Skin temperature changes in patients with unilateral lumbosacral radiculopathy

The effect of a physical rehabilitation program on temperature symmetry, mobility, functionality and gait in amputee patients

INTRODUCTION

Rehabilitation centers offer specialized programs for amputees aimed at enhancing their functional abilities and quality of life. This study aimed to evaluate the impact of a hospital-based rehabilitation program on lower-limb skin temperature distribution, mobility, functionality and gait in individuals with lower-limb amputations.

MATERIAL AND METHODS

This is a pilot, longitudinal, observational study, with pre-post-intervention assessments of 14 patients admitted for inpatient intensive rehabilitation program. The skin temperature of the thigh, knee, and leg was evaluated with an infrared thermography camera (FLIR T650SC®), and mobility, functionality and gait were tested with the Timed Up and Go, Amputee Mobility test Predictor (AMP), and the 2-minute walk test, before and after the multidisciplinary physical rehabilitation program. The baseline and post-intervention data were compared with the Student's T-test or Wilcoxon test for paired data according to data distribution. The α level was established at 5%.

RESULTS

The comparison of baseline and post-intervention temperature outcomes showed no significant changes regardless of the side. There was a significant improvement in balance (AMP scores from 32±7.10 to 35.07±6.76; p<0.0001), gait (2-MWT distance 73.14±52.87m to 96.57±60.91m; p=0.004), and function (TUG total time from 27.14±22.68s to 16.82±10.09s; p<0.001).

CONCLUSION

This study demonstrated that individuals with lower limb amputees experienced improvements in terms of mobility, functionality and gait after the physical rehabilitation program, however, they did not have significant changes in relation to the distribution of skin temperature between the lower limbs.

Usefulness of digital infrared thermography video using the FLIR T560 in detecting hypothermia associated with lumbosacral radiculopathy following spinal stenosis: A CARE-compliant case report

RATIONALE

Here, we investigated the effectiveness of the FLIR T560 thermal imaging camera in detecting hypothermic changes associated with radiculopathy caused by spinal stenosis. This study aimed to determine whether the FLIR T560 could serve as a portable, efficient tool for diagnosing radiculopathy and its related sympathetic dysfunction in clinical practice.

PATIENT CONCERNS

A 77-year-old male had a 1-year history of neuropathic pain in the right distal lower leg, confirmed as L5 and S1 radiculopathy due to central stenosis at L4-5 and L5-S1, as shown by MRI and electrodiagnostic studies. The FLIR T560 recorded thermal images in an insulated room, revealing a significantly lower surface temperature (approximately 1.0°C difference) on the lateral and posterior right distal lower leg and right toes compared with the left side. By referencing the color map and scale, we estimated that the relative temperature difference between corresponding areas was approximately 1.0°C.

DIAGNOSES

L5 and S1 radiculopathy due to central stenosis at L4-5 and L5-S1.

INTERVENTIONS

A transforaminal epidural steroid injection targeting the right L5 and S1 nerve roots was conducted.

OUTCOMES

The patient's pain improved significantly.

LESSONS

The FLIR T560 camera offers a portable and convenient alternative to traditional digital infrared thermographic imaging, allowing real-time thermal imaging in a clinical setting without the need for additional equipment. Our case report suggests that the FLIR T560 is a valuable tool for detecting sympathetic dysfunction associated with radiculopathy. Further studies with larger patient populations are recommended to validate its clinical utility.

The diagnostic accuracy of infrared thermography in lumbosacral radicular pain: a prospective study

BACKGROUND

To identify the sensitivity, specificity, and overall diagnostic accuracy of infrared thermography in diagnosing lumbosacral radicular pain.

METHODS

Patients sequentially presenting with lower extremity pain were enrolled. A clinical certainty score ranging from 0 to 10 was used to assess the likelihood of lumbosacral radicular pain, with higher scores indicating higher likelihood. Infrared Thermography scans were performed and the temperature difference (ΔT) was calculated as ΔT = T1 - T2, where T2 represents the skin temperature of the most painful area on the affected limb and T1 represents the skin temperature of the same area on the unaffected limb. Upon discharge from the hospital, two independent doctors diagnosed lumbosacral radicular pain based on intraoperative findings, surgical effectiveness, and medical records.

RESULTS

A total of 162 patients were included in the study, with the adjudicated golden standard diagnosis revealing that 101 (62%) patients had lumbosacral radicular pain, while the lower extremity pain in 61 patients was attributed to other diseases. The optimal diagnostic value for ΔT was identified to fall between 0.8℃ and 2.2℃, with a corresponding diagnostic accuracy, sensitivity, and specificity of 80%, 89%, and 66% respectively. The diagnostic accuracy, sensitivity, and specificity for the clinical certainty score were reported as 69%, 62%, and 79% respectively. Combining the clinical certainty score with ΔT yielded a diagnostic accuracy, sensitivity, and specificity of 84%, 77%, and 88% respectively.

CONCLUSION

Infrared thermography proves to be a highly sensitive tool for diagnosing lumbosacral radicular pain. It offers additional diagnostic value in cases where general clinical evaluation may not provide conclusive results.

TRIAL REGISTRATION

ChiCTR2300078786, 19/22/2023.

Reference Standard for Digital Infrared Thermography of the Surface Temperature of the Lower Limbs

Digital infrared thermographic imaging (DITI) is a supplementary diagnostic technique to visualize the surface temperature of the human body. However, there is currently no reference standard for the lower limbs for accurate diagnosis. In this study, we performed DITI on the lower limbs of 905 healthy Korean volunteers (411 males and 494 females aged between 20 and 69 years) to obtain reference standard data. Thermography was conducted on the front, back, lateral sides, and sole area, and 188 regions of interest (ROIs) were analyzed. Additionally, subgroup analysis was conducted according to the proximity of ROIs, sex, and age groups. The mean temperatures of ROIs ranged from 24.60 ± 5.06 to 28.75 ± 5.76 °C and the absolute value of the temperature difference between both sides reached up to 1.06 ± 2.75 °C. According to subgroup analysis, the sole area had a significantly lower temperature than any other areas, men had higher temperatures than women, and the elderly had higher temperatures than the young adults except for the 20s age group (p < 0.001, respectively). This result could be used as a foundation for the establishment of a reference standard for DITI. Practical patient DITI can be accurately interpreted using these data, and it can serve as a basis for further scientific research.

Tibial Nerve Block as Treatment of Chronic Foot Pain

Background

Minimally invasive therapies can alleviate pain and improve walking in individuals with persistent foot and ankle pain.

Objectives

The current study aimed to define the protracted consequences of tibial nerve blocks with steroids for individuals with persistent foot pain and to investigate the link between the thermography of the plantar foot and the beneficial effect of a tibial nerve block with steroids.

Methods

All patients with chronic foot pain (n = 45) in this cohort underwent a block of the tibial nerve in the Department of Pain Therapy of Pain Clinic De Bilt, Utrecht, Netherlands, within November 2019 to April 2020. The thermographic images of patients were taken before and after injection. Results were retrospectively evaluated after 18 months.

Results

In this study, 53% of the patients had pain relief at 7 weeks of follow-up with a unilateral or bilateral block of the tibial nerve. An improvement in walking distance was reported by 22% of the patients. Side effects of the tibial nerve block reported at 7 weeks of follow-up increased pain (5%) and the occurrence of leg cramps (5%) among the treated patients. At 18 months, 45% of the successfully treated feet still had benefits. A difference between the big toe's temperature and the foot's average temperature of less than -0.9°C on thermography before and after the tibial nerve block can predict a beneficial result of therapy.

Conclusions

Tibial nerve block provides a safe, minimally invasive treatment option for almost half of the patients with painful feet in this cohort, and when successful, it can last a long term. Thermographic imaging of the plantar foot can predict only to a small extent the beneficial effect of the tibial nerve block with steroids on foot pain. Tibial nerve block should be considered when custom foot orthoses have been inadequate for pain relief or restricted walking distance.

Feasibility for Using Thermography Throughout an Exercise Program in Mastectomized Patients

Introduction

Breast cancer is the most common in the female population. Physical training is safe and indicated after surgical treatment for breast cancer. During exercise, body temperature changes due to tissue metabolic activity; in this sense, infrared thermography is used to map the thermal patterns of the body surface.

Objective

This study aimed to evaluate the feasibility of using thermography during a physical rehabilitation program in mastectomized patients by analyzing the change in body temperature caused by physical exercise in the breast region.

Methodology

This is a simple and covert clinical trial, in which the sample was constituted for convenience. The women were submitted to a supervised physical exercise protocol, three times a week, for 20 sessions. They were evaluated in the first, tenth, and twentieth sessions in relation to changes in body temperature in the breast region (infrared thermography).

Results

Twenty patients who underwent mastectomy surgery were recruited. No patient had drain infection, scar dehiscence, or lymphedema, and only one patient had seroma removed. The mean age was 50.45 ± 2.00 years, and the body mass index (BMI) was 28.95 ± 1.11 kg/m2. In the body thermography of the patients’ breast region, no significant difference was observed when comparing the thermograms of the plastron region of the patients in the first, tenth, and twentieth sessions (p = 0.201). However, when comparing the plastron region with the control breast, a reduction in temperature was observed in the operated region in the first (p = 0.012) and tenth sessions (p = 0.004).

Conclusion

Through this study, we can conclude that the use of infrared thermography is viable for the analysis of the body temperature of mastectomized patients during a supervised physical exercise protocol and, therefore, suggest that this instrument is increasingly used in the cancer public.

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.

Hyperthermia associated with spinal radiculopathy as determined by digital infrared thermographic imaging

In general, in digital infrared thermographic imaging (DITI) of patients with unilateral spinal radicular pain, the thermal pattern of the extremities of the side of lesion shows hypothermia compared to the opposite, intact side. However, sometimes, DITI shows hyperthermia on the side of the lesion, and this variation can cause confusion. We compared the data of both hypothermia and hyperthermia patients to clarify the factors determining different thermal characteristics in spinal radiculopathy.We retrospectively collected data from patients who underwent DITI at a single center. The final cohort (n = 224) was allocated into 2 groups, a hypothermia group (n = 180) or a hyperthermia group (n = 44). We compared the various factors, including demographic factors and symptom-related factors, that might affect the results of DITI.Except the presence of trauma history (13.9% vs 31.8%, odds ratio 2.893, P = .008), no significant intergroup difference was found in baseline demographic factors, including age, gender, diabetes mellitus, spinal level of pathology, and intervention history. Among symptom-related factors, in the hyperthermia group, the symptom duration was shorter (10.64 weeks [95% confidence interval (CI) 8.36-13.04] vs 2.10 weeks [95% CI 1.05-3.53], P < .001) and Visual Analogue Scale (VAS) of radicular pain was higher (4.23 ± 1.29 vs 5.18 ± 1.40, P < .001) than in the hypothermia group. Also, in the regression analysis, significant factors for hyperthermia include the presence of trauma history, shorter symptom duration (cut-off value 2.50 weeks or less) and higher VAS of radicular pain (cut-off value 4.50 or more).In patients with trauma history, acute phase, and severe radicular pain, hyperthermia in DITI is not unusual and careful interpretation of the DITI results is necessary for proper diagnosis and treatment decisions in spinal radiculopathy.

Use of Digital Infrared Thermal Imaging in the Electromyography Clinic: A Case Series

Introduction: Foot drop often results from denervation of the dorsiflexor muscles in the leg. Neurological evaluation begins with lower extremity motor testing followed by electromyography needle electrode examination (EMG-NEE). We explored digital infrared thermography (IRT) as a complementary tool in diagnosing peripheral nerve disorders.

Methods: Using a digital IRT camera, we recorded differences in skin surface temperatures from affected and unaffected limbs in three patients with unilateral foot drop. Denervation in the affected limb was confirmed with EMG-NEE.

Results: IRT imaging revealed lower relative skin surface temperatures in regions of the leg corresponding to denervated dorsiflexor muscles for all three consecutive patients who presented to the EMG Clinic with foot drop. 

Conclusions: Denervation appears to cause a decrease in thermal energy output from affected muscle groups. Alongside the EMG and magnetic resonance imaging (MRI), IRT may have an important role in assessing the severity and prognosis of a nerve injury. This observation may have implications for chronic pain syndromes, such as complex regional pain syndrome (CRPS), in which thermal change is a diagnostic criterion.

Improvement of sensory function after sequestrectomy for lumbar disc herniation: a prospective clinical study using quantitative sensory testing

BACKGROUND

Previous studies have investigated sensory recovery in patients with lumbar disc herniation using rather subjective methods. There have been no reports on changes of sensory function in patients suffering from a preoperative sensory deficit using quantitative sensory testing (QST). The aims of this prospective study were (1) to assess the recovery of preoperative sensory dysfunction after lumbar sequestrectomy and (2) to quantify the strength of relationship between a sensory deficit and the patient's quality of life.

METHODS

We applied the QST protocol of the German Research Network on Neuropathic Pain (DFNS) in fifty-two patients with a single lumbar disc herniation confirmed on MRI treated by lumbar sequestrectomy. Further evaluation included a detailed medical history, a physical examination, numeric rating scale for leg, EQ-5D questionnaire, and thermometer.

RESULTS

Disc surgery resulted in a significant reduction of leg pain and a significant gain of quality of life. Thermal, mechanical, and vibration perception thresholds showed an obvious side-to-side difference preoperatively (p < 0.005). An early recovery of mechanical and vibration perception thresholds was detected, whereas cold perception needed more than 6 months to recover (p < 0.05). Quality of life was independent from perception thresholds, but correlated significantly with pain reduction.

CONCLUSION

Our data clearly show that there is a subjective and quantifiable improvement in sensory dysfunction postoperatively. The current data suggest that a sensory dysfunction does not influence a patient's quality of life.

Extracorporeal Shock Wave Stimulation as Alternative Treatment Modality for Wrist and Fingers Spasticity in Poststroke Patients: A Prospective, Open-Label, Preliminary Clinical Trial

Objective. To evaluate the effectiveness of radial shock waves (rESW) for wrist and fingers flexors spasticity in stroke patients. Methods. Twenty patients with upper limb muscle spasticity were enrolled in the study and treated with a single session of rESW. The spasticity level of the radio carpal (RC) and finger (FF) joints was assessed using Modified Ashworth Scale (MAS). The resting bioelectrical activity of the flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU) was examined using surface electromyography (sEMG). Trophic conditions were measured using infrared thermal (IRT) imaging. All measurements were conducted at baseline (t₀), immediately after rESW (t₁), and 1 (t₂) and 24 (t₃) hours following rESW. Results. Significant reduction in MAS was observed for the RC joint in t₁, as well as for the FF joints in t₁, t₂, and t₃. A significant decrease in sEMG was shown for the FCR muscle in t₁ and t₂, as well as for the FCU muscle in t₁ and t₃. Also, a significant increase in IRT value was observed in t₃ only. Conclusions. A single session of rESW could be an effective alternative treatment for reduction of limb spasticity and could lead to improvement of trophic conditions of the spastic muscles.