixed lytic and blastic, lifts periosteum (painful); heme spread to lungs, bone, brain
second most common primary malignant bone CA
what is the most common primary malignant bone tumor?
chondrosarcoma
what is a chondrosarcoma?
malignant tumor of cartilage
pelvis of middle aged men; shoulders, ribs, painful enlarging mass
can mets
what is ewings sarcoma?
bone cancer
more common in young, extremely malignant
viscous liquid like pus in marrow, sheets of round cells
metastatic
etiology and presentation infectious arthritis
GC, staph, strep, TB, lyme
common post trauma
acute painful swollen single joint, fever
etiology and presentation of gouty arthritis
hyperuricemia, uric acid in and around joints
1st MTP, tophi in olecranon, prepatellar, calcaneal tendon, pinna
genetic, heavy alcohol use (ddx pseudogrout, same signs/sx no uric acid inc)
etiology/presentation ankylosing spondylitis
marie stumpell dz, adolescent males
bony ankylosis of SI ad vertebral processes with severe spinal immobility
RA presentation/etiology
collagen vascular dz, females 25-50, RF pos
nodules at PIP joints, boutonniere deformity
arthritis in 3+ joints, symmetric
pannus (inflamed synovial tissue), rice bodies (fibrin), infiltrates, vasculitis, feltys syndrome
splenomegaly, neutropenia, deformity
bakers cyst, prolonged am stiffness
OA etiology/presentation
progressive erosion of articular cartilage (injured/overused joints)
bouchards node at PIP
herberdens nodes (osteophytes at DIP)
sundrondral cysts, osteophytes, hips, knees, lumbar, cervical
what conditions can lead to an inflammatory arthritis and effusion?
infection
gout
RA
what are the seronegative arthridities?
psoriatic arthritis
enteropathogenic arthritis
reactive arthritis
what marker results are present with the seronegtive arthritidies?
RF-
HLA B27+
presentation psoriatic arthritis
HLA B27+
DIP degernation
10% pts with psoriasis
enteropathogenic arthritis presentation/etiology
HLA B27+
pts with UC / chrohns
also after salmonella/shigella/yersinia infxn
symmetric arthritis of knees, ankles, wrists, SI joints
presentation/etiology reactive arthritis/reiters syndrome
HLA B27+
male dominant, post chlamydia infxn
urethritis, conjunctivitis, asymmetric lower extremity arthritis (knees, ankles, fingers, toes) - cant pee cant see cant dance w me
what is chondromalacia
benign softness of the articular (hyaline) cartilage, usually involving the patella
can potentially be caused by unbalancing elements of the quads with patellar misalignment during movement
what is a ganglion?
cystic tumor (benign) developing on a tendon or aponeurosis
arises from cystic or myxoid degeneration of connective tissue
spinal stenosis presentation
pain starts in low back and radiates down buttocks BL, continues along back of both legs
sx usually worse with walkign and improve when pt bends foward (like over a shopping cart)
as opposed to true claudication, pain resolves very quickly when person stops walking and assumes upright position and peripheral pulses are normal
crepitus is suggestive of what type of pathology?
DJD
what is ballotment?
slightly flexing knee, place one hand on suprapatellar pouch and gently push toward patella to move fluid and push down on patella with thumb; with effusion will “bounce” back up
mechanism of injury for the ACL
foot is planted while extreme rotational force is applied (a cleated foot caught in turf while athlete attempts to rotate toward that side)
direct force on lateral knee while foot is planted
sudden deceleration, hyperextension, and internal rotation of tibia on femur
mechanism of injury for the PCL
posterior force on tibia when tibia is flexed or hyperextended (such as tibia striking against dashboard in MVA)
mechanism of injury for the LCL
direct force on medial knee while foot is planted
mechanism of injury for the MCL
direct force on lateral knee while foot is planted
what is the disease process causing the pain in patellofemoral syndrome?
chondromalacia: issue with patella articulation and tracking with femur wears down the underside patellar cartilage
what tests would elicit pain in patellofemoral syndrome?
pushing on patella with slightly flexed leg
moving patella side to side/palpate undersurface
hold patella in place while pt contracts quads
presentation/PEs lateral epicondylitis
tennis elbow; repetitive extension (back hand motion in tenni) of wrist can cause inflammation and pain around lateral epicondyle where extensors/supinators of wrist insert
pain on palpation around lat epicondyle
reproducing pain with resisted wrist extension and supination
absence of warmth, erythema, or other signs acute inflammation
presentation medial epicondylitis
golfers elbow; repetitive flexion of wrist can cause inflammation and pain around medial epicondyle where flexors and pronators of wrist insert
pain on palpation around med epiconyle
reproduced pain with resisted wrist flexion
absence of warmth, erythema, or other signs acute inflammation
etiology and presentation of non-inflammatory olecranon bursitis
repeated trauma > excess fluid within bursa
swelling at tip of elbow
no pain, redness, warmth
full, painless ROM of elbow
etiology and presentation of inflammatory olecranon bursitis
infxn (via abrasion to overlying skin) or other inflammatory process (gout, RA)
swelling at tip of elbow
warmth, redness, pain
ROM usually preserved (distinguishes from infl arthritis)
etiology and presentation of carpal tunnel syndrom
precise cause unknown
numbness/tingling in median n distributino (thumb, index, middle, lateral 1/2 of ring)
sx worse at night (flex wrist during sleep)
pts try to “shake out” hands to reduce pain/restore “blood flow”
what is a ganglion cyst?
idiopathic, spontaneous protrusion of joint fluid outside articular space
painless, dorsal aspect of wrist
swelling
fluid filled consistency, non tender to palpation
transilluminates
etiology/presentation “trigger finger”
flexor tendors connect muscles proximal to wrist to the fingers; when muscles shorten, pulls on tendons to flex fingers
nodules/irregularities along tendons interfere with the flexion/extension of affected finger and when it slips through > sudden freeing of tendon (triggering)
most common acute sports injury and mechanism of injury
ankle sprains; inversion and plantar flexion of the foot when landing off balance or clipping another players foot
sequence/incidence of affected ligaments in ankle sprains
anterior talofibular ligament
calcaneofibular ligament
posterior talofibular ligament
musculotendious units supporting ankle joint
dx ankle sprains
xrays, stress tests
inversion stress, ant drawer stress
MRI in uncertain cases
grade 1 (mild) sprains
ligament(s) affected
stress test results
tx
ant talofibular ligament
minimal change on inversion, normal ant drawer
encourage early active movement (walking with semi rigid brace/splint, stationary cycling)
NSAIDs, physiotherapy, functional progression to running, jumping, etc into 6 weeks
grade 2 (moderate) sprains
ligament(s) affected
stress test results
tx
complete tear of anterior talofibular ligament with some damage of calcaneofibular ligament
laxity with inversion, ant drawer present
tx: 1 week crutches, joint taped, or in aircast splint, follow grade 1 rehab
grade 3 (severe) sprains
ligament(s) affected
stress test results
tx
uncommon; associated with fractures
tx: 10 days NWB in aircast brace or POP, then PWB with the brace up to 6 weeks
aggresive rehab follows, surgical reconstruction considered
action and mechanism of injury peroneal tendon
strong everters and weak plntar flexors of foot
lateral ligament injuries
forced dorsiflexion with slight inversion and reflex contrtaction of tendons (sprinting, uneven ground, ballet)
peroneal tendon injury presentation and tx
discomfort/swelling behind lat malleolus
subluxation on resisting dorsiflexion with eversion
acute phase: well moulded short case with pad over lat malleolus
chronic: surgical correction, POP 4 weeks
rupture of peroneal tendons: surgical correction
peroneal tendonitis etiology and tx
dancers, basketball players, volleyball players
rest, temp use heel wedge
physiotherapy ( extreme: local injection into sheath)
avoid rapid direction changes or sprinting for 6 weeks
plantar fasciitis causes
running on hard surfaces, tennis, netball, jumping
MTP extension produces a “windlass” stress over plantar fascia lifting the longitudinal arch of the foot
periosteal rxn may product a heel spur (XR)
plantar fasciitis presentation and tx
pain under medial aspect of heel, worse on tip toeing, early in morning, stairs
tx:
200,000 IU retinol daily for 2 mo
NSAIDS, 4-8mm heel raise, physiotherapy, orthotics to modify overpronation
sesamoiditis etiology and tx
sesamoid bones in the tendon of flexor hallicus brevis
dancers, ice skaters, gymnasts, basketball
crush fractures, avulsion, osteonecrosis
XR and bone scan
tx: shoes w elevated heels avoided, orthotics, adhesive padding and rest, surgical excision
common ankle fractures and tx
talus fracture: surgical tx to avoid osteonecrosis
calcaneum fractures: most conservative, early ROM
metatarsal fractures: reduce dislocations, most common fracture 5th metatarsal base (Jones)
toe fractures: most tx conservative, strapping w next toe for 3 weeks
workup of osteoporosis
urinary N telopeptide assesses bone breakdown
DEXA scan
what is adhesive capsulitis? what is the tx?
frozen shoulder
primary: idiopathic, DM - BL, resolves in 9-18 mo
secondary: prolonged immobilization post shoulder trauma, stroke, MI
tx: NSAIDSm steroids, PT
what ortho test would be used for lateral epicondylitis?
cozens/mills
what ortho test would be used for medial epicondylitis?
reverse cozens/mills
ulnar nerve entrapment would present with what findings?
nerve pain down 4th/5th fingers
what ortho test would be used for carpal tunnel syndrome
+ Phalens
+ Tinels
what is de quervain tenosynovitis?
tenosynovitis of first dorsal compartment of wrist (APL and EPB)
what ortho test would be used for de quervian tenosynovitis
+Finkelsteins
what is dupuytren contracture and how do you tx it
painless contracture of palmar fascia causing flexion contractures at metacarpophalangeal joint and interphalangeal joint
most common 4th > 5th > 3rd finger
tx: therapeutic US, surgery
what is spondylosis?
progressive degenerative process of cervical spine > canal stenosis
C5-C6 more common
M>F, 40-50
what is torticollios?
rare condition where neck muscles contract, causing the head to twist to one side
can be inherited and is seen soon after birth
at what level is sciatica?
L4-S3
orthos positive in sciatica
pos
Bechterews
SLR <70 deg and aggrevated by ankle dorsiflexion
Braggards
Kernigs
what is IT band syndrome? how can pain be reproduced?
laternal knee pain worse with activity
reproducable with knee flexion to 30 degrees w varus stress applied to knee
what is a baker cyst? how is it usually detected?
popliteal cyst arising between tendons of medial head of gastroc and semimembranosus, posterior to medial femoral condyle
often deteced by MRI
what is osgood-schlatter disease?
childhood repetitive use injury that causes a painful lump below the kneecap
what is medial tibial stress syndrome
pain in tibial compartment due to ischemia and minute muscle tears after running on hard surfaces
what is gowers sign? in what condition would it be positive?
walking up thighs to stand
+ in duchennes MD
what is the most frequently dislocated joint?
glenohumoral (90% anterior)
describe the type of fracture:
oblique
angular fracture line
describe the type of fracture:
spiral
spirals along long axis
describe the type of fracture:
transverse
fracture line perpendicular to long axis
describe the type of fracture:
comminuted
2+ fracture fragments
hallux valgus vs varus vs malleus
valgus (bunion): big toe deviates laterally toward other toes
varus: big toe points away from second toe, creating gap between them
malleus: “hammer toe”, flexion of IP joint
what is a morton neuroma? what are sx?
thickening of tissue surounding an interdigital nerve, usu due to nerve irritation and compression from tight shoes/heels or repetitive pressure on forefoot - typically between 3rd and 4th toes
sharp burning pain on ball of foot
feeling a pebble/fold in sock
nerve sx of affected toe
Patterns of joint pain: U/L pain DDX
Infectious, crystalline, trauma, hip AVN / slipped capital femoral epiphysis
Patterns of joint pain: B/L pain DDX
RA, enteropathogenic, psoriatic
Urinary n-telopeptide is used to measure _______
Bone breakdown
Typically used when evaluating effectiveness of osteoporosis tx.
What effect does cholecalciferol have on the absorption of calcium, magnesium, and phosphorus?
Increases all 3
Supplements most beneficial for building strong bones
D3, K2, calcium
Common benign tumor in growing children, grows slowly and painlessly on bone, sometimes in the same area of a previous injury.
Osteochondroma
Osteochondromas increase the risk of _______
Fractures d/t structural weakness of affected bone
Which of the following herbs is best for relieving pain in JA?
Lobelia
Thymus
Harpagophytum
Sambucus nigra
c. Devils claw (topical)
Positive RF in JA suggests the condition will:
Resolve in 6 months
Progress to adult arthritis
Progress to death in 6 months without treatment
Progress to adult arthritis
Which herb is best for prevention of OA?
Salix alba
Arnica montana
Curcuma long
Curcuma long
What does the Lachman ortho test assess for?
ACL path
What does the knee valgus stress test assess for?
MCL path
What is diathermy and what can it be used for?
Short wave: 1.8-30 MHz freq, 3-200 wavelength. Most common = 27.12 MHz
Uses: arthritis, back pain, muscle spasms, sprains, arthritis
Safety considerations diathermy
Avoid use with:
Metal implants
Over open growth plates
Areas with reduced blood supply
Infections
Bleeding disorders
Pregnancy
Over eyes, ears, brain, spinal cord, heart, reproductive organs
In demyelinating conditions like MS (inc rate of nerve conduction can cause conduction block)
What is high voltag galvanism and what can it be used for?
Unidirectional, monophonic, interrupted current up to 500 volts
Dec pain, muscle spasms, and edema; muscle exercise and re-education; inc circulation
(+) pole = analgesic, constricts blood vessels, mild germicidal
(-) pole = trigger points, soften adhesions, dilate blood vessels, exercise muscles
Safety considerations high voltage galvanism
CI:
Over low back/abdomen during pregnancy
Over neoplasms
Pacemakers
Over eyes, brain, heart
Hemorrhage
What is low voltage galvanism and what can it be used for?
Acid base rxn under active pad (risk for chem burn, do not exceed therapeutic times)
Stimulates de-innervated muscles, restricted joint motions, arthritis, neuralgia, sprains, strains, pain, excessive scarring, pressure ulcers
(+) pole (anode) = oxidative rxn, attracts oxygen, hardens scar tissue, vasoconstriction, analgesics, antimicrobial
(-) pole (cathode) = reductive rxn, attracts hydrogen, softens scar tissue, vasodilation, tissue relaxation
Safety considerations low voltage galvanism
Do not exceed therapeutic time, risk of chem burn
Do not break circuit suddenly
CI
Over abdomen/pelvis in pregnancy
Over cancer lesions
Pacemaker
Metallic implants
Tx on metal table
What is infrared and what can it be used for?
Light of 700 nm - 1 mm wavelength
Uses: arthritis, chronic low back pain, fractures, peripheral neuropathy, muscle spasm, strains, skin infxns, psoriasis, relaxing tissues before other PT, Raynaud’s, thrombophlebitis
Safety considerations infrared
CI
Photosensitivity
Poor blood flow
Hemorrhage
Edema
Gangrene
Sunburn
Fair skin
Over abdomen during pregnancy
Eyes
Infants
Metal
What is interferential current? What can it be used for?
Form of TENS with 2 alternating medium frequency (4000 Hz) currents. 4 pads (further = deeper) x 10-20 mins
Uses: pain relief, inc blood flow, muscle stimulation post injury
Safety considerations for interferential current
CI:
recent sutures, open wounds, abscesses
Circulatory conditions
DVT
Metal implants
Over pacemakers
Near low back/abdomen in preg
Local malignancy
Fracture or areas of bone fusion
What is iontophoresis and what can it be used for?
Low amplitude electrical current to facilitate transdermal drug delivery, esp with dexamethasome
Penetration depth 3-20 mm, drug penetration 40-80 milliamp mins
List the types of iontophoresis and their uses
Acetate for Ca deposits
Copper for fungal infxn
Dexamethasone for inflammation
Lidocaine for local anesthetic
Magnesium for muscle relaxation
Zinc for dermal ulcers/wounds
Safety considerations for iontophoresis
CI:
Pacemaker
Implant cardiac defibrillator
Unstable arrhythmias
Pregnancy over abdomen/low back
Malignant tumors
Venous or arterial thrombosis
Thrombophlebitis
NO USE after ice/heat/US
What is microcurrent and what can it be used for?
Stimulation between 200-800 microamps, floods tissue with ATP to speed healing. Stim > 1000 = plateauing then reduction in ATP. Place electrode with sterile hydrogel over wound, and other one 5 cm away
Uses: inc wound healing, sprains, strains, contusions, chronic pain, acute pain, OA
Safety considerations microcurrent
CI
Pain syndromes without est etiology
Pregnancy
Pacemakers
Over metal implants
Infected wounds
Malignant or benign tumors
Through eyes, carotid sinus
Over laryngeal musculature
Over thorax intersecting heart
What is sine wave and what can it be used for?
Low frequency current, low voltage, low amperage
Continuous alternating, slow pulsating, surged sinusoidal, tetanizing sinusoidal
Uses: adhesions, muscle spasms, muscle atrophy, restricted joint motion, passive exercise, pain, edema, de-inneravation, ischemia
Explain the four forms of sine wave and their uses
Continuous alternating (1-2000 Hz) - dec edema/congestion
Slow pulsating (5-30 Hz) - contracted smooth muscle
Surged sinusoidal - develop strength in muscles, tendons, ligaments
Tetanizing sinusoidal - muscle spasms, pain
Safety considerations sine wave
CI
Over eye
Brain hematoma
Fracture
Metallic implant
Pregnancy
Pacemaker
Cancerous lesion
What can therapeutic US be used for?
CTS
What is TENS and what can it be used for?
Short duration (50-80 us) high frequency (100-150 pps)
Controls pain via dorsal column stimulation (gait control with noxious stimuli)
Endorphin release: 1-15 Hz, for chronic pain (lasts hours)
Enkephalin release: 80-140 Hz, for acute pain (ends when tx ends)
TENS safety considerations
Do not use with muscle or tendon tear, overuse, acute injury because it may disrupt healing
What is UV radiation and what can it be used for?
EM radiation frequency range of 7.5 x 10^14 to 10^15 and wavelengths of 290-400 nm
UVA: 320-400, fluorescence
UVB: 290-320: skin erythema, psoriasis
UVC: <290, germicidal, wound healing
Safety considerations UV radiation
CI
Irradiation of eyes (use goggles)
Skin cancer
TB
Cardiac/liver/kidney dz
SLE
Fever
Photosensitizing meds/sups
Use of hot hydrotherapy applications
Chronic inflammation, muscle tension
CI for hot hydrotherapy applications
Ischemia
Bleeding
Impaired sensation, inability to respond to pain/communicate
Acute trauma
Scar tissue
Edema
Atrophic skin
Poor thermal regulation
Uses of cold hydrotherapy applications
Acute inflammation/traumatic conditions, arthritis, bursitis, trigger points, immediate tx of minor burns
CI cold hydrotherapy applications
Raynauds
Cardiac disease
Hypoesthesia
