==================================HSR35================================== 35. Thermography for indications other than breast. 1 UI - 87111213 AU - Meeker WC ; Gahlinger PM TI - Neuromusculoskeletal thermography: a valuable diagnostic tool? AB - The use of neuromusculoskeletal thermography is rapidly increasing. Recent studies have begun to document the types of diagnostic and other clinically useful information which may be derived from the procedure. This paper provides a review and summary of current research and a comparison with myelography, computerized tomography, electromyography and clinical and surgical findings in cases of presumed musculoskeletal pain syndromes. The importance of diagnostic sensitivity, specificity, positive and negative predictive value, and accuracy (validity) are discussed. In general, the literature reports high sensitivity and negative predictive value, but lower specificity and positive predictive value. The implications of these findings are examined in regard to clinical case management, with emphasis on potential usefulness to chiropractors. Although thermography appears to be a promising diagnostic tool, there remain a number of threats to the scientific validity of current research which must be accounted for in future work. MH - Bone Diseases/*DIAGNOSIS/RADIOGRAPHY ; *Chiropractic ; Comparative Study ; Electromyography ; Evaluation Studies ; Human ; Muscular Diseases/ *DIAGNOSIS/RADIOGRAPHY ; Myelography ; Nervous System Diseases/*DIAGNOSIS/ RADIOGRAPHY ; Pain/DIAGNOSIS/ETIOLOGY ; Prognosis ; Review ; Spinal Diseases/DIAGNOSIS/RADIOGRAPHY ; Support, Non-U.S. Gov't ; *Thermography ; Tomography, X-Ray Computed SO - J Manipulative Physiol Ther 1986 Dec;9(4):257-66 2 UI - 87102850 AU - Giacovazzo M ; Martelletti P ; Valducci G TI - Computerized telethermographic assessment in migraine, with particular reference to the prodromal phase. AB - We have studied the angular orbit and supraorbital arteries in 58 patients with classic migraine (36 females, 22 males; age (means), 43.5 years). A Dorex telethermograph apparatus, which utilizes the infrared radiations emitted by a patient, was used. The individual is placed at standard distance, and the temperature and humidity of the environment are kept constant. Three thermographic tests were performed in each patient: the first in basal condition, the other during the visual and/or sensory aura, and the last during the pain phase. The skin temperature levels decreased during the prodromal phase and increased during the migraine attack as compared with the levels obtained in basal conditions. There were significant asymmetries during the pain phase. MH - Adult ; Diagnosis, Computer Assisted ; Female ; Human ; Male ; Migraine/ *DIAGNOSIS ; Skin Temperature ; Support, Non-U.S. Gov't ; *Thermography/ INSTRUMENTATION SO - Cephalalgia 1986 Dec;6(4):219-22 3 UI - 87066986 AU - Rosenberg N ; Ryckaert A TI - Use of thermogram in detection of meningitis. AB - Thermography of the lumbar area was performed on 169 patients under two years of age. Twenty-four percent (21/87) of afebrile patients and nine percent (6/66) of febrile patients without meningitis had increased lumbar heat (false-positive). Sixteen patients with a cerebrospinal fluid pleocytosis and/or pathogens present demonstrated increased heat in the lumbar area. Clinical evaluation at a level of greater than 2 (0-10) had a sensitivity of 100% and a specificity of 80%. Thermographic evaluation at a grade of 6 or higher (0-10) for the presence of midline heat had a sensitivity of 100% and a specificity of 92%. Thermography of the lumbar area may be a useful clinical adjunct to screen for meningitis. MH - Human ; Infant ; Meningitis/*DIAGNOSIS ; Meningitis, Aseptic/DIAGNOSIS ; Meningitis, Haemophilus/DIAGNOSIS ; Meningitis, Pneumococcal/DIAGNOSIS ; Spinal Puncture ; *Thermography SO - Pediatr Emerg Care 1986 Jun;2(2):71-4 4 UI - 87058492 AU - White BA ; Lockhart PB ; Connolly SF ; Sonis ST TI - The use of infrared thermography in the evaluation of oral lesions. AB - This study was conducted to quantitate the degree of inflammation associated with oral lesions by using infrared thermography. It was reasoned that the increased vascularity associated with inflamed tissue may result in measurable increases in surface temperature. One subject with normal oral mucosa and three subjects with oral lesions of varying causes were studied with a thermal video system, using an infrared imager and microprocessor. A clinical photograph of each subject was obtained. Multiple thermograms were made in a temperature range of 30.0 C to 34.2 C at a sensitivity of 0.2 C. Photographs were taken on different occasions to determine whether the temperature readings could be duplicated and to test the accuracy of each reading. The normal surface temperature of the control subject's mucosa was significantly cooler than were the temperatures of the inflamed areas in the subjects with lesions induced by chemotherapy. The temperature of the areas of stomatitis was consistent (subject 3, mean = 33.7 C; subject 4, mean = 33.9 C). The necrotic center of a traumatic ulcer inhibited measurement of an underlying inflamed base and, thus, was equivalent to the control in temperature (subject 1 (control), mean = 31.9 C; subject 2 (necrotic lesion), mean = 31.7 C). These results suggest that infrared thermography may provide a means to quantitatively assess the degree of mucosal inflammation. MH - Adult ; Female ; Human ; Male ; Middle Age ; Mouth Diseases/*DIAGNOSIS ; Mouth Mucosa/PATHOLOGY ; Stomatitis/DIAGNOSIS ; Support, Non-U.S. Gov't ; *Thermography ; Ulcer/DIAGNOSIS SO - J Am Dent Assoc 1986 Nov;113(5):783-6 5 UI - 87052268 AU - Canter RJ TI - A non-invasive method of demonstrating the nasal cycle using flexible liquid crystal thermography. AB - The relationship between air flow at 38 degrees C and area colour change on a flexible liquid crystal film was found to be virtually linear between the values of 1 and 31 min-1 cm-2. This value of flow per unit area corresponded to values expected at the level of the nostril during quiet breathing. A series of 6 subjects were asked to breathe over a flexible liquid crystal film regularly during the day and the area of colour change produced by flow from each nostril was examined. Four subjects showed a regular change in relative flow through each nostril whilst 2 subjects showed a constant flow through each nostril. This simple and non-invasive technique provides a method of examining the nasal cycle in adults and children in health and disease. MH - Adult ; Female ; Human ; Male ; Nose/*PHYSIOLOGY ; *Respiratory Airflow ; Support, Non-U.S. Gov't ; Thermography/INSTRUMENTATION/*METHODS SO - Clin Otolaryngol 1986 Oct;11(5):329-36 6 UI - 87042892 AU - Edeiken J ; Shaber G TI - Thermography: a reevaluation. AB - This is a brief review of the physical and physiologic aspects and theories of thermography and its clinical use in musculoskeletal conditions. Thermography is a simple, non-invasive procedure with a potential for usefulness. However, the majority of clinical studies to date have not been performed independent of other examinations with controlled verification, nor are there standards of normal available for comparison. Thermography should not be offered to the public as a confirmed and reliable tool for the diagnosis and management of musculoskeletal problems. It is still experimental, and its clinical use cannot be justified until appropriate data support it. MH - Autonomic Nervous System/PHYSIOLOGY ; Body Temperature Regulation ; Capillaries/INNERVATION ; Human ; Skin Temperature ; Skin/BLOOD SUPPLY ; Spinal Nerve Roots/PHYSIOLOGY ; *Thermography ; Vasodilation SO - Skeletal Radiol 1986;15(7):545-8 7 UI - 87042624 AU - Theuvenet WJ ; Koeyers GF ; Borghouts MH TI - Thermographic assessment of perforating arteries. A preoperative screening method for fasciocutaneous and musculocutaneous flaps. AB - Pre-operative localization of the involved perforating arteries in the planning of musculocutaneous or fasciocutaneous flaps may lead to a higher survival rate of the whole skin island. This in particular will be of importance in donor areas with changed haemodynamics. A noninvasive method is described for the accurate preoperative localization of the perforating arteries of the trunk and extremities; a method which causes minimal discomfort to the patient, but which will help in preparing for a successful operation. We have used this method since 1983 for all high-risk patients, and it has proved to be very useful in our hands. MH - Adult ; Aged ; Arteries/*ANATOMY & HISTOLOGY ; Fascia/*BLOOD SUPPLY ; Female ; Human ; Infrared Rays ; Male ; *Surgical Flaps ; *Thermography SO - Scand J Plast Reconstr Surg 1986;20(1):25-9 8 UI - 87013306 AU - Jochimsen PR ; Folk GE Jr ; Sundell M ; Loh PM TI - B16 melanoma in hairless mice: a model for thermographic research. AB - Little is understood concerning the mechanism of tumor-induced thermographic abnormalities observed in man. An ideal animal model is lacking. In an effort to create such a model we have worked with hairless mice, subcutaneously inoculated with B16 melanoma cells. This report documents the progress of that work and the subsequent development of a totally satisfactory system for the study of such tumors in a hairless animal. MH - Animal ; Melanoma, Experimental/*DIAGNOSIS ; Mice ; Mice, Inbred HRS ; Neoplasm Transplantation ; Skin Neoplasms/*DIAGNOSIS ; Support, Non-U.S. Gov't ; *Thermography SO - J Surg Oncol 1986 Sep;33(1):50-2 9 UI - 86316206 AU - Mills GH ; Davies GK ; Getty CJ ; Conway J TI - The evaluation of liquid crystal thermography in the investigation of nerve root compression due to lumbosacral lateral spinal stenosis. AB - The role of liquid crystal thermography (LCT) in the investigation of nerve root compression due to lumbosacral lateral spinal stenosis was evaluated using a quantitative analysis technique. In 28 healthy volunteers, normal lower limb dermatomal asymmetry was found to follow a Gaussian distribution, with a normal range of less than 1.0 degree for the lower limbs and less than 1.9 degrees for the feet. The results of LCT from a patient group were compared with those from other investigations, with the following results: clinical assessment (107 patients), 53% agreement; myelography (60 patients), 45% agreement; computerized tomography (35 patients), 46% agreement; electromyography (27 patients), 41% agreement; and surgical findings (19 patients), 53% agreement. Each method of investigation was compared against the surgeon's final overall assessment. Clinical assessment agreed in 76%, myelography in 71%, computerized tomography in 71%, and electromyography in 70%. However, agreement could be demonstrated in only 48% of cases using LCT; therefore, it would appear that LCT is by far the least reliable of these techniques in the diagnosis of nerve root compression. MH - Body Temperature ; Comparative Study ; Evaluation Studies ; Female ; Human ; Lumbosacral Region ; Male ; Nerve Compression Syndromes/*ETIOLOGY/ PHYSIOPATHOLOGY ; *Spinal Nerve Roots ; Spinal Stenosis/*COMPLICATIONS ; Support, Non-U.S. Gov't ; Thermography/*METHODS/STANDARDS SO - Spine 1986 Jun;11(5):427-32 10 UI - 86314181 AU - Thurston NM ; Kent B ; Jewell MJ ; Blood H TI - Thermographic evaluation of the painful shoulder in the hemiplegic patient. AB - In this study, we investigated the applicability of thermography as a technique for evaluating the painful postcerebrovascular accident (CVA) shoulder in hemiplegic patients. A thermographic series was taken of the upper extremities and upper trunk of 27 female subjects. The four groups we evaluated were nonhemiplegic subjects (n = 9), post-CVA subjects with recovered function (n = 6), hemiplegic subjects with upper extremity motor impairment (n = 6), and hemiplegic subjects with both motor impairment and ipsilateral shoulder pain (n = 6). The data revealed a normal thermographic series in 8 of the 9 nonhemiplegic subjects, but only in 1 of the 18 post-CVA subjects. The majority of the abnormal thermographic series of post-CVA subjects showed a 1 degree to 5 degree C coolness on the involved side. No consistent thermographic patterns emerged that could be related to the severity or location of pain. Further studies are needed to evaluate the efficacy of thermography as a means of determining the relationship between ipsilateral post-CVA coolness and hemiplegic shoulder pain. MH - Aged ; Cerebrovascular Disorders/COMPLICATIONS ; Comparative Study ; Evaluation Studies ; Female ; Hemiplegia/*COMPLICATIONS ; Human ; Middle Age ; Pain/*DIAGNOSIS/ETIOLOGY ; *Shoulder ; Support, Non-U.S. Gov't ; *Thermography SO - Phys Ther 1986 Sep;66(9):1376-81 11 UI - 86303166 AU - Luk KD ; Yeung PS ; Leong JC TI - Thermography in the determination of amputation levels in ischaemic limbs. AB - The reliability of thermography for the determination of the level of amputation for an ischaemic lower limb was compared with that of the doppler flowmeter and the clinical judgement of an experienced surgeon. The results showed that thermography tended to overestimate the degree of ischaemia and to indicate a higher level of amputation than was necessary. The advantages and the limitations of each method are discussed. It is concluded that the clinical judgement of the surgeon was the most reliable method and that the other investigations are only an adjunct to clinical assessment. MH - Aged ; *Amputation ; Comparative Study ; Female ; Flowmeters ; Human ; Ischemia/*SURGERY ; Knee ; Leg/*BLOOD SUPPLY ; Male ; Middle Age ; *Thermography SO - Int Orthop 1986;10(2):79-81 12 UI - 86273873 AU - Stess RM ; Sisney PC ; Moss KM ; Graf PM ; Louie KS ; Gooding GA ; Grunfeld C TI - Use of liquid crystal thermography in the evaluation of the diabetic foot. AB - Liquid crystal thermography (LCT) was used to determine temperature variations on the plantar surface of feet. The purpose was to identify thermal emission patterns associated with diabetic foot ulcers. Three population groups were screened: group I, 16 nondiabetic controls; group II, 21 diabetic patients with no history of pedal ulcers; and group III, 28 diabetic patients with active pedal ulceration or history of foot ulcerations. The results demonstrate a generalized increase in plantar foot temperature in group III compared with groups I and II. Temperature readings under metatarsal heads 1-5, great toe, heel, and lateral band were significantly increased (P less than .01) in group III. Additionally, the warm lateral surface displayed by group III patients was not significantly different in temperature from the medial arch of the foot. In groups I and II, the lateral band was significantly cooler (P less than .01) than the medial arch. In group III patients with active ulceration on only one foot, no significant difference in temperature was found between the foot with active ulceration compared with the contralateral nonulcerated foot. When patients with active pedal ulceration were compared with patients with a history of foot ulcers, no significant difference in temperature was seen at five of seven sites tested. A warm concentric color band surrounding active plantar ulcers was identified in group III. This pattern extended from the center of the ulcer to a distance of 8 mm. A significant change in temperature (P less than .01) was noted at 6- and 8-mm distances from the center of the ulcer. In addition, a mottled thermographic pattern was observed more frequently in group III patients than in groups I and II.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Diabetic Angiopathies/*PHYSIOPATHOLOGY ; Foot/BLOOD SUPPLY ; Foot Diseases/ETIOLOGY/*PHYSIOPATHOLOGY ; Human ; Male ; *Skin Temperature ; Skin Ulcer/ETIOLOGY/*PHYSIOPATHOLOGY ; Support, U.S. Gov't, Non-P.H.S. ; Thermography/*METHODS SO - Diabetes Care 1986 May-Jun;9(3):267-72 13 UI - 86238600 AU - Andersson S TI - Thermography and plethysmography in the diagnosis of deep venous thrombosis--a comparison with phlebography. AB - Ninety-two patients with suspected unilateral deep venous thrombosis (DVT) in the lower limb were examined by thermography, plethysmography and phlebography. ROC analysis (Receiver Operating Characteristics) was used to evaluate discrimination thresholds and to compare thermography and plethysmography (four variables) with phlebography. The sensitivity of thermography, 85% (94% for out-patients), was higher than that of plethysmography (58-79%) for the discrimination thresholds chosen. The specificity of thermography was low, 39% (42% for out-patients) or 55%, if obvious relevant clinical findings were included in the evaluation. The specificity of plethysmography was much higher (80-97%). Optimum combination of the four plethysmographic variables showed predictive values of 93-94%, while combination of thermography and plethysmographic variables showed higher predictive values (95-97%), mostly because of a higher sensitivity of thermography for distal DVT. A possible reduction of the number of phlebographic examinations by at least 50% and a cost reduction of 25% could have been obtained without any appreciable loss of diagnostic accuracy. A follow-up study of 112 consecutive patients, examined according to the recommended screening method, showed a reduction of phlebographic examinations by 62%. MH - Acute Disease ; Comparative Study ; Costs and Cost Analysis ; Evaluation Studies ; Follow-Up Studies ; Human ; *Plethysmography/ECONOMICS ; *Thermography/ECONOMICS ; Thrombophlebitis/*DIAGNOSIS SO - Acta Med Scand 1986;219(4):359-66 14 UI - 86236274 AU - Jonker JJ ; Sing AK ; de Boer AC ; den Ottolander GJ TI - The value of adding thermographic leg scanning to impedance plethysmography in the detection of deep vein thrombosis. AB - The clinical value of adding thermographic leg scanning to impedance plethysmography was evaluated and compared in 52 patients with clinically suspected deep venous thrombosis. Both tests were performed on the day of referral and phlebography within 72 hours. The sensitivity of thermography was 83%, the specificity 41% and the accuracy 61%. In comparison IPG had a sensitivity of 83%, a specificity of 96% and an accuracy of 90% The combination of thermography and IPG showed a sensitivity of 92%, a specificity of 41% and an accuracy of 65%. It is concluded that the addition of thermography to IPG is of no clinical value. MH - Comparative Study ; Evaluation Studies ; Female ; Human ; Leg/*BLOOD SUPPLY ; Male ; Middle Age ; Plethysmography, Impedance/*METHODS ; Thermography/*METHODS ; Thrombophlebitis/*DIAGNOSIS SO - Thromb Res 1986 Jun 1;42(5):681-8 15 UI - 86232960 AU - Maultsby JA ; Meek JB ; Routon J ; Fletcher D ; Underwood DL 3d ; Chabon SJ TI - Thermography: its correlation with the pain drawing. The clinical correlation found among four independent interpreters participating in a blinded study. AB - Forty medical charts were selected at random from a larger sample of orthopedic patients who had received medical, electronic thermographic, physical therapy, and psychological evaluations for complaints of chronic lumbar pain. The thermograms were then evaluated by four independent, experienced thermography interpreters who were blind to all other patient data. All of the patients had experienced chronic low back pain of unknown etiology for longer than three months. In 80 percent of the cases evaluated the four interpreters agreed as to the presence of normality or abnormality in the thermograms. The ability of the interpreter to create from the thermographic evidence a pain drawing similar to the patient's own original pain drawing was also evaluated. In thirty cases, the interpreters were able to construct a pain drawing from the thermograms which covered at least 50 percent of the surface area of the patient's pain drawing. The results of this study generally support the indication of at least a moderate correspondence between the objective area of abnormality and the subjective area of pain reported by the patient. MH - Backache/*DIAGNOSIS ; Comparative Study ; Human ; Medical Records ; Pain/ DIAGNOSIS ; Random Allocation ; *Thermography SO - Postgrad Med 1986 Mar;Spec No:90-2 16 UI - 86232958 AU - Adams WJ ; Lloyd JT TI - Empirical evaluation of the chronic pain diagnosis. AB - One hundred patients with complaints of chronic pain, most commonly of cervical origin, were evaluated for the presence of three components believed associated with pain: elevated skin temperature, muscle tension and personality changes. A high degree of correlation (94%) between thermography and myelographic findings was observed in patients with cervical pain. In descending order, thermographic evaluations were positively correlated with muscle scan (60%), CAT scan (50%), MMPI (40%) and EMG (26%). In patients with lumbar pain the correlation values for thermography in relation to other tests was somewhat higher: myelogram (71%), CAT scan (83%), MMPI (56%) and EMG (40%). MH - Chronic Disease ; Comparative Study ; Electromyography ; Human ; Muscle Contraction ; Myelography ; MMPI ; Pain/*DIAGNOSIS/PSYCHOLOGY ; Personality Assessment ; Prospective Studies ; Skin Temperature ; *Thermography ; Tomography, X-Ray Computed SO - Postgrad Med 1986 Mar;Spec No:86-9 17 UI - 86232957 AU - Shandell KE ; Saboda S TI - Thermographic examinations and the differential diagnosis of psychogenic versus organic factors in patients with pain. AB - Sixty patients with complaints of persistent recurrent or chronic pain associated with the spine were carefully evaluated physically, thermographically and psychometrically in an attempt to identify the cause of the pain experience. Forty-two (70%) presented evidence of positive thermograms while thermographic evaluations in 18 (30%) patients were considered to be within normal limits. Psychological assessments revealed that 32 (53.3%) individuals presented evidence of gross psychopathology while 28 (46.7%) did not. Among the 18 individuals with normal thermograms 13 (7 2.2%) manifested clinically substantial psychopathology. Among those 42 individuals who evidenced abnormal thermograms 19 (45.2%) were felt to also present evidence of a psychological disorder. MH - Adult ; Diagnosis, Differential ; Female ; Human ; Male ; Pain/*DIAGNOSIS ; Psychophysiologic Disorders/*DIAGNOSIS ; *Thermography SO - Postgrad Med 1986 Mar;Spec No:83-5 18 UI - 86232956 AU - Herrick RT ; Herrick S ; Purohit R ; Smith L TI - Liquid crystal thermography in the detection of carpal tunnel syndrome. AB - A retrospective review was conducted of 35 patients who, in each case, had been thermographically evaluated prior to the establishment of a diagnosis of carpal tunnel syndrome. Twenty-eight (80%) of these individuals had also been evaluated by electronic diagnostic methodologies. Eighteen had positive thermographic readings but negative or normal electronic evaluations. Eight of these recovered without the need for surgery. Another nine had positive findings with both diagnostic approaches. Eight of these recovered after appropriate surgical intervention. The remaining individual had electronic studies indicating the presence of carpal tunnel syndrome, but thermographic evaluations suggested a thoracic outlet disorder. Subsequent long-term follow-up eventually confirmed the latter diagnosis. MH - Adult ; Carpal Tunnel Syndrome/*DIAGNOSIS ; Comparative Study ; Electromyography ; Evoked Potentials, Somatosensory ; Female ; Human ; Male ; Neural Conduction ; Occupational Diseases/*DIAGNOSIS ; Retrospective Studies ; *Thermography SO - Postgrad Med 1986 Mar;Spec No:78-82 19 UI - 86232955 AU - Green J ; Noran WH ; Coyle MC ; Gildemeister RG ; Becker C TI - Electronic infrared thermography and its relationship to other neurodiagnostic modalities. AB - An objective blinded expert comparison of the results obtained by thermographic evaluations to those obtained by a variety of established electrodiagnostic techniques was conducted in 100 patients with complaints attributable to cervical or lumbosacral radiculopathy. A substantial degree of correlation was found between thermographic evaluations and electrodiagnostic assessments. These data indicate that thermography offers a reliable clinical tool for the evaluation of radiculopathy disorders. MH - Adult ; Comparative Study ; Electromyography ; Evoked Potentials, Somatosensory ; Female ; Human ; Infrared Rays/DIAGNOSTIC USE ; Male ; Myelography ; Neural Conduction ; Radiculitis/*DIAGNOSIS ; *Thermography/ METHODS SO - Postgrad Med 1986 Mar;Spec No:74-7 20 UI - 86232954 AU - Hubbard JE TI - Statistical review of thermography in a neurology practice: pain evaluation. AB - In a study of 805 consecutive thermographic evaluations for pain, statistical correlations were examined between patient symptom distribution, pain mapping diagrams, and other diagnostic studies, including electromyography (EMG), computerized tomographic (CT) scanning, and myelography. The findings reveal a high correlation (94%) in both the lumbar (with lower extremities) and cervical (with upper extremities) regions when the observed thermographic abnormalities were compared with pain distribution maps. Furthermore, the thermographic results appeared to be well correlated with EMG (lumbar - 68%; cervical - 70%), myelography (lumbar - 95%; cervical 79%), and CT scanning (lumbar 80%; cervical 81%). In addition, among 52 control evaluations performed in a young asymptomatic population, approximately 90% were interpreted as normal. This study serves to document the clinical usefulness and reliability of cutaneous thermal imaging for the evaluation of pain. MH - Adolescence ; Adult ; Aged ; *Cervical Vertebrae ; Electromyography ; Female ; Human ; *Lumbar Vertebrae ; Male ; Middle Age ; Myelography ; Neurologic Examination ; Pain/*DIAGNOSIS ; Spinal Diseases/DIAGNOSIS ; Support, Non-U.S. Gov't ; *Thermography ; Tomography, X-Ray Computed SO - Postgrad Med 1986 Mar;Spec No:65-72 21 UI - 86232953 AU - Uricchio JV Jr TI - Thermography: the clinical use of thermography in orthopedic practice. AB - Soft tissue injuries about the neck and lower back, as well as their radicular components, have long represented an intriguing challenge to diagnostic efforts and medical management. With the introduction of thermographic examinations, considerable advancement has been made in both areas. Thermography has been shown to be closely correlated with myelographic findings in this series. Of 195 myelograms performed among a population of 1288 patients who had undergone thermograms, the latter were shown to directly correlate with the myelograms in 90% of the cases. Thermography has emerged as a most useful adjunctive diagnostic test in the recognition and treatment of musculoskeletal injuries, peripheral nerve insult, reflex sympathetic dystrophy, and nerve root fiber irritation. Thermography does not replace nor eliminate physical examinations, CT scan, EMG or myelogram. However, it allows a new dimension for recognition of clinical pain complaints and can be applied with discretion to screen patients and thereby promote more intelligent use of those invasive procedures. MH - Back/*INJURIES ; Backache/*DIAGNOSIS ; Comparative Study ; Human ; Myelography ; Neck/*INJURIES ; Peripheral Nerves/INJURIES ; Retrospective Studies ; Spinal Injuries/*DIAGNOSIS ; Sprains and Strains/DIAGNOSIS ; *Thermography SO - Postgrad Med 1986 Mar;Spec No:62-4 22 UI - 86232951 AU - Rosenblum JA TI - Documentation of thermographic objectivity in pain syndromes. AB - Three hundred eighteen patients were subjected to thermographic evaluations of various complaints of pain. Of these 178 (56%) were regarded as abnormal. Of the 262 patients whose pain syndromes were the subject of litigation, 146 (56%) were determined to have abnormal thermographic evaluations. Source of referral did not appear to influence the results of thermographic assessments performed upon the patients involved in litigation. Of 216 defendant referrals, 120 (56%) thermograms were evaluated as abnormal. Among 46 plaintiff patients, 26 (57%) were abnormal. In more than 80 percent of the cases with evidence of abnormal thermograms, there was clinical evidence of disability while in over 90 percent of the normal readings, no clinical evidence of disability could be recognized. These data provide evidence for the objectivity of thermography as a clinical procedure. MH - Disability Evaluation ; Human ; *Jurisprudence ; Myofascial Pain Syndromes/*DIAGNOSIS ; New York City ; Prospective Studies ; Referral and Consultation ; *Thermography SO - Postgrad Med 1986 Mar;Spec No:59-61 23 UI - 86232950 AU - Goldberg GS TI - Thermography and magnetic resonance imaging correlated in 31 cases. AB - Preliminary experience with two diagnostic tests for the evaluation of low back pain is reported. Magnetic resonance imaging and electronic thermography were compared in 31 patients. These findings were also correlated with myelography carried out in 8 of these individuals. In 9 patients with normal thermographs, 6 had no evidence of disc degeneration on magnetic resonance imaging and 3 had mild disc degeneration. No cases were observed in which a negative thermogram was associated with evidence of severe degenerative disc disease on magnetic resonance imaging. Thirteen patients had definitely abnormal thermograms and, of these, 9 appeared to have significant disc degeneration on magnetic resonance imaging, while 3 had evidence of mild disc degeneration and one was regarded as normal. Our results suggest that thermography is valuable as an initial test in patients with persistent low back pain. If the test is negative, the presence of a lesion amenable to surgical intervention is unlikely and other costly and/or invasive tests can be avoided. MH - Adult ; Backache/*DIAGNOSIS ; Case Report ; Comparative Study ; Human ; Intervertebral Disk Displacement/*DIAGNOSIS ; Male ; Myelography ; Nuclear Magnetic Resonance/*DIAGNOSTIC USE ; Retrospective Studies ; *Thermography ; Tomography, X-Ray Computed SO - Postgrad Med 1986 Mar;Spec No:54-8 24 UI - 86232949 AU - Uricchio JV Jr ; Walbroel CE TI - Blinded reading of electronic thermography. AB - Under blinded conditions, 24 electronic thermograms performed on 22 patients were evaluated for evidence of abnormality. The blinded reader was given no information about each patient's clinical picture nor what other diagnostic tests may have been performed. The thermographic interpretations were then compared with the findings discovered upon CT scan and/or myelographic examinations performed on the same patient. All significant pathology detected by CT scan and myelogram was recognized on the blind thermographic readings. There were no false negative readings of the thermograms. A few equivocal or questionable slightly positive thermographic interpretations were matched with similarly equivocal CT scan or myelographic findings. Electronic thermography is felt to be a most precise and helpful addition to the diagnostic armamentarium. When combined with CT scan findings, it can be highly predictive of myelographic abnormalities. MH - Adult ; Aged ; *Cervical Vertebrae ; Comparative Study ; Female ; Human ; *Lumbar Vertebrae ; Male ; Middle Age ; Myelography ; Spinal Diseases/ DIAGNOSIS ; *Thermography ; Tomography, X-Ray Computed SO - Postgrad Med 1986 Mar;Spec No:47-53 25 UI - 86232948 AU - Weinstein SA ; Weinstein G TI - A clinical comparison of cervical thermography with EMG, CT scanning, myelography and surgical procedures in 500 patients. AB - Cervical thermograms were performed in 500 patients with complaints of pain referrable to the neck or upper extremities. One hundred ninety-seven (39.4%) were found to be positive for root pathology. Of these, 190 (96.4%) were ultimately confirmed by an alternative diagnostic procedure: EMG, CT scanning, myelography and/or surgical exploration. Of particular interest was a finding of trigger point injury in 60 of the 500 patients. Trigger point disorders represent difficult clinical problems to properly document without the application of thermography. MH - Comparative Study ; Electromyography ; Human ; Myelography ; *Neck ; Pain/ *DIAGNOSIS/SURGERY ; Retrospective Studies ; *Thermography ; Tomography, X-Ray Computed SO - Postgrad Med 1986 Mar;Spec No:44-6 26 UI - 86232947 AU - Weinstein SA ; Weinstein G TI - A review of 500 patients with low back complaints: comparison of five clinically-accepted diagnostic modalities. AB - Thermographic evaluations conducted in a large series of patients with complaints of pain attributable to the lumbar spine region were compared to the evaluations obtained in these same patients with four alternative diagnostic modalities: EMG, CT scanning, myelography and surgical exploration. As a primary indicator of the presence or absence of pathology, thermography was found to be 10 to 20% more accurate than each of the alternatives studied. This degree of accuracy, superimposed upon the low-risk, non-invasive nature of the procedure, strongly suggests that thermography should be employed as a cost-effective initial screening procedure to distinguishing between patients with substantive radicular disorders and those experiencing minor localized injury, the former to be subjected to a more extensive diagnostic evaluation while the latter could immediately undergo appropriate treatment for their limited disorder. MH - Backache/*DIAGNOSIS ; Comparative Study ; Diagnosis, Surgical ; Electromyography ; Human ; Myelography ; Retrospective Studies ; *Thermography ; Tomography, X-Ray Computed SO - Postgrad Med 1986 Mar;Spec No:40-3 27 UI - 86232944 AU - Schnitzlein HN TI - The neuroanatomy and physiology related to thermography. AB - Thermography does not detect pain but records the cutaneous vascular response to pain as well as other stimuli. Sympathetic preganglionic axons in the ventral roots (i.e., within the spinal canal) are found only in thoracic and upper lumbar segments and not in cervical or lower lumbar and sacral roots. A single preganglionic axon may synapse on four different postganglionic chain ganglia thereby producing a spread of its peripheral effect. Postganglionic sympathetic neurons constricting cutaneous blood vessels are adrenergic and anything affecting norepinephrine will have an effect on the cutaneous vessels and skin temperature. Sensory cutaneous dermatomes do not coincide with sympathetic "dermatomes:. Several areas of the brainstem and especially the hypothalamus regulate cutaneous blood flow through descending reticulospinal pathways. The hypothalamus is under the influence of the cerebral cortex, especially the frontal lobe, through the medial forebrain bundle. Causes of detectable "warm spots: include: axon reflexes and the peripheral release of substance P or histamine; destruction of sympathetic neurons or sympathetic dystonia; activation of descending autonomic pathways inhibiting sympathetic tone; infections, mechanical stimulation, radiation, etc. Causes of detectable "cold spots: include: reflex activation of sympathetic adrenergic neurons; direct stimulation of peripheral sympathetic adrenergic nerves; inhibition of the reuptake of norepinephrine at vascular terminals; sweating and evaporation. Because of the number of variables which may cause backache and the responses of the cutaneous circulation to painful stimuli, three consistent thermographic recordings over a period of time are recommended. MH - Autonomic Nervous System/*PHYSIOLOGY ; Brain/PHYSIOLOGY ; Human ; Nervous System/*PHYSIOLOGY ; Norepinephrine/PHYSIOLOGY ; Pain/*PHYSIOPATHOLOGY ; Regional Blood Flow ; Skin/BLOOD SUPPLY ; *Skin Temperature ; Spinal Cord/ PHYSIOLOGY ; Spinal Nerves/PHYSIOLOGY ; Sympathetic Nervous System/ *PHYSIOLOGY ; *Thermography SO - Postgrad Med 1986 Mar;Spec No:21-5 28 UI - 86232900 AU - Frymoyer JW ; Haugh LD TI - Thermography: a call for scientific studies to establish its diagnostic efficacy. AB - Thermography is reported to provide objective evidence of physiologic dysfunction in patients with low back pain and sciatica. This diagnostic test is appealing because it is painless, non-invasive, has no known adverse biologic effects, presents comprehensible graphic information, requires only a moderate investment in equipment, and should be an inexpensive procedure to perform. Unfortunately, the complete scientific information necessary to assess its diagnostic reliability is not available. This article discusses other experiments which have been performed to assess the diagnostic accuracy of tests for low back pain and sciatica and outline some features of an experimental protocol which would be essential to establish the reliability of thermography in the diagnosis of low back pain and sciatica due to herniated nucleus pulposus. MH - Backache/ETIOLOGY ; Diagnostic Errors ; Human ; Intervertebral Disk Displacement/COMPLICATIONS/*DIAGNOSIS ; Sciatica/ETIOLOGY ; *Thermography SO - Orthopedics 1986 May;9(5):699-700 29 UI - 86194992 AU - Haig G TI - Portable thermogram technique for topically applied benzydamine cream in acute soft-tissue injuries. AB - A double-blind, parallel trial was undertaken with 3% benzydamine cream compared with a matching placebo, on patients suffering acute soft-tissue injuries. 21 patients received active material and 22 received placebo material. Patients applied the cream lightly 6 times a day for 6 days. Assessments were made (by the same physician) on days 0, 2, 4 and 6, and signs and symptoms were graded as "absent:, "slight:, "moderate: or "severe:. Thermograms were taken on day 0 and day 6. The results showed significant relief of spontaneous pain, significant reduction in tenderness on pressure and in swelling on days 2, 4 and 6 of the trial, and a significant reduction in functional impairment on days 4 and 6, in the patients who had received the 3% benzydamine cream. MH - Administration, Topical ; Benzydamine/ADMINISTRATION & DOSAGE/ *THERAPEUTIC USE ; Clinical Trials ; Double-Blind Method ; Female ; Human ; Male ; Pyrazoles/*THERAPEUTIC USE ; Thermography/*METHODS ; Wounds and Injuries/*DRUG THERAPY SO - Int J Tissue React 1986;8(2):145-7 30 UI - 86177272 AU - Harway RA TI - Precision thermal imaging of the extremities. AB - Precision thermal imaging can give valuable physiological information which is not obtainable by any other means. It is particularly useful for follow up because it is painless and noninvasive. Meticulous attention to technique is necessary. A strict pre-examination protocol must be adhered to. Proper equilibration with ambient temperature is essential. The parts to be imaged must be insulated from other parts of the body. Standard views must be obtained. Adherence to good technique will yield repeatable accurate images. MH - Adolescence ; Adult ; Carpal Tunnel Syndrome/DIAGNOSIS ; Electronics ; Female ; Foot Deformities, Acquired/DIAGNOSIS ; Human ; Male ; Radiometry/ INSTRUMENTATION ; *Thermography/INSTRUMENTATION ; Ulnar Nerve/INJURIES SO - Orthopedics 1986 Mar;9(3):379-82 31 UI - 86096899 AU - Ash CJ ; Shealy CN ; Young PA ; Van Beaumont W TI - Thermography and the sensory dermatome. AB - The basic neuroanatomic and physiologic aspects of the sympathetic outflow to the limbs are reviewed and correlated with the somatic sensory dermatomes. The recent literature is considered. A thermocouple thermometer was used to test 30 normal patients and 87 patients with clinically proven nerve root lesions. Thermographic imaging of the sensory dermatome is not plausible, and thermography is not recommended for clinical documentation of painful conditions of the neck, back, or limbs. MH - Female ; Human ; Intervertebral Disk Displacement/*DIAGNOSIS ; Male ; Skin/*INNERVATION ; Spinal Diseases/*DIAGNOSIS ; Spinal Nerves/*ANATOMY & HISTOLOGY ; *Thermography SO - Skeletal Radiol 1986;15(1):40-6 32 UI - 86086080 AU - Devereaux MD ; Parr GR ; Lachmann SM ; Thomas DP ; Hazleman BL TI - Thermographic diagnosis in athletes with patellofemoral arthralgia. AB - Pain in front of the knee is common in athletes and is often called patellofemoral arthralgia, but it is difficult to prove that the pain arises in that joint. Thermograms of 30 athletes clinically considered to have patellofemoral arthralgia were compared with those of a similar number of unaffected athletes matched for age and sex. A comparison was also made with thermograms of two older groups of 30 patients with knee involvement from either rheumatoid arthritis or osteoarthritis. Twenty-eight of the athletes with patellofemoral arthralgia had a diagnostic pattern on thermography. The anterior knee view showed a rise in temperature on the medial side of the patella and the medialis knee view showed that this temperature rise radiated from the patellar insertion of the vastus medialis into the muscle itself. The possible aetiological role of quadriceps muscle imbalance in athletes with patellofemoral arthralgia is discussed in relation to these findings. MH - Adolescence ; Adult ; Arthritis, Rheumatoid/DIAGNOSIS ; Athletic Injuries/ *DIAGNOSIS ; Child ; Comparative Study ; Exercise Therapy ; Female ; Human ; Knee Injuries/*DIAGNOSIS/PHYSIOPATHOLOGY/REHABILITATION ; Knee Joint ; Male ; Middle Age ; Osteoarthritis/DIAGNOSIS ; Pain ; Support, Non-U.S. Gov't ; *Thermography SO - J Bone Joint Surg [Br] 1986 Jan;68(1):42-4