To investigate changes in the core temperature and body surface temperature in patients with incomplete spinal cord injuries (SCI). In incomplete SCI, the temperature change is difficult to see compared with complete spinal cord injuries. The goal of this study was to better understand thermal regulation in patients with incomplete SCI.
Fifty-six SCI patients were enrolled, and the control group consisted of 20 healthy persons. The spinal cord injuries were classified according to International Standards for Neurological Classification of Spinal Cord Injury. The patients were classified into two groups: upper (neurological injury level T6 or above) and lower (neurological injury level T7 or below) SCIs. Body core temperature was measured using an oral thermometer, and body surface temperature was measured using digital infrared thermographic imaging.
Twenty-nine patients had upper spinal cord injuries, 27 patients had lower SCIs, and 20 persons served as the normal healthy persons. Comparing the skin temperatures of the three groups, the temperatures at the lower abdomen, anterior thigh and anterior tibia in the patients with upper SCIs were lower than those of the normal healthy persons and the patients with lower SCIs. No significant temperature differences were observed between the normal healthy persons and the patients with lower SCIs.
In our study, we found thermal dysregulation in patients with incomplete SCI. In particular, body surface temperature regulation was worse in upper SCIs than in lower injuries. Moreover, cord injury severity affected body surface temperature regulation in SCI patients.
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To investigate the predictive value of the sympathetic skin response (SSR) in diagnosing complex regional pain syndrome (CRPS) by comparing three diagnostic modalities-SSR, three-phasic bone scans (TPBS), and thermography.
Thirteen patients with severe limb pain were recruited. Among them, 6 were diagnosed with CRPS according to the proposed revised CRPS clinical diagnostic criteria described by the International Association for the Study of Pain. SSR was measured in either the hands or feet bilaterally and was considered abnormal when the latency was prolonged. A positive TPBS finding was defined as diffuse increased tracer uptake on the delayed image. Thermographic findings were considered positive if a temperature asymmetry greater than 1.00℃ was detected between the extremities.
Five of 6 CRPS patients showed prolonged latency on SSR (83% sensitivity). TPBS was positive in the 5 CRPS patients who underwent TPBS (100% sensitivity). Thermography was positive in 4 of 5 CRPS patients who underwent the procedure (80% sensitivity). The remaining 7 non-CRPS patients differed on examination. SSR latencies within normal limit were noted in 4 of 7 non-CRPS patients (57% specificity). Results were negative in 4 of 5 non-CRPS patients who underwent TPBS (80% specificity), and negative in 3 of 5 non-CRPS patients who underwent thermography (60% specificity).
SSR may be helpful in detecting CRPS.
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Evaluation of the Sympathetic Skin Response in Men with Chronic Prostatitis: A Case-Control Study
To clarify the relationship of skin temperature changes to clinical, radiologic, and electrophysiological findings in unilateral lumbosacral radiculopathy and to delineate the possible temperature-change mechanisms involved.
One hundred and one patients who had clinical symptoms and for whom there were physical findings suggestive or indicative of unilateral lumbosacral radiculopathy, along with 27 normal controls, were selected for the study, and the thermal-pattern results of digital infrared thermographic imaging (DITI) performed on the back and lower extremities were analyzed. Local temperatures were assessed by comparing the mean temperature differences (ΔT) in 30 regions of interest (ROIs), and abnormal thermal patterns were divided into seven regions. To aid the diagnosis of radiculopathy, magnetic resonance imaging (MRI) and electrophysiological tests were also carried out.
The incidence of disc herniation on MRI was 86%; 43% of patients showed electrophysiological abnormalities. On DITI, 97% of the patients showed abnormal ΔT in at least one of the 30 ROIs, and 79% showed hypothermia on the involved side. Seventy-eight percent of the patients also showed abnormal thermal patterns in at least one of the seven regions. Patients who had motor weakness or lateral-type disc herniation showed some correlations with abnormal DITI findings. However, neither pain severity nor other physical or electrophysiological findings were related to the DITI findings.
Skin temperature change following lumbosacral radiculopathy was related to some clinical and MRI findings, suggesting muscle atrophy. DITI, despite its limitations, might be useful as a complementary tool in the diagnosis of unilateral lumbosacral radiculopathy.
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Objective: To assess the proper type of outsole for the diabetic shoes according to the hardness of outsole in diabetic patients.
Method: Seventeen diabetic patients and 33 normal control volunteers in the 5∼6th decade were participated in this study. Walking exercise in the treadmill was performed in all subjects wearing the custom-made shoes with the two layers of hard outsole and one layer of soft outsole, respectively. Peak plantar pressures were measured after exercise by Pedar system with pressure sensitive insoles inserted in each shoes and compared with two types of outsoles. The degree of oxygen saturation was measured in the fourth toe by Oxysensor and the plantar thermography were measured by infrared thermometer before and after exercise, and compared with the two types of outsoles in diabetic and control groups, respectively.
Results: There were not significant differences of peak plantar pressures in all measuring points according to the type of outsole in diabetic group. The degree of oxygen saturation in the fourth toe was not significantly changed between the two types of outsoles before and after exercise in diabetic group. The plantar temperatures were significantly increased after exercise in all groups, but there was not significant difference according to the type of outsole.
Conclusion: There was not significant difference between hard and soft outsole with the custom-made shoes for diabetic patient applied in this study. But more advanced studies about the outsole of diabetic shoe should be needed. (Korean Acad Rehab Med 2002; 26: 598-605)
Objective: The purpose of this study is to assess the changes of skin temperature quantitatively in the stroke patients with reflex sympathetic dystrophy syndrome (RSDS) using thermography according to their clinical phases as well as changes after treatment.
Method: Patient group was consisted of 17 stroke patients with RSDS. Mean onset time of RSDS after stroke was 10.6 weeks. All patients were assessed by triphasic bone scan and clinically classified by phase I, II, and III. Control group was consisted of 9 stroke patients without RSDS. Temperature difference between affected side and unaffected side in wrist and hand regions were assessed in all subjects using Thermovision 570 (Agema Infrared Systems, USA) when initial clinical diagnosis was made. Seven patients were reassessed after high dose steroid and physical therapy.
Results: In patients with phase I RSDS, affected wrist and hand showed higher temperature distribution than the unaffected side. On the other hand, patients with phase II and III showed lower temperature in the affected side. The mean temperature difference in patients with phase I RSDS was significantly greater than control group. After treatment, skin temperature of affected side was decreased in phase I patients, but increased in phase II patients. Skin temperature difference tended to be normalized after successful treatment.
Conclusion: Using thermography, temperature change of affected hand can be assessed quantitatively in stroke patients with RSDS. The thermography is considered to be a useful tool for evaluation of clinical phases and treatment effect in these patients.
Objective: To analyze the diagnostic value of digital infrared thermographic imaging(DITI) and to compare the therapeutic effects of lidocaine injection(LI) and dry needling(DN) in the treatment of myofacial pain syndrome(MPS) by using the DITI and visual analogue scale(VAS).
Method: After 20 minutes adaptation time, 41 patients with MPS and 15 controls undertook DITI. LI and DN were randomly given in the trigger points of the patient group and to either side of the upper trapezius muscle in the controls. The effects of treatment were immediately assessed by measuring the temperature difference(ΔT) of the involved area and the corresponding area on the opposite side of the body using the DITI and VAS. Follow up assessments of VAS, change of VAS, ΔT and change of ΔT were performed 1, 3, 5 and 7 days after the treatment, respectively.
Result: 1) The sensitivity and specificity of hot spots for TrP were 78.1% and 73.3 %, respectively. 2) ΔT and VAS continuously declined for 7 days after the treatment as compared to before the treatment in groups Ia (n= 16, ΔT＞0.6℃, LI) and Ib (n=16, ΔT＞0.6℃, DN). 3) ΔT and VAS ware not statistically different for groups Ia and Ib. 4) There was no statistically significant correlation between ΔT and VAS in both groups I and Ib.
Conclusion: These data suggest that DITI can be used as one of the valuable tools for the evaluation of trigger points. No significant difference noted in the therapeutic effects of LI and DN for MPS.
Digital infrared thermal imaging(DITI) has been proposed as a diagnostic aid in patient with many disease entities, such as the cardiovascular, the neurologic, the musculoskeletal diseases and so on. Supporters of thermography state that normal patients have the normal thermograms and abnormal patients have the abnormal thermograms. The purpose of this study was to determine how much a cigarette will affect skin temperature change in the course of normal day's smoking.
Twenty one healthy smokers(mean age, 27.4⁑5.1 years old) and fourteen nonsmokers(mean age, 24.4⁑1.6 years old) took parts in the study. All were male. The cigarette consumption averaged 14.0 per day. Smokers maintained their smoking habit in the ambient temperature before on initial measurement and smoked a cigarette in the controlled laboratory room. Measurements were taken for 5 minutes, 1 hour and 2 hours afterward. The skin temperature of the face, the both palms and the both soles was measured using DorexⰒ digital infrared thermal imaging system.
In all sessions, the skin temperature was higher on the face and lower on the sole. There were no significant differences of skin temperature on both sides of body in all subjects(p＞0.05). The skin temperature of all measured parts was significantly lower in the smoking group before and 5 minutes after smoking(p＜0.01). There were no significant differences of skin temperature between smoker and nonsmoker after 1 hour of smoking(p＞0.01).
Thermography shows skin temperature changes in various conditions of body. Skin temperature changes according to the subcutaneous blood flow which is regulated by the autonomic nervous system. Peripheral neuropathic pain can be influenced by the sympathetic activities which also can change the skin temperature of affected sites.
To evaluate the usefulness of thermography in the detection of peripheral neuropathic pain, authors analyzed thermographic images of 47 cases with peripheral nerve injuries of upper extremities.
The peripheral nerve injuries were confirmed by Electromyographic studies in all of the cases. The peripheral neuropathic pain was present in twenty three cases.
The results show that 97.5% of nerve injury patients with pain and 45.8% of nerve injury patients without pain had abnormal thermograms with a mean temperature changes of △ T=0.99oC △T=0.13oC respectively. Authors conclude that thermography can be an usefal tool for the detection of peripheral neuropathic pain.
Treatment of the trigger points(TrP) is the most important thing for management of myofascial pain syndrome(MPS). The most effective treatment of TrP is local injection with various types of drug or dry needling, but the effectiveness of each drug was not the same by each investigator. The purposes of this study are to evaluate diagnostic value of Digital Infrared Thermographic Imaging(DITI) for trigger points and therapeutic effects of lidocaine and normal saline by DITI. This study included 15 patients who have TrP on upper trapezius muscles as a patient group and 10 normal adults as a control group. 2 cc of 2% Lidocaine was injected to the TrP of upper trapezius muscles in a patient group and to one side of upper trapezius muscles in a control group. One week after the first injection, 2 cc of normal saline was injected by the same method in a patient group. DITI was taken sequentially, preinjection(Pre), immediately after injection(P0), 15(P15), 30(P30), 60(P60) minutes and 24 hours(P24h) after injection. The parameters, temperature difference(ԤT) of both sides, changes of ԤT(ԤdT), visual analogue scale(VAS) were recorded at each point. It was considered abnormal, when the ԤT was above 0.6oC. The patient group was subdivided as Group I(hot spot), Group II(cold spot) and Group III(no difference) according to preinjection thermographic findings of TrP. The results were as follows: 1) ԤT of control group was within 0.52oC(95% confidence interval), 2) the numbers were 9 in Group I, 3 in Group II and 3 in Group III, and the sensitivity and specificity of hot spots for MPS were 81.8% and 57.1%, respectively, 3) ԤT was more reduced after lidocaine- than normal saline-injection, 4) VAS was more reduced after lidocaine- than normal saline-injection, especially in Group I and II. It is concluded that DITI can be used as one of the diagnostic tools for TrP and lidocaine is more effective than normal saline for the treatment of TrP.
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