Foot evaluation by infrared imaging.
DiBenedetto M, Yoshida M, Sharp M, Jones B.
Source
University of Virginia, Department of Physical Medicine and Rehabilitation, 545 Ray C. Hunt Drive, Suite 240, Charlottesville, VA 22903-2981, USA.
Abstract
For better assessment of foot injury severity during basic military training, we evaluated a simple
noninvasive technique: thermography. With this infrared imaging method, we determined normal foot
parameters (from 30 soldiers before training), thermographic findings in different foot stress fractures (from 30 soldiers so diagnosed), and normal responses to abnormal stresses in 30 trainees who underwent the same training as the previous group but did not have musculoskeletal complaints. We found that normal foot thermograms show onion peel-like progressive cooling on the plantar surface, with a medially located warm center at the instep. Thermograms of injured feet show areas of increased heat, but excessive weight bearing pressures on feet, new shoes, or boots also cause increased infrared emission even without discomfort. Differentiation remains difficult; however, thermography can detect injury early. It does not reveal exact diagnoses, but its greatest benefit is easy follow-up to monitor severity and healing.
Friday, April 29, 2016
Thursday, April 28, 2016
Infrared thermography. Its role in dental research with particular reference to craniomandibular disorders.
Infrared thermography. Its role in dental research with particular reference to craniomandibular disorders.
Biagioni PA, Longmore RB, McGimpsey JG, Lamey PJ.
Source
School of Clinical Dentistry, Queen's University of Belfast, UK.
Abstract
The use of infrared thermography in dentistry has been minimal, principally due to technological inadequacies of previous thermal imaging systems. However, with the ever-developing advancement in technology, current systems are capable of producing real-time, highly sensitive digitized thermal images. This development has led to an increased use of infrared imaging within both medical and dental research. The present paper describes these techniques and their previous applications within dentistry, and, through the use of a pilot study, highlights possible future applications in the assessment of craniomandibular disorders.
Biagioni PA, Longmore RB, McGimpsey JG, Lamey PJ.
Source
School of Clinical Dentistry, Queen's University of Belfast, UK.
Abstract
The use of infrared thermography in dentistry has been minimal, principally due to technological inadequacies of previous thermal imaging systems. However, with the ever-developing advancement in technology, current systems are capable of producing real-time, highly sensitive digitized thermal images. This development has led to an increased use of infrared imaging within both medical and dental research. The present paper describes these techniques and their previous applications within dentistry, and, through the use of a pilot study, highlights possible future applications in the assessment of craniomandibular disorders.
Wednesday, April 27, 2016
Evaluation of provocation test monitoring palmoplantar temperature with the use of thermography for diagnosis of focal tonsillar infection in palmoplantar pustulosis.
Evaluation of
provocation test monitoring palmoplantar temperature with the use of thermography for diagnosis of focal
tonsillar infection in palmoplantar pustulosis.
Source
Department of Dermatology, Nara Medical University, 840 Shijo-cho Kashihara, 634-8522,
Nara, Japan. asadah@naramed-u.ac.jp
Abstract
BACKGROUND:
Since focal tonsillar
infections are often associated with palmoplantar pustulosis (PPP), provocation
tests have been performed for preoperative evaluation of tonsillectomy.
However, these tests have not been fully established.
OBJECTIVES:
To introduce a more sensitive operative indication for
tonsillectomy to the patients with PPP, we have monitored the temperature after
provocation tests at palmoplantar sites, as measured by thermography, and we hypothesized that this methodology may
lead to a more sensitive marker for tonsillectomy.
METHODS:
Twenty-two PPP patients with/without clinical tonsillitis were
included in this study. After mechanical tonsillar massage, using infrared thermography, we have monitored the surface temperature at
palmoplantar sites of 22 patients with PPP, five chronic tonsillitis patients
without PPP, and four healthy controls, to compare the findings with the skin
lesional outcome after tonsillectomy.
RESULTS:
There was a significant relationship between the effects of
tonsillectomy and the results of provocation tests assessed by thermography. The sensitivity, specificity, and efficiency
of the provocation tests with thermography of detecting a favorable outcome of tonsillectomy were 75.0, 83.3,
and 77.3%, respectively, while those of the provocation tests as estimated with
the conventional criteria were 37.5, 83.3, and 50.0%, respectively.
CONCLUSION:
Our results suggest that
a new indicator using non-invasive thermography for the provocation tests is useful in
predicting the effects of tonsillectomy for PPP.
Wednesday, April 20, 2016
About Complex Region Pain Syndrome
About Complex Region Pain Syndrome
“The more names the medical profession has for a condition, the less they understand it”
--Charlie April M.D. ISIS Meeting October 2006
Previously called Reflex Sympathetic Dystrophy (RSD), CRPS (called crips) is a subset of neuropathic pain that generalizes from an injury site to affect an entire extremity. It will occasionally ‘spread’ without additional injury to other parts of the body. Statistically it is a rare condition. There are considered to be about 15,000 new cases diagnosed in the United States each year, one new case for every 100,000-300,000 people. Unfortunately, CRPS is like being struck by lightning or bitten by a shark, it doesn’t matter how rare it is if it happens to you.
The condition has never been well understood by clinicians. However, a model is slowly emerging and treatment options are available for the condition.
First, it is important to understand Neuropathic Pain. While all CRPS is neuropathic, not all neuropathic pain is CRPS. Neuropathic pain occurs when nerves are injured, deteriorate, or are compressed. Some common examples are carpal tunnel syndrome, radiculopathy, or diabetic neuropathy. Common features of nerve pain are a reduction in normal ability to feel replaced with burning and shooting pain in the distribution of the affected nerve. These conditions are treated with a variety of medical tools ranging from epidural steroid injections, to physical therapy, to acupuncture and chiropractic, to pharmacologic agents, to decompressive surgeries. The hallmark of neuropathic pain is its clinical pattern of distribution along the zone of the damaged nerve or nerves.
It is also important to be aware of the difference between the inflammation of infection, tissue injury, and arthritis. Each of these conditions is similar but slightly different. The body has a way of using similar mechanisms to solve different problems. Inflammation to combat infection results in the activation of white cells, other components of the immune system and the vascular system. Inflammation to treat injury is a mechanism to clean up a damaged component of the body. In autoimmune inflammation such as rheumatoid arthritis the body actually attacks itself as if it were a foreign object. One of the components of CRPS is an inflammation that is activated by the nervous system that seems to incorporate both normal and pathologic elements of the inflammatory process.
In some fashion the sympathetic nervous system becomes involved (the old name Reflex Sympathetic Dystrophy). The primary role of the sympathetic nervous system is the regulation of blood flow into the extremities and tissues to control heat regulation, excretion of metabolites, and nutrition. In normal tissues it has no role in pain. This seems to change in CRPS with confusing series of changes in the tissues, warm and red, blue and sweaty, and rapid changes back and forth.
Compared to neuropathic pain and injury, which is very common, Complex Regional Pain is very highly unusual. For CRPS to develop linkage to the central nervous system including the brain and the spinal cord relay centers occurs. Peripheral links to the immune system and the endocrine system can occur. Changes in the involved limb take on characteristics seen when the nerve is
severely injured. Burning pain rapidly moves beyond the area of the original injury. Unpredictable changes in limb color, temperature, and sweating occur. ‘Trophic changes’, meaning unexpected swelling, atrophy, and nail bed changes occur.
Diagnosis can be relatively simple when the limb changes are obvious and far more difficult when the changes are more subtle. One of the more common mistakes is for a practioner to classify neuropathic injury as CRPS. Unfortunately there is no gold standard test for the condition. Commonly use studies in Colorado are the three phase bone scan, quantitative Sudomotor reflex testing (QSART), and infrared thermography. Sympathetic blocks are still commonly used for treatment but are not very helpful for the diagnosis. Each of the tests documents a different element of how the nervous system changes. However, the changes seen in each case can occur in other conditions. The International Association for the Study of Pain (the people who named it CRPS) has a set of clinical criteria that form the basis of clinical diagnosis and research protocols.
These include the following:
1. The presence of an initiating noxious event, or a cause of immobilization.
2. Continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event.
3. Evidence at some time of edema, changes in skin blood flow, or abnormal Sudomotor activity in the region of the pain.
4. This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.
5. Criteria 2-4 must be satisfied.
Treatment of the condition has evolved rapidly of the last few years. In reality the treatment is not much different that that used for neuropathic pain. A pyramid of medications including the tricylic antidressants, older and newer anticonvulsants such as carbamazipine and pregabalin, as well as several medications directed toward the NMDA (n-methyl D aspartate) receptor are used. Pain control includes cervical or lumbar blocks, antiinflamatories, opioids, physical therapy, electrical stimulation, topical lidocaine (EMLA or Lidoderm), custom made local anesthetic creams, and even spinal cord stimulation or implantable pumps.
With recent advances in medications many cases of CRPS can be helped. STAR makes every attempt to return patients to work and to living the most normal life possible. Just as in the case of other chronic conditions such as stroke, spinal cord injury, or heart disease much of the treatment is about solving and treating the conditions that can be treated, managing the others and helping a patient come to terms with the condition.
1. CRPS: Current Diagnosis and Therapy / Eds Peter R. Wilson, Michael-Hicks, R. Normal Harden. ISBN 0-931092-55-8, IASP Press, 2005
2. Mechanisms and Mediators of Neuropathic Pain, Malberg & Chaplin, eds., Berkhauser Verlag, Sweden 2002. ISBN 3-7643-6237-5
3. Emerging Strategies for the Treatment of Neuropathic Pain, Campbell, et al eds, IASP Press Seattle 2006 ISBN 0-931092-61-2
4. Hyperalgesia: Molecular Mechanisms and Clinical Implications Brune & Handwerker, eds IASP Press Seattle 2004 ISBN 0-931092-50-7
“The more names the medical profession has for a condition, the less they understand it”
--Charlie April M.D. ISIS Meeting October 2006
Previously called Reflex Sympathetic Dystrophy (RSD), CRPS (called crips) is a subset of neuropathic pain that generalizes from an injury site to affect an entire extremity. It will occasionally ‘spread’ without additional injury to other parts of the body. Statistically it is a rare condition. There are considered to be about 15,000 new cases diagnosed in the United States each year, one new case for every 100,000-300,000 people. Unfortunately, CRPS is like being struck by lightning or bitten by a shark, it doesn’t matter how rare it is if it happens to you.
The condition has never been well understood by clinicians. However, a model is slowly emerging and treatment options are available for the condition.
First, it is important to understand Neuropathic Pain. While all CRPS is neuropathic, not all neuropathic pain is CRPS. Neuropathic pain occurs when nerves are injured, deteriorate, or are compressed. Some common examples are carpal tunnel syndrome, radiculopathy, or diabetic neuropathy. Common features of nerve pain are a reduction in normal ability to feel replaced with burning and shooting pain in the distribution of the affected nerve. These conditions are treated with a variety of medical tools ranging from epidural steroid injections, to physical therapy, to acupuncture and chiropractic, to pharmacologic agents, to decompressive surgeries. The hallmark of neuropathic pain is its clinical pattern of distribution along the zone of the damaged nerve or nerves.
It is also important to be aware of the difference between the inflammation of infection, tissue injury, and arthritis. Each of these conditions is similar but slightly different. The body has a way of using similar mechanisms to solve different problems. Inflammation to combat infection results in the activation of white cells, other components of the immune system and the vascular system. Inflammation to treat injury is a mechanism to clean up a damaged component of the body. In autoimmune inflammation such as rheumatoid arthritis the body actually attacks itself as if it were a foreign object. One of the components of CRPS is an inflammation that is activated by the nervous system that seems to incorporate both normal and pathologic elements of the inflammatory process.
In some fashion the sympathetic nervous system becomes involved (the old name Reflex Sympathetic Dystrophy). The primary role of the sympathetic nervous system is the regulation of blood flow into the extremities and tissues to control heat regulation, excretion of metabolites, and nutrition. In normal tissues it has no role in pain. This seems to change in CRPS with confusing series of changes in the tissues, warm and red, blue and sweaty, and rapid changes back and forth.
Compared to neuropathic pain and injury, which is very common, Complex Regional Pain is very highly unusual. For CRPS to develop linkage to the central nervous system including the brain and the spinal cord relay centers occurs. Peripheral links to the immune system and the endocrine system can occur. Changes in the involved limb take on characteristics seen when the nerve is
severely injured. Burning pain rapidly moves beyond the area of the original injury. Unpredictable changes in limb color, temperature, and sweating occur. ‘Trophic changes’, meaning unexpected swelling, atrophy, and nail bed changes occur.
Diagnosis can be relatively simple when the limb changes are obvious and far more difficult when the changes are more subtle. One of the more common mistakes is for a practioner to classify neuropathic injury as CRPS. Unfortunately there is no gold standard test for the condition. Commonly use studies in Colorado are the three phase bone scan, quantitative Sudomotor reflex testing (QSART), and infrared thermography. Sympathetic blocks are still commonly used for treatment but are not very helpful for the diagnosis. Each of the tests documents a different element of how the nervous system changes. However, the changes seen in each case can occur in other conditions. The International Association for the Study of Pain (the people who named it CRPS) has a set of clinical criteria that form the basis of clinical diagnosis and research protocols.
These include the following:
1. The presence of an initiating noxious event, or a cause of immobilization.
2. Continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event.
3. Evidence at some time of edema, changes in skin blood flow, or abnormal Sudomotor activity in the region of the pain.
4. This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.
5. Criteria 2-4 must be satisfied.
Treatment of the condition has evolved rapidly of the last few years. In reality the treatment is not much different that that used for neuropathic pain. A pyramid of medications including the tricylic antidressants, older and newer anticonvulsants such as carbamazipine and pregabalin, as well as several medications directed toward the NMDA (n-methyl D aspartate) receptor are used. Pain control includes cervical or lumbar blocks, antiinflamatories, opioids, physical therapy, electrical stimulation, topical lidocaine (EMLA or Lidoderm), custom made local anesthetic creams, and even spinal cord stimulation or implantable pumps.
With recent advances in medications many cases of CRPS can be helped. STAR makes every attempt to return patients to work and to living the most normal life possible. Just as in the case of other chronic conditions such as stroke, spinal cord injury, or heart disease much of the treatment is about solving and treating the conditions that can be treated, managing the others and helping a patient come to terms with the condition.
1. CRPS: Current Diagnosis and Therapy / Eds Peter R. Wilson, Michael-Hicks, R. Normal Harden. ISBN 0-931092-55-8, IASP Press, 2005
2. Mechanisms and Mediators of Neuropathic Pain, Malberg & Chaplin, eds., Berkhauser Verlag, Sweden 2002. ISBN 3-7643-6237-5
3. Emerging Strategies for the Treatment of Neuropathic Pain, Campbell, et al eds, IASP Press Seattle 2006 ISBN 0-931092-61-2
4. Hyperalgesia: Molecular Mechanisms and Clinical Implications Brune & Handwerker, eds IASP Press Seattle 2004 ISBN 0-931092-50-7
Thermography and laser-Doppler flowmetry for monitoring changes in finger skin
blood flow upon cigarette smoking.
Bornmyr S, Svensson H.; Department of Clinical Physiology, Allmanna Sjukhuset, Malmo, Sweden.
Haemodynamic changes after smoking two 1.1 mg nicotine cigarettes were monitored in 24 smokers on two different occasions. Smoking caused an increase in heart rate and arterial blood pressure, whereas finger temperature as measured by thermography and finger skin blood flow as measured by laser-Doppler flowmetry (LDF) decreased. Lowest values were seen within 15 min by LDF, and after 30 min by thermography. Changes in the two methods correlated closely, however, when maximum responses during a 45-min period after smoking were compared. The wider distribution of LDF values would seem to be due to the small measuring volume which is susceptible to differences in vascular anatomy and reactivity. In both methods, responses showed a high degree of reproducibility.
blood flow upon cigarette smoking.
Bornmyr S, Svensson H.; Department of Clinical Physiology, Allmanna Sjukhuset, Malmo, Sweden.
Haemodynamic changes after smoking two 1.1 mg nicotine cigarettes were monitored in 24 smokers on two different occasions. Smoking caused an increase in heart rate and arterial blood pressure, whereas finger temperature as measured by thermography and finger skin blood flow as measured by laser-Doppler flowmetry (LDF) decreased. Lowest values were seen within 15 min by LDF, and after 30 min by thermography. Changes in the two methods correlated closely, however, when maximum responses during a 45-min period after smoking were compared. The wider distribution of LDF values would seem to be due to the small measuring volume which is susceptible to differences in vascular anatomy and reactivity. In both methods, responses showed a high degree of reproducibility.
Tuesday, April 19, 2016
Advances in breast imaging.
Advances in breast imaging.
Agnese DM. The Ohio State University, Columbus, Ohio.
Although mammography remains the most widely used tool for the early detection of breast cancers and evaluation of palpable abnormalities, a number of other imaging tools are being developed and used. Ultrasonography (US) is an excellent adjunct to conventional mammography. In addition to identifying solid and cystic abnormalities, US can often distinguish benign and malignant solid nodules. Magnetic resonance imaging (MRI) also is useful in assessing the extent of disease within the breast, particularly in women with dense breasts. MRI may be a more sensitive screening tool in women at elevated breast cancer risk. Newer techniques based on the metabolic activity of breast tumors also have been developed. One such technique is scintimammography, which uses radiolabeled tracers to detect breast malignancies. Positron emission tomography (PET), which relies on the high metabolic rate of tumors, also has been described as a method to evaluate breast disease. Other techniques, such as optical tomography and thermography, rely on angiogenesis and generated heat to identify cancers. These and other tools may help to improve both the sensitivity and specificity of cancer detection. Ideally, this improved detection results in improved outcomes in those who have breast cancer and avoidance of unnecessary procedures in those who do not.
J Biomech Eng. 2004 Apr;126(2):204-11.
Agnese DM. The Ohio State University, Columbus, Ohio.
Although mammography remains the most widely used tool for the early detection of breast cancers and evaluation of palpable abnormalities, a number of other imaging tools are being developed and used. Ultrasonography (US) is an excellent adjunct to conventional mammography. In addition to identifying solid and cystic abnormalities, US can often distinguish benign and malignant solid nodules. Magnetic resonance imaging (MRI) also is useful in assessing the extent of disease within the breast, particularly in women with dense breasts. MRI may be a more sensitive screening tool in women at elevated breast cancer risk. Newer techniques based on the metabolic activity of breast tumors also have been developed. One such technique is scintimammography, which uses radiolabeled tracers to detect breast malignancies. Positron emission tomography (PET), which relies on the high metabolic rate of tumors, also has been described as a method to evaluate breast disease. Other techniques, such as optical tomography and thermography, rely on angiogenesis and generated heat to identify cancers. These and other tools may help to improve both the sensitivity and specificity of cancer detection. Ideally, this improved detection results in improved outcomes in those who have breast cancer and avoidance of unnecessary procedures in those who do not.
J Biomech Eng. 2004 Apr;126(2):204-11.
Somatic sympathetic vasomotor changes documented by medical thermographic imaging during acupuncture analgesia.
Somatic sympathetic vasomotor changes documented by medical thermographic imaging during acupuncture analgesia.
Thomas D1, Collins S, Strauss S.
Abstract
Acupuncture is widely used for pain relief in many musculoskeletal disorders, and evidence suggests that modulation of the sympathetic nervous system responses which play an integral part in somatic pain, is an important mechanism of acupuncture action. This prospective study of 20 patients with neck and arm pain measured finger temperature, controlled by somatic sympathetic vasomotor activity before and after needle acupuncture. Responses were correlated with visual analogue scale (VAS) of pain severity. An association was found between pain relief and reduced sympathetic vasomotor activity. In 10 patients with significant reduction in visual analogue scale (VAS) pain (p less than .05), the mean change in temperature (delta t degrees C) was 0.55 (SD +/- 0.86) with significant difference in pre to post treatment temperatures (p less than .01). In 10 patients without significant pain relief on VAS scoring (p greater than .05), the mean t degrees C was 0.20 (SD +0.72) without significant difference in pre to post treatment temperatures (p greater than .05). The relevance of somatic sympathetic influences on musculoskeletal pain and modulation of sympathetic activity by acupuncture will be discussed.
Thomas D1, Collins S, Strauss S.
Abstract
Acupuncture is widely used for pain relief in many musculoskeletal disorders, and evidence suggests that modulation of the sympathetic nervous system responses which play an integral part in somatic pain, is an important mechanism of acupuncture action. This prospective study of 20 patients with neck and arm pain measured finger temperature, controlled by somatic sympathetic vasomotor activity before and after needle acupuncture. Responses were correlated with visual analogue scale (VAS) of pain severity. An association was found between pain relief and reduced sympathetic vasomotor activity. In 10 patients with significant reduction in visual analogue scale (VAS) pain (p less than .05), the mean change in temperature (delta t degrees C) was 0.55 (SD +/- 0.86) with significant difference in pre to post treatment temperatures (p less than .01). In 10 patients without significant pain relief on VAS scoring (p greater than .05), the mean t degrees C was 0.20 (SD +0.72) without significant difference in pre to post treatment temperatures (p greater than .05). The relevance of somatic sympathetic influences on musculoskeletal pain and modulation of sympathetic activity by acupuncture will be discussed.
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