Normal thermographic standards for the cervical spine and upper extremities

The Immediate Effect of Exercising in a Virtual Reality Treadmill (C-Mill) on Skin Temperature of a Man with Lower Limb Amputation

Background

In amputees, exercising can impact the distribution of body temperature. The aim of this case report is to verify the acute effect of exercising in C-Mill on the temperature distribution in the lower limbs of a man with unilateral transfemoral amputation.

Materials and Methods

The thigh and legs of a man with left distal transfemoral amputation were evaluated by thermography (infrared sensor FLIR T650sc) before and after a single 30-minute exercise session performed in a virtual reality treadmill device (C-Mill).

Results

The thermographic evaluation showed a difference in temperature between the thighs both before and after the intervention. However, there was a decrease in asymmetry, which went from 4.0°C to 3.1°C in the anterior view and from 5.3°C to 2.9°C in the posterior view, after the intervention.

Conclusion

Thermography allowed us to assess the difference in temperature in the lower limbs. Even though the temperature discrepancy has decreased after the single exercise session using the C-Mill, this difference persisted.

The use of thermal imaging for monitoring the training progress of professional male sweep rowers

This study assesses the thermal profile of the skin in highly trained rowers and investigates the relationship between resting skin temperature (Ts) and the muscle peak torque (PT) measured in statics at the beginning (autumn) and the end (spring) of the preparatory period. Ten professional male sweep rowers, members of the Polish national rowing team, were investigated. A thermal imaging camera was used to analyze the Ts. The PT of the muscles involved in the rowing cycle were measured isometrically. No significant temperature asymmetries were found, except in front of arms after exercise in the spring (p = 0.0228). In contrast, the PT test in the autumn confirmed the significant asymmetry of the knee joint extensors (p = 0.0192). In spring compared to autumn, Ts in many areas of the body were slightly higher, as was PT of underlying muscles. Significant correlations between resting Ts and PT of the underlying muscles were found. Thermal imaging makes it possible to observe changes in skin temperature and symmetry before and after exercise. At this stage, it does not appear to be a method that, without supporting of other methods such as those assessing muscle function, will allow monitoring of training progress.

Assessment of neuropathic pain in leprosy patients with relapse or treatment failure by infrared thermography: A cross-sectional study

BACKGROUND

Neuropathic pain (NP) is one of the main complications of leprosy, and its management is challenging. Infrared thermography (IRT) has been shown to be effective in the evaluation of peripheral autonomic function resulting from microcirculation flow changes in painful syndromes. This study used IRT to map the skin temperature on the hands and feet of leprosy patients with NP.

METHODOLOGY/PRINCIPAL FINDINGS

This cross-sectional study included 20 controls and 55 leprosy patients, distributed into 29 with NP (PWP) and 26 without NP (PNP). Thermal images of the hands and feet were captured with infrared camera and clinical evaluations were performed. Electroneuromyography (ENMG) was used as a complementary neurological exam. Instruments used for the NP diagnosis were visual analog pain scale (VAS), Douleur Neuropathic en 4 questions (DN4), and simplified neurological assessment protocol. The prevalence of NP was 52.7%. Pain intensity showed that 93.1% of patients with NP had moderate/severe pain. The most frequent DN4 items in individuals with NP were numbness (86.2%), tingling (86.2%) and electric shocks (82.7%). Reactional episodes type 1 were statistically significant in the PWP group. Approximately 81.3% of patients showed a predominance of multiple mononeuropathy in ENMG, 79.6% had sensory loss, and 81.4% showed some degree of disability. The average temperature in the patients' hands and feet was slightly lower than in the controls, but without a significant difference. Compared to controls, all patients showed significant temperature asymmetry in almost all points assessed on the hands, except for two palmar points and one dorsal point. In the feet, there was significant asymmetry in all points, indicating a greater involvement of the lower limbs.

CONCLUSION

IRT confirmed the asymmetric pattern of leprosy neuropathy, indicating a change in the function of the autonomic nervous system, and proving to be a useful method in the approach of pain.

Thermal imaging in total knee replacement and its relation with inflammation markers

Total knee replacement is an end-stage surgical treatment of osteoarthritis patients to improve their quality of life. The study presents a thermal imaging-based approach to assess the recovery of operated-knees. The study focuses on the potential of thermal imaging for total knee replacement and its relation with clinical inflammatory markers. A total of 20 patients with bilateral knee replacement were included for thermal imaging and serology, where data was acquired on pre-operative day and five post-operative days. To quantify the inflammation, the temperature-based parameters (like mean differential temperature, relative percentage of raised temperature) were evaluated from thermal images, while the clinically proven inflammation markers were obtained from blood samples for clinical validation. Initially, the knee region was segmented by applying the automatic method, subsequently, the mean skin temperature was calculated and investigated for a statistical relevant relationship with inflammatory markers. After surgery, the mean skin temperature was first increased (>2.15 ℃ for different views) then settled to pre-operative level by 90th day. Consequently, the mean differential temperature showed a strong correlation with erythrocyte sedimentation rate (r > 0.893) and C-reactive protein (r > 0.955). Also, the visual profile and relative percentage of raised temperature showed promising results in quantifying the temperature changes both qualitatively and quantitatively. This study provides an automatic and non-invasive way of screening the patients for raised levels of skin temperature, which can be a sign of inflammation. Hence, the proposed temperature-based technique can help the clinicians for visual assessment of post-operative recovery of patients.

Body temperature and esthesia in individuals with stroke

Patients with sequelae of stroke commonly report somatosensory losses. It is believed that body temperature may be associated with tactile sensibility and sensorimotor recovery of these patients. Demonstrate the associations among tactile sensibility, cutaneous temperature, subjective temperature perception, and sensorimotor recovery of patients with stroke sequelae. 86 patients with stroke sequelae were included. Patients had standardized regions of interest (ROIs) assessed with infrared thermography (FLIR T650SC) and monofilaments esthesiometry, and global motor recovery was evaluated with Fugl-Meyer Assessment (FMA). The presence of self-reported perception of temperature difference was used to divide the participants into two groups of 43 patients, and correlation tests were applied to establish correlations among variables. There is no clinically relevant association between tactile sensibility and cutaneous temperature of the foot, regardless of the subjective sensation of temperature changes. Sensorimotor recovery evaluated by FMA is associated with the difference of sensibility between both sides of the body (p < 0.001), as well as with the difference of tactile sensibility (p < 0.001). A clinically significant association between the difference of cutaneous temperature and tactile sensibility was not found, regardless of the presence or absence of subjective perception of such temperature difference. However, sensorimotor recovery is correlated with cutaneous temperature differences and tactile sensibility.

Associations Between Skin Surface Temperature and Pressure Pain Tolerance Thresholds of Asymptomatic Individuals Exposed to Cryotherapy and Thermotherapy

Objective

The purpose of this study was to evaluate associations between skin surface temperature and pressure pain tolerance thresholds (PPTs) of asymptomatic individuals exposed to cryotherapy and thermotherapy.

Methods

Twenty-two asymptomatic female university students aged between 18 and 35 years underwent thermography and algometry assessments at 6 points in both knees before, immediately after, and 20 minutes after the application of frozen (cryotherapy) or heated (thermotherapy) gel bags in the right knee for 20 minutes. Data were analyzed by 1-way analysis of variance, Student t test, and Pearson or Spearman correlation tests.

Results

There was a significant change in skin surface temperature after cryotherapy and thermotherapy, which was maintained after 20 minutes of withdrawal (P < .001). After the intervention, no significant differences were observed regarding PPT compared with the baseline measurements, nor between the experimental and control knees.

Conclusion

Cryotherapy and thermotherapy produced significant changes in the temperature of the evaluated points after their application. No differences in pain tolerance were observed in these asymptomatic participants. There was little association between skin surface temperature and PPT in the knees of healthy women after application of the resources.

Pain Tolerance: The Influence of Cold or Heat Therapy

Objectives

Resources of heat or cold therapies have been widely used for their low cost, analgesic action and for assisting the rehabilitation of acute or chronic injuries. The objective of this study was to search for associations between skin surface temperature and pressure pain tolerance thresholds (PPTs) of healthy individuals undergoing cryotherapy and thermotherapy.

Methods

This is an experimental clinical trial with 22 healthy university students aged between 18 and 35 years. Volunteers underwent thermography and algometry assessments at 6 points in both knees before, immediately after, and 20 minutes after the application of frozen (cryotherapy) or heated (thermotherapy) gel bags in the right knee for 20 minutes. Data were analyzed by 1-way analysis of variance, Student's t test, and Pearson or Spearman correlation tests.

Results

There was a significant change in skin surface temperature after cryotherapy and thermotherapy, which was maintained after 20 minutes of withdrawal (P < .001). After the intervention, no significant differences were observed regarding the PPT compared to the baseline measurements, nor between the experimental and control knees.

Conclusion

Cryotherapy and thermotherapy produced significant changes in the temperature of the evaluated points after their application. Despite this, no differences in pain tolerance were observed, and there was little association between skin surface temperature and PPT in the knees of healthy women after application of the resources.

Body temperature of healthy men evaluated by thermography: A study of reproducibility

BACKGROUND

Thermography is a safe, painless, and efficient method for checking the temperature of the skin.

OBJECTIVE

Was to assess the pattern of skin temperature of healthy men, as well as to verify the reproducibility of the method.

METHODS

This cross-sectional observational study was conducted with 30 men evaluated by thermography in two moments by using an infrared camera (FLIR +T650SC®). The skin temperature of 24 regions of interest (ROI) was measured.

RESULTS

The mean difference in temperature of 10 ROIs in the two evaluations was not statistically significant. The comparisons of the ΔTsk between the right and left sides by the two evaluations showed no differences. The intra-class correlation coefficient (ICC) between the two moments of evaluation were statistically significant, where the dorsal measurements (Left forearm and Right dorsal arm) showed poor correlations and the others ranged from moderate to strong. Greater reproducibility was confirmed for ventral and dorsal hand ROIs; however, they presented the highest coefficient of variation (9% and 8%).

CONCLUSION

There is a similarity between the temperatures of the ROIs and the reproducibility in 22 of the 24 ROIs varies from moderate to strong, showing that thermography is a reproducible method in healthy men.

Changes in Body Temperature in Incomplete Spinal Cord Injury by Digital Infrared Thermographic Imaging

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Thermal Increasing Information for Foot Surface during Jogging

Thermography information of foot is playing very important role in body character and related products design. The purpose of this study is to investigate the distribution and change character of foot skin temperature variety during low-intensity movement. Totally 19 subjects participated in this testing, skin surface temperature monitor was using high-precision Infrared Thermal Imager. The average foot skin temperature existed a significant difference at rest condition. After 30min persistent low-intensity exercise, each area of the foot was increased, and the increasing trend was quite similar. This study could provide the basis of foot physiological function understanding.

Do changes in electrical skin resistance of acupuncture points reflect menstrual pain? A comparative study in healthy volunteers and primary dysmenorrhea patients

Electrical skin resistance (ESR) measurements were performed with a four-electrode impedance detector at 10 points bilaterally on the first day of and the third day after menstruation in 48 healthy volunteers and 46 primary dysmenorrhea (PD) patients, to assess whether ESR changes of acupuncture points can reflect menstrual pain or not. The results showed statistical reductions in ESR imbalance ratio between left and right side that were detected at SP8 (Diji) and GB39 (Xuanzhong) (P < 0.05), and a statistical increase was detected at SP6 (Sanyinjiao) (P = 0.05) on the first day of menstruation compared with those values on the third day after menstruation in dysmenorrhea group. No significant differences were detected at other points within and between two groups (P > 0.05). This study showed that the imbalance of ESR at uterine-relevant points in PD patients is not significantly different from those of healthy women on both the 1st day of and the 3rd day after menstruation. The ESR imbalance ratio of certain points can either be lower or higher during menstruation in PD patients. The ESR property of acupuncture points needs to be investigated in further clinical trials with appropriate points, diseases, larger sample sizes, and optimal device.

The infrared radiation temperature characteristic of acupoints of mammary gland hyperplasia patients

Objective. To ascertain pathological information on hyperplasia of mammary glands (HMG) of patients via the infrared radiation temperature of acupoints. Method. Patients with HMG and healthy controls were tested using an infrared thermal imager. Results. In controls, no significant difference in temperature was observed between points with the same name (P > 0.05). The temperature of all tested points was found to be higher in the group with HMG than in that of the healthy controls, except for the left and right Zusanli (ST36). The temperature of the right Rugen (ST18), Guanyuan (CV4), Qihai (CV6), and Hegu (LI4) reached a statistically significant heightened level (P = 0.046~P < 0.001). The temperature of the Zusanli (ST36) and Hegu (LI4) present on the right side was significantly higher than that of the left (P = 0.001 and P = 0.004, resp.), while the temperature of the left Youmen (KI21) was significantly higher than that of the right (P = 0.008). Conclusion. The temperature of the bilateral acupoints in healthy controls was symmetrical, and the raised temperatures observed of the Rugen (ST18), Guanyuan (CV4), Qihai (CV6), and Hegu (LI4) acupoints of HMG patients and the imbalance of the temperature of the bilateral acupoints Zusanli (ST36), Youmen (KI21), and Hegu (LI4) carried special pathological information about HMG disease.

"Mood rings": a new method of objective clinical assessment of peripheral nerve injuries

The clinical assessment of patients with peripheral nerve injury is primarily dependent on subjective clinical examination. We aimed to assess whether a thermotropic liquid crystal ring (TLC-ring) could provide the basis for an objective assessment of peripheral nerve injury by detecting temperature changes in the digits innervated by the damaged nerve. A group of patients with known median, ulnar or both digital nerve injuries were compared against a control group. TLC-rings, marketed to the general public as "mood rings", were applied to the affected and unaffected digits and the colour change recorded. Areas with nerve damage showed a statistically significant difference in colour response to those without damage. This study establishes the ability of TLCs to detect cutaneous temperature changes associated with peripheral nerve injuries. Further studies and improvements are needed to refine TLC as an acute assessment tool for peripheral nerve injuries.

Infrared imaging of the anterior deltoid during overhead static exertions

Infrared imaging has been used to detect the presence of neuromuscular disorders of the cervical spine and upper extremities. Despite diagnostic uses, evaluative or prognostic uses of thermography are limited. The objective of this study was to quantify surface temperature changes over the anterior deltoid and evaluate efficacy of thermography as an assessment tool. Surface temperature, discomfort ratings and endurance time were quantified during overhead static exertions until exhaustion at two work loads (15 and 30% maximum voluntary contraction) and shoulder angles (90 degrees and 115 degrees ). Ten participants free of confounding conditions participated in the study. The 90 degrees shoulder angle and 30% exertion level resulted in significantly faster thermal image rates of change, shorter endurance times and faster perceived discomfort increases. Thermography readings were more sensitive to changes in shoulder posture than load changes. This study provides preliminary evidence that thermography may be a useful exposure assessment tool. There is a need for new evaluation tools to quantify risk factor exposure for injury. Thermography was sensitive to changes in task loadings, illustrating its potential use for risk assessment. Specifically, changes in observed blood flow patterns during task performance are likely to conform to known physiological responses to injury.

Effects of a manually assisted mechanical force on cutaneous temperature

OBJECTIVE

Digitized infrared segmental thermometry (DIST) is a tool used for measuring cutaneous temperature (CT). This project ascertains the effect of a manually assisted mechanical force producing a chiropractic adjustment in the lumbar spine after the Activator Methods Chiropractic Technique on CT during 2 different time recording periods (TRPs).

METHODS

Sixty-six healthy subjects (36 women and 30 men) without acute low back conditions or symptoms were recruited. Subjects were randomly divided into 2 groups based on the length of the acclimatization period (8 or 30 minutes; TRP(8) and TRP(30), respectively). In turn, each recording period group was divided into 3 subgroups (n = 11 per subgroup): treatment, sham, and control subgroups. Bilateral DIST was conducted at L-4 (TRP(30)) and L-5 (TRP(8)) using infrared cameras (Subluxation Station Insight 7000; Chiropractic Leadership Alliance, Mahwah, NJ).

RESULTS

Before treatment (t(-0.5)), the TRP(8) CT was significantly different between the ipsilateral and the contralateral sides for all subgroups. At 10 minutes (t(10)) after intervention, CT increased significantly (P < .05) for the treatment group but not for the sham and control groups. In contrast, there were no significant differences in the TRP(30) CT before treatment between the ipsilateral and the contralateral sides; but at t(10), CT was significantly (P < .05) greater for all 3 subgroups compared with preintervention CT.

CONCLUSION

Contacting the skin with the instrument with (treatment group TRP(30)) or without (sham group TRP(30)) a thrust with a sustained pressure stronger than the loading principle taught in the Activator Methods Chiropractic Technique protocol or a thrust respecting the standard loading principle (treatment group TRP(8)) of the instrument produced a CT cooling immediately after the adjustment. Furthermore, we observed that when contacting the skin with the instrument with a thrust respecting the standard loading principle (treatment group TRP(8)) of the instrument, it produced a secondary cooling at t(5) followed by a rewarming at t(10). Finally, contacting the skin with the instrument without a thrust and respecting the standard loading principle (sham TRP(8)) of the instrument did not produce a CT change.

Thermographic assessment of inferior alveolar nerve injury in patients with dentofacial deformity

PURPOSE

The purpose of this study was to evaluate the injury and recovery of the inferior alveolar nerve in orthognathic patients at 1 and 4 weeks after surgery using electronic thermography.

MATERIALS AND METHODS

Twenty subjects with Class III dentofacial deformity were studied. All patients underwent bilateral sagittal split ramus osteotomy. To image the temperature of the face, 1 anteroposterior view and 1 lateral view were taken from both the right and left sides. Similar images were taken at 1 and 4 weeks after surgery. The control was the presurgical temperature of the 20 patients who showed unilateral or bilateral nerve damage after surgery.

RESULTS

In the patients with unilateral nerve damage (n = 14), on the anteroposterior views, the temperatures of the mentum on the 2 sides differed by 0.64 degrees C at 1 week after surgery, and the difference decreased to 0.23 degrees C at 4 weeks after surgery. On the lateral images, the differences in temperature between the mentum areas were 0.10 degrees C at 1 week and 0.27 degrees C at 4 weeks after surgery. In the patients with bilateral nerve injury (n = 6), on the anteroposterior views, the temperatures of the mentum on the 2 sides differed by 0.20 degrees C at 1 week after surgery and 0.13 degrees C after 4 weeks. On the lateral views, the differences were 0.18 degrees C at 1 week and 0.34 degrees C at 4 weeks after surgery. Using the repeated measurement analysis method, the anteroposterior view showed statistically significant results in the patients with unilateral nerve damage.

CONCLUSION

The infrared body temperature method is an objective method that can be applied as a supplemental diagnostic method for inferior alveolar nerve injury.

Digitized Infrared Segmental Thermometry: Time Requirements for Stable Recordings

OBJECTIVES

Digitized infrared segmental thermometry (DIST) is a method for measuring and recording skin surface body temperatures. The project evaluated the required length of time for patients to acclimatize their core body temperature to ambient conditions to obtain stable DIST readings.

METHODS

Seventeen subjects were allowed a 20-minute acclimatizing period in a temperature-controlled room. The bilateral DIST temperature was measured with thermistors in combination with infrared cameras (IRCs) at the C4 and L4 levels. All IRC temperatures were recorded after a 20-minute stabilization period. The room temperature and relative humidity were recorded throughout all trials. The acclimatization trend was computed from the 20- to 24-minute period for the IRCs, and the acclimatization trend was computed continuously for a total of 30 minutes (at 2-minute intervals) for 5 days.

RESULTS

We discovered a stabilization trend in the early trial stages, with the thermistor recordings between 8 and 16 minutes. The IRC trend was also conclusive for the core temperature requirements.

CONCLUSIONS

This study determined a core body temperature acclimatization trend tested among patients using thermistor recordings in a controlled environment. Based on these findings, we recommend acclimatization in a temperature- and humidity-controlled environment for a minimum 8-minute period, followed by an 8-minute maximum recording period with the patient in a prone position to obtain accurate DIST recordings.

Validity of Infrared Thermal Measurements of Segmental Paraspinal Skin Surface Temperature

OBJECTIVE

The purpose of this study was to evaluate the validity of thermal measurements by infrared camera thermometry.

METHODS

Seventeen subjects underwent a 30-minute acclimatizing period in a controlled environment room. Thermal recordings were executed at the levels of C4 and L4. Fifteen recordings per segment were acquired in an alternating mode that always started at L4. Each subject was required to participate on 5 occasions. The exclusion criteria for the subjects included the following: no inflammatory disease or fever, no consumption of beverages containing caffeine, and no participation in physical activity 2 hours before the recording session; female subjects could not be menstruating on a day of recording.

RESULTS

A total of 2550 recordings for the cervical area and the lumbar area was recorded. Strong significant correlations were found for the left (r = .77) and right (r = .71) lumbar sections (P < .0001) whereas weaker significant correlations were observed for the left (r = .56) and right (r = .63) cervical areas (P < .0001). The limits of agreement (Bland-Altman) showed good relationships but poor interchangeability.

CONCLUSIONS

In this study, the infrared cameras showed that they were valid tools in a controlled environment; however, the technique for the cervical measurements needs to be reassessed.

Neck and shoulder pain related to computer use

The neck and shoulder pain (NSP) symptoms are very common among intensive computer users. This paper reviews recent 20 years' research publications, which have focused on pathophysiology and other aspects of the neck and shoulder pain related to computer use (NSPRCU). The disorder is usually multidimensional, occupational, personal and social factors are among these evolved. Suggestions concerning the diagnostics, procedures of prevention, and treatment options have been discussed. As the details of pathophysiology of these disorders are not yet clear, further studies on NSPRCU are necessary.

Treatment of Bipolar, Seizure, and Sleep Disorders and Migraine Headaches Utilizing a Chiropractic Technique

OBJECTIVE

To discuss the use of an upper cervical technique in the case of a 23-year-old male patient with rapid-cycling bipolar disorder, sleep disorder, seizure disorder, neck and back pain, and migraine headaches.

CLINICAL FEATURES

The patient participated in a high school track meet at age 17, landing on his head from a height of 10 ft while attempting a pole vault. Prior to the accident, no health problems were reported. Following the accident, the patient developed numerous neurological disorders. Symptoms persisted over the next 6 years, during which time the patient sought treatment from many physicians and other health care practitioners.

INTERVENTION AND OUTCOME

At initial examination, evidence of a subluxation stemming from the upper cervical spine was found through thermography and radiography. Chiropractic care using an upper cervical technique was administered to correct and stabilize the patient's upper neck injury. Assessments at baseline, 2 months, and 4 months were conducted by the patient's neurologist. After 1 month of care, the patient reported an absence of seizures and manic episodes and improved sleep patterns. After 4 months of care, seizures and manic episodes remained absent and migraine headaches were reduced from 3 per week to 2 per month. After 7 months of care, the patient reported the complete absence of symptoms. Eighteen months later, the patient remains asymptomatic.

CONCLUSION

The onset of the symptoms following the patient's accident, the immediate reduction in symptoms correlating with the initiation of care, and the complete absence of all symptoms within 7 months of care suggest a link between the patient's headfirst fall, the upper cervical subluxation, and his neurological conditions. Further investigation into upper cervical trauma as a contributing factor to bipolar disorder, sleep disorder, seizure disorder, and migraine headaches should be pursued.

Skin surface temperature over the temporomandibular joint and masseter muscle in healthy children and adolescents

Skin surface temperature (SST) measurements were carried out over the temporomandibular joint (TMJ) and masseter muscle (MM) of 159 healthy children and adolescents aged 7, 11, 15 and 18 years. No current symptoms were found of impaired general health or from the masticatory system or recurrent headache. The recordings were done with a thermocouple in contact with the skin. The mean SST over the TMJ and MM increased with age, and from the youngest to the oldest group regarding the TMJ by 1.3 degrees C (right) and 1.6 degrees C (left), and for MM by 2.1 degrees C (right) and 2.5 degrees C (left). Variation in the mean difference between sides of the TMJ was 0.0-0.2 degrees C and for the MM 0.1-0.3 degrees C. The variation in SST between sides was reduced with increasing age, but was higher for MM than for TMJ in all age groups. In the 7-years group, there was a significant difference between right and left SST over TMJ and MM. It is concluded that SST increases with growth during childhood and that the SST for the TMJ is higher than MM in all age groups. The finding of a high degree of thermal symmetry between sides in all age groups may have diagnostic potential for pathological conditions involving blood flow and in evaluation of treatment of these conditions.

A comparison of the donor-site morbidity after using the prelaminated fasciomucosal flap and the fasciocutaneous radial forearm flap for intraoral reconstruction

Since 1996 we have performed mucosal prelamination of the distal radial forearm flap for functional reconstruction of defects of the intraoral lining. This study was undertaken to demonstrate that the prelaminated fasciomucosal radial forearm flap can provide physiological oropharyngeal reconstruction with mucus-producing tissue, while avoiding the donor-site complications of the fasciocutaneous radial forearm flap. We examined the donor hand at least 6 months postoperatively in 20 patients after using a prelaminated fasciomucosal radial forearm flap and in 15 patients after harvesting a classical fasciocutaneous radial forearm flap. The evaluation of hand function included range of motion, grip power, pinch power, sensibility and vascular analysis in both hands. The patients were asked about cold intolerance, pain and any restrictions in daily life, and the cosmetic appearance of the donor hand was noted. In the prelaminated-flap group (n 20), two patients had decreased wrist extension, and one of these patients also had reduced strength and mild hypaesthesia in the donor hand. In the classical-fasciocutaneous-flap group (n 15), six patients had decreased wrist extension, five patients had reduced strength and four patients had diminished sensibility in the donor hand. Painful neuromas were found only after fasciocutaneous flaps (three cases). Subjective assessment revealed restricted hand function in one patient in the prelaminated-flap group, and in five patients who had undergone fasciocutaneous flap transfer. The results of this study show that using the prelaminated fasciomucosal radial forearm flap minimises the donor-site morbidity. Furthermore, we were able to improve the cosmetic appearance of this very exposed region.

Upper cervical chiropractic management of a patient with Parkinson's disease: a case report

OBJECTIVE

To discuss the use of upper cervical chiropractic management in managing a single patient with Parkinson's disease and to describe the clinical picture of the disease.

CLINICAL FEATURES

A 60-year-old man was diagnosed with Parkinson's disease at age 53 after a twitch developed in his left fifth finger. He later developed rigidity in his left leg, body tremor, slurring of speech, and memory loss among other findings.

INTERVENTION AND OUTCOME

This subject was managed with upper cervical chiropractic care for 9 months. Analysis of precision upper cervical radiographs determined upper cervical mis-alignment. Neurophysiology was monitored with paraspinal digital infrared imaging. This patient was placed on a specially designed knee-chest table for adjustment, which was delivered by hand to the first cervical vertebrae, according to radiographic findings. Evaluation of Parkinson's symptoms occurred by doctor's observation, the patient's subjective description of symptoms, and use of the Unified Parkinson's Disease Rating Scale. Reevaluations demonstrated a marked improvement in both subjective and objective findings.

CONCLUSION

Upper cervical chiropractic care aided by cervical radiographs and thermal imaging had a successful outcome for a patient with Parkinson's disease. Further investigation into upper cervical injury as a contributing factor to Parkinson's disease should be considered.

Thermography of hands after a radial forearm flap has been raised

To evaluate possible circulatory changes in the donor hand 18 patients underwent cold stress testing and thermography of both hands a mean of 13 months after a radial forearm flap had been harvested. Temperatures were measured with a computed Inframetrics 600L infrared thermocamera, and the images were videotaped at room temperature and after a cold challenge (immersion in a water bath at 15 degrees C for five minutes). Temperatures were measured on the volar aspect of each fingertip, and rewarming curves were plotted for both hands. The patients could be divided into three groups according to the rewarming pattern: mean temperature of the donor hand was more than 0.5 degree C warmer than that of the other hand (n = 7), rewarming was similar in both hands (n = 6), and the mean temperature of the donor hand was less than 0.5 degree C colder than that of the other hand (n = 5). Patients with a colder donor hand had significantly wider (Pearson's r = 0.62, p = 0.005) and longer (r = 0.71, p = 0.001) defects. The rewarming pattern did not correlate with subjective cold intolerance, but the temperature of the donor hand was a mean of 0.5 degree C less than that of the other hand in room temperature in subjects who experienced cold intolerance (p = 0.019). We conclude that the raising of a radial forearm flap, particularly a large one, affects the thermoregulatory system of the donor hand, results in abnormal rewarming, and can cause subjective cold intolerance.

Future applications of electronic thermography

The dental literature does not yet indicate the full range of facial thermographic findings in health and disease. Thermography is not useful in assessing some common dental problems, such as periapical granuloma. Promising reports, however, support its use in the diagnosis of neuralgias and atypical odontalgia, TMJ, nerve damage and repair after oral surgery, and in evaluating local dental anesthesia. Unfortunately, few if any of these studies were properly designed or conducted, limiting current attempts to define the value of thermography in dentistry. Until this situation resolves, ET of the face, for use in dentistry, can only be considered an investigational procedure. More research will clarify the precise contribution of thermography to dental problems.

The utilization of contact liquid crystal thermography in the evaluation of temporomandibular dysfunction

A previously diagnosed patient population of 109 volunteers having temporomandibular dysfunction agreed to undergo pretreatment and post-treatment thermographic examination. In 1988, at the time of this study, a contact liquid crystal thermographic unit was utilized in accordance with the protocol advocated by the Academy of Neuro-Muscular Thermography. The examination consisted of pretreatment and post-treatment thermograms repeated in a series of three sets, i.e., in triplicate, incorporating four different views per set, namely, frontal face, right lateral face, left lateral face, and posterior cervical. This study revealed that the application of contact liquid thermography in the evaluation of temporomandibular dysfunction was a reliable, valid, and efficacious diagnostic tool in approximately 95% of the cases. Resolution of thermographic asymmetry and/or decrease in Delta T was demonstrated in approximately 81% of the post-treatment population. Thermography also proved to be a reliable indicator of pretreatment duration of dysfunction (chronicity pattern) in approximately 78% of the cases.

Medical thermography and its use in posttraumatic cephalagia

The use of infrared thermographic imaging in the diagnosis of human illness is discussed from the point of view of its historical development and its multiple uses to the present time. Future goals for its use are outlined. Several case histories are presented documenting the use of thermography in post traumatic cephalalgia.

Devices for the diagnosis and treatment of temporomandibular disorders. Part III: Thermography, ultrasound, electrical stimulation, and electromyographic biofeedback

This last article in the three-part series on devices for the diagnosis and treatment of temporomandibular disorders (TMD) compared the claimed diagnostic usefulness of thermography with the present scientific evidence. In a similar manner, the therapeutic efficacy of ultrasound, electrical stimulation, and electromyographic biofeedback was also reviewed. This evaluation concluded that the application of thermography to the diagnosis of TMD is limited by variations within and among subjects and by intrinsic problems with controls of the test environment. It also concluded that evidence that therapeutic ultrasound alone is useful for the treatment of TMD is lacking, that positive clinical results of electrical stimulation may not be due to specific therapeutic effects, and that it is doubtful that the use of electrical stimulation devices can produce a position of the mandible that has any diagnostic or therapeutic significance. There is evidence, however, that relaxation training, assisted by EMG biofeedback, can reduce daytime muscle activity.

Electronic thermography in the diagnosis of atypical odontalgia: a pilot study

Atypical odontalgia (AO) is a dental condition that is usually diagnosed by exclusion after failure of multiple dental treatments. A functional definition of AO includes (1) continuous pain in and about a tooth or teeth, (2) pain present for longer than 4 months, (3) inadequate local cause (no abnormality detected on dental radiographs), and (4) anesthetic blockade gives equivocal relief of toothache. The purpose of this study was to assess the potential role of electronic thermography in the diagnosis of AO. Results from measurements of facial thermal symmetry indicated that normal subjects = 83.5%, AO group = 65.8% (p less than 0.01). Electronic thermography interpreted by thermography experts has promise as a diagnostic test for AO among patients with toothache for which the dentist can find no convincing dental explanation.

Electronic thermography of normal facial structures: a pilot study

New electronic thermographic instruments capable of routine clinical examination need to be evaluated for their potential as a diagnostic aid in dentistry. This study assessed thermal symmetry of the face and neck in 20 normal subjects with the use of frontal and lateral views, at 1.0 degree C and 0.5 degree C sensitivity, under controlled conditions. Electronic thermographic images were analyzed for thermal symmetry, by means of a grid matching technique, in 12 anatomic regions and the overall face. Results indicated that thermal symmetry for the entire face was high (70.2%). The 12 specific facial areas demonstrated varying levels of thermal symmetry. Regions of high symmetry on frontal projections included the anterior portion of the neck (82.0%), the TMJ (80.0%), the lower lip (78.6%), and the upper lip (77.3%). The temporal region (46.7%) was found to be of relatively low thermal symmetry. Regions of high symmetry on lateral projections included the nasal region (69.5%) and the inframandibular region (67.0%). The posterior neck region (44.2%) was found to be of relatively low thermal symmetry. In general, normal subjects demonstrated high levels of thermal symmetry over most regions of the face. This pilot investigation is an early step in the evaluation of electronic thermography for future use in dentistry.

Quantification of thermal asymmetry. Part 1: Normal values and reproducibility

The use of thermography in evaluating nerve injury is based on the presence of temperature asymmetries between the involved area of innervation and the corresponding area on the opposite side of the body. However, interpretation of the thermographic image has been troubled by subjectivity. This paper describes a computer-calculated method of collecting data that eliminates subjective biases. Comprehensive normative data are presented on the degree of thermal asymmetry in the human body. The degree of thermal asymmetry between opposite sides of the body (delta T) is very small. For example, the value of delta T for the forehead (mean +/- standard deviation) was 0.18 degree +/- 0.18 degree C, for the leg it was 0.27 degree +/- 0.2 degree C, and for the foot it was 0.38 degree +/- 0.31 degree C. These values were reproducible in both short- and long-term follow-up measurements over a period of 5 years. The delta T's reported here were obtained from 40 matched regions of the body surface of 90 asymptomatic normal individuals. These values can be used as a standard in assessment of sympathetic nerve function, and the degree of asymmetry is a quantifiable indicator of dysfunction.

Thermography in posttraumatic pain

Posttraumatic pain is often associated with complex disturbances of the sympathetic nervous system which also controls microcirculation of the skin. Circulatory skin changes are in turn reflected by altered superficial thermal emission, which can be reliably imaged by thermography. Examples of classic thermographic patterns associated with commonly occurring injuries and detected along cutaneous distributions of peripheral nerves or spinal root dermatomes are presented. Thermographic abnormalities may also occur in ondermatomal distributions to involve an entire hand, foot, or extremity as observed in reflex sympathetic dystrophy. Such thermographic findings often appear before skin or roentgenographic changes become manifest and lead to earlier diagnosis. Prompt and more effective treatment, particularly in reflex sympathetic dystrophy, may thereby be initiated so that full blown, difficult to manage, chronic disability may be averted. The diagnosis of malingering may also be strengthened or suspected if thermographic studies together with other examinations are normal.

The use of thermography for the diagnosis and management of patellar tendinitis

Computerized thermography was used to evaluate 17 patients diagnosed with patellar tendinitis. The intent of this study was to determine if a specific patellar tendinitis thermal pattern could be distinguished using infrared thermography. A specific thermal abnormality was found over the patellar tendon in 14 subjects (78%). Twelve subjects showed focal "hot" spots, while two showed focal "cold" spots. The thermal abnormalities appeared as specific focal areas directly overlaying the patellar tendon, without disruption to the thermal pattern of the remaining peripatellar regions. The thermal gradient slope over the patellar tendon was greater in symptomatic knees. Five subjects returned 2-4 weeks later for follow-up thermographic examination. Among the follow-up subject group, changes in thermal asymmetry correlated with changes in symptoms 80% of the time. Computerized thermography appears useful as a noninvasive, objective method of detecting inflammation of the soft tissues about the patellar tendon, and also helps to differentiate this disorder from other knee pathologies. J Orthop Sports Phys Ther 1987;9(4):132-140.

Comparison of neurothermography and contrast myelography

Eighty consecutive patients who first had an electronic infrared thermogram (neurothermogram) and a subsequent oil myelogram were studied retrospectively. All patients had cervical and/or lumbosacral radiculopathy for 90 days. Negative neurothermograms were predictive of negative myelograms in 93% of our series. Positive neurothermograms were predictive of positive myelograms in 71% of the patients. The neurothermogram is not a specific test for intraspinal axis lesions as a cause of radiculopathy. Proximal neuropathic lesions of other causes will also produce abnormalities of the sympathetic autonomic (peripheral) nervous system. The major pathophysiologic findings detected by neurothermograms are complimentary to the EMG, NCVS, and late response techniques. Neurothermography was successful in predicting the outcome of myelography in 82% of patients in this study.