Musculoskeletal

Musculoskeletal System, Sport Medicine and athletic training

An Overview of Recent Application of Medical Infrared Thermography in Sports Medicine in Austria

Abstract

Medical infrared thermography (MIT) is used for analyzing physiological functions related to skin temperature. Technological advances have made MIT a reliable medical measurement tool. This paper provides an overview of MIT’s technical requirements and usefulness in sports medicine, with a special focus on overuse and traumatic knee injuries. Case studies are used to illustrate the clinical applicability and limitations of MIT. It is concluded that MIT is a non-invasive, non-radiating, low cost detection tool which should be applied for pre-scanning athletes in sports medicine.

Conclusions

Thermal imaging in medicine is not new, but early investigation with old and insufficient techniques has led to work with dubious results. Recent work with modern 21st century technology has demonstrated the value of MIT in medical application when used as an auxiliary tool. Knowledge about thermoregulation, anatomy, physiology, morphology and pathophysiological processes is important to counteract inaccurate diagnoses.

The aim of this technique is not to be a substitute for clinical examination but to enhance it. Further research and follow-up studies are warranted to create databases for clinical measurements and further determine its viability in real-world medical settings. Empirical evidence of correlation between pathology and infrared imaging is essential to further predict the value of MIR. It should be used as a multidisciplinary assessment tool by experts from different fields.

Based on the advantages of MIT as a non-invasive, non-radiating, low cost first-line detection modality, it should be applied in the field of sports medicine as a pre-scan team assessment tool. The extension of sport specific databases may further contribute to the detection of high risk athletes and help them to start early intervention.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292141/

Assessment of hand osteoarthritis: correlation between thermographic and radiographic methods.

Varjú G¹, Pieper CF, Renner JB, Kraus VB.

Author information

Abstract

OBJECTIVE:

Anatomical stages of digital osteoarthritis (OA) have been characterized radiographically as progressing through sequential phases from normal to osteophyte formation, progressive loss of joint space, joint erosion and joint remodelling. Our study was designed to evaluate a physiological parameter, joint surface temperature, measured with computerized digital infrared thermal imaging, and its association with sequential stages of radiographic OA (rOA).

METHODS:

Thermograms, radiographs and digital photographs were taken of both hands of 91 subjects with nodal hand OA. Temperature measurements were made on digits 2-5 at distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints and metacarpophalangeal (MCP) joints (2184 joints in total). We fitted a repeated measures ANCOVA model to analyse the effects of rOA on temperature, with handedness, joint group, digit and NSAID use as covariates.

RESULTS:

The reliability of the thermoscanning procedure was high (generalizability coefficient 0.899 for two scans performed 3 h apart). The mean joint temperature decreased with increasing rOA severity, defined by the Kellgren-Lawrence (KL) scale. The mean temperature of KL0 joints was significantly different from that of each of the other KL grades (P </= 0.002). After adjustment for the other covariates, there was a strong association of rOA with joint surface temperature (P<0.001). The earliest discernible radiographic disease (KL1) was associated with a higher surface temperature than KL0 joints (P = 0.01) and a higher surface temperature than any other KL grade. Joint erosions were not associated with a change in joint temperature.

CONCLUSION:

Joint surface temperature varied with the severity of rOA. Joints were warmer than normal at the onset of OA. As the severity of rOA worsened, joint surface temperature declined. These data support the supposition that digital OA progresses in phases initiated by an inflammatory process. The cooler surface temperatures in later stages of the disease may in part explain the paucity of symptoms reported by patients with hand OA.

http://www.ncbi.nlm.nih.gov/pubmed/15126670

CASE REPORT

Thermal imaging – a hotspot for the future?: A case report

Case report

A 6-year-old boy presented to accident and emergency with his mother complaining of a painful right elbow following a fall that day. He fell whilst walking up steps and gave a history of directly striking the elbow on the step. He had not been using the arm since. There was a recent history of a comminuted intra-articular fracture of the proximal ulna of the same elbow, and a cast had been removed just 5 weeks previously.

The patient was seen and examined by an experienced A&E senior house officer. He was difficult to assess and was complaining of pain in the entire arm. There was no swelling or deformity and no apparent bony tenderness to the limb. He was unwilling to actively move the elbow joint, however there was a good range of passive movement throughout the arm and good grip strength was noted. An X-ray of the elbow was performed and no bony injury or effusion of the elbow joint was apparent. The child was treated for a soft tissue injury of the elbow, advised regular analgesia and discharged.

The patient represented two days later complaining of persistent pain to the arm. He was now localising pain to the wrist and there was a corresponding area of tenderness over the distal radius. A thermal image was taken of the limb using a hand held FTI Mv thermal imager interfacing with LIPS Mini PC software. The image identified an obvious “hotspot” corresponding to the area of tenderness over the distal radius (Fig. 1), which clearly differed from a thermal image of the normal wrist (Fig. 2). Subsequent X-ray of the wrist revealed an undisplaced greenstick fracture of the distal radius. The child was treated with a plaster cast, referred to the orthopaedic fracture clinic and made an uneventful recovery.

Discussion

Thermal Imaging has been considered for use in a wide range of medical circumstances. It has been shown to be useful in aiding diagnosis and guiding management of foot injuries in military recruits when combined with clinical examination, radiographs and bone scanning.⁴ Telethermography has been demonstrated as a useful tool in aiding diagnosis and management of sports injuries.⁵ Cole et al. demonstrated a significant relationship between early thermographic assessment of the depth of skin burns and clinical outcome.³ Various types of thermal imaging have also been used in studies of diabetic neuropathic feet,¹ the detection of carpal tunnel syndrome,⁷ the investigation of tendon injuries in horses⁶ and in the monitoring of undesirable thermal proximity damage during surgical energized dissection and coagulation.² During the international severe acute respiratory syndrome (SARS) crisis of 2003, thermal imaging was employed as a screening tool at border points. At Singapore’s Changi International airport alone 442,973 passengers were screened and of those 136 identified for further investigation and observation.⁸ The modality’s sensitivity for identifying passengers with even low grade pyrexia (>37.5 °C) highlights recent technological advances and brings to attention future possible uses.

The main problems previously identified with the use of thermal imaging in the evaluation of a possibly injured limb include a lack of specificity in identifying the site and nature of pathology and difficulty in establishing normal references. While thermography could never replace radiography as a diagnostic tool, it may be useful as an adjunct to clinical examination and X-ray. As this case demonstrates, children can prove difficult to assess in the accident and emergency department environment. Injury localisation in this patient group can prove difficult and the “survey” of a limb with X-ray may result. The use of thermal imaging could improve the sensitivity of clinical examination and therefore assist in injury localisation, preventing unnecessary X-ray exposure.

In this case it may be postulated that thermal imaging has detected a localised increase in temperature associated with the normal inflammatory response to a fracture. This is an early response and if it was shown to be reliable then the modality may be useful in a wider area of emergency medicine. Early radiological findings can be unreliable in conditions such as scaphoid fracture and the “toddler’s” type fracture of the tibial shaft. Thermal imaging could potentially be used in early follow-up to exclude fracture in these situations and prevent prolonged immobilisation and possibly more invasive and expensive bone scanning. It is likely that thermal imaging would be of use when examining bones that are relatively superficial where temperature changes are going to be more apparent.

Thermal imaging has been shown to be effective in assessing the depth of skin burns³ by measuring different skin temperatures created by varying states of perfusion. It may therefore be useful as a real time assessment tool examining changes in peripheral perfusion during the resuscitation of a shocked patient, giving a continuous recording of response to treatment.

Modern thermal imaging is rapid, non-invasive, non-emitting and with improving technology becoming more user-friendly and more cost effective. Given these attributes and the potential applications to emergency medicine outlined above, there is a need for our speciality to study the technique further.

http://www.sciencedirect.com/science/article/pii/S1572346105000413

Use of Telethermography in the Management of Sports Injuries

Summary

Telethermography can contribute to the diagnostic process in the management of sports injuries by clearly demonstrating thermal alterations in the tissues involved. Although there are no typical images, in general hyperthermic images are found when inflammatory reactions prevail, and hypothermic pictures when compression or degenerative processes are present.

Telethermography is not only an aid to diagnosis, it also appears to be an ideal tool in controlling the injury evolution and treatment efficacy. In fact this objective method of evaluation is noninvasive, innocuous and repeatable, and well-related to the clinical and functional status.

http://link.springer.com/article/10.2165%2F00007256-199010040-00005

Foot evaluation by infrared imaging

DiBenedetto, M., Yoshida, M., Sharp, M., Jones, B.

University of Virginia, Dept. of Physical Med. and Rehab., 545 Ray C. Hunt Drive, Charlottesville, VA 22903-2981, United States

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.

https://www.scopus.com/record/display.uri?eid=2-s2.0-0036107299&origin=inward&txGid=0

Liquid crystal thermography: Quantitative studies of abnormalities in carpal tunnel syndrome

Meyers, S.^a ^b, Cros, D.^a ^b, Sherry, B.^a ^b, Vermeire, P.^a ^b

^aDepartment of Psychiatry and Neurology, Tulane Medical School, Massachusetts General Hospital, New Orleans, LA, United States
^bClinical Neurophysiology Laboratories, Department of Neurology, Massachusetts General Hospital, Boston, MA, United States

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Abstract

We performed liquid crystal thermography (LCT) in 38 normal hands and in 23 hands with carpal tunnel syndrome (CTS) documented by nerve conduction studies (NCS). Two of the authors unaware of the clinical situation read the 2 palmar thermograms taken at a 5-minute interval. They determined the absolute temperatures of the tip of digit 1 (Dl), D2, D3, D4, D5, and of the thenar and hypothenar eminences. We calculated the temperature differences (absolute values throughout) between any 2 of these 7 sites, and computed the median index (MI = [Dl — D2] + [Dl — D3] + [D2 — D31). Comparison of the control and CTS groups revealed greater temperature differences in CTS between D1 — D3, D1 — D4, D3 — D5, D4 — D5, and MI. There was a marked overlap between the 2 groups. Comparieon of individual CTS hands with controls revealed definite thermographic abnormalities in 0 of 9 hands with mild NCS abnormalities, and in 7 of 14 hands with marked NCS abnormalities. These findings indicate that the sensitivity of LCT in CTS is low compared with NCS, and previous favorable reports concerning thermography in CTS may have been due to lack of control series or absence of quantitation. © 1989 American Academy of Neurology.

https://www.scopus.com/record/display.uri?eid=2-s2.0-0024853719&origin=inward&txGid=0

Thermal signature analysis as a novel method for evaluating inflammatory arthritis activity

M Brenner, C Braun, M Oster, and P S Gulko

Abstract

Objective

To examine the potential usefulness of a novel thermal imaging technique to evaluate and monitor inflammatory arthritis activity in small joints using rat models, and to determine whether thermal changes can be used to detect preclinical stages of synovitis.

Methods

Three different rat strains were studied in a model of inflammatory arthritis of the ankle induced by an intra‐articular (IA) injection of complete Freund’s adjuvant (CFA), compared with the contralateral ankle injected with normal saline. Arthritis activity and severity scores, ankle diameters, pain related posture scores, and thermal images were obtained at 10 different times between 0 h (before induction) and day 7. The pristane induced arthritis (PIA) model was used to study preclinical synovitis. Thermal images were obtained at each time point using the TSA ImagIR system and were digitally analysed.

Results

Rats developed similar ankle arthritis detected six hours after the IA injection of CFA, which persisted for seven days. All ankle clinical indices, including arthritis activity and severity scores, correlated significantly with ankle thermal imaging changes in the monoarthritis model (p<0.003). No thermal imaging changes were detected in preclinical stages of PIA. However, PIA onset coincided with increased ankle thermal signature.

Conclusions

Thermal measurements correlated significantly with arthritis activity and severity indices. The technique was highly sensitive and could measure directly two cardinal signs of inflammation (warmth and oedema, based on ankle diameter) in an area (ankle) that is less than half the size of a human interphalangeal joint, suggesting a potential use in drug trials or clinical practice.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1798043/

Thermatomal changes in cervical disc herniations.

Zhang HY¹, Kim YS, Cho YE.

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Abstract

Subjective symptoms of a cool or warm sensation in the arm could be shown objectively by using of thermography with the detection of thermal change in the case of radiculopathy, including cervical disc herniation (CDH). However, the precise location of each thermal change at CDH has not been established in humans. This study used digital infrared thermographic imaging (DITI) for 50 controls and 115 CDH patients, analyzed the data statistically with t-test, and defined the areas of thermatomal change in CDH C3/4, C4/5, C5/6, C6/7 and C7/T1. The temperature of the upper trunk and upper extremities of the control group ranged from 29.8 degrees C to 32.8 degrees C. The minimal abnormal thermal difference in the right and left upper extremities ranged from 0.1 degree C to 0.3 degree C in 99% confidence interval. If delta T was more than 0.1 degree C, the anterior middle shoulder sector was considered abnormal (p < 0.01). If delta T was more than 0.3 degree C, the medial upper aspect of the forearm and dorsal aspect of the arm, some areas of the palm and anterior part of the fourth finger, and their opposite side sectors and all dorsal aspects of fingers were considered abnormal (p < 0.01). Other areas except those mentioned above were considered abnormal if delta T was more than 0.2 degree C (p < 0.01). In p < 0.05, thermal change in CDH C3/4 included the posterior upper back and shoulder and the anterior shoulder. Thermal change in CDH C4/5 included the middle and lateral aspect of the triceps muscle, proximal radial region, the posterior medial aspect of the forearm and distal lateral forearm. Thermal change in CDH C5/6 included the anterior aspects of the thenar, thumb and second finger and the anterior aspects of the radial region and posterior aspects of the pararadial region. Thermal change in CDH C6/7 included the posterior aspect of the ulnar and palmar region and the anterior aspects of the ulnar region and some fingers. Thermal change in CDH C7/T1 included the scapula and posterior medial aspect of the arm and the anterior medial aspect of the arm. The areas of thermal change in each CDH included wider sensory dermatome and sympathetic dermatome. There was a statistically significant change of temperature in the areas of thermal change in all CDH patients. In conclusion, the areas of thermal change in CDH can be helpful in diagnosing the level of disc protrusion and in detecting the symptomatic level in multiple CDH patients.

http://www.ncbi.nlm.nih.gov/pubmed/10565248

Foot evaluation by infrared imaging.

DiBenedetto M¹, Yoshida M, Sharp M, Jones B.

Author information

Abstract

http://www.ncbi.nlm.nih.gov/pubmed/12053846

The use of thermal infrared imaging to assess the efficacy of a therapeutic exercise program in individuals with diabetes.

Al-Nakhli HH¹, Petrofsky JS, Laymon MS, Arai D, Holland K, Berk LS.

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Abstract

BACKGROUND:

Exercise is of great value for individuals with diabetes in helping to control their hemoglobin A1c levels and in increasing their insulin sensitivity. Delayed-onset muscle soreness (DOMS) is a common problem in healthy individuals and in people who have diabetes. People with diabetes are also faced with metabolic and endothelial impairments, which could make DOMS even worse. But because they usually have neuropathies, they may not feel this soreness appropriately, leading to premature return to exercise and causing further injuries.

RESEARCH DESIGN:

One hundred eighteen subjects participated in this study and were divided into four groups. Two groups (healthy and diabetes) performed a series of abdominal exercises, and the other two groups (healthy and diabetes) performed a series of arm exercises to induce DOMS. Skin temperature above the muscle was assessed using a thermal infrared camera, and perceived soreness of the exercised muscle was assessed using a 100-mm visual analog scale. Serum myoglobin concentrations were also measured.

RESULTS:

There was a significant increase in skin temperature 24 h post-exercise for all four exercise groups (P<0.05), where the combined average increase in skin temperature for all four groups was approximately 0.65°C from baseline. Also, 24 h post-exercise, all four groups were significantly sorer than they were at baseline (P<0.05). Serum myoglobin levels were also significantly higher on day 3 compared with day 1 (P<0.05).

CONCLUSION:

Infrared thermal imaging may be a valuable technique of seeing which muscles are sore hours or even days after the exercise is over. Thus, thermal imaging would be an efficient and painless way of looking at DOMS in both healthy individuals and individuals who have diabetes, even if they are facing neurological problems.

http://www.ncbi.nlm.nih.gov/pubmed/22011006

An overview of temperature monitoring devices for early detection of diabetic foot disorders.

Roback K¹.

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Abstract

Diabetic foot complications are associated with substantial costs and loss of quality of life. This article gives an overview of available and emerging devices for the monitoring of foot temperature as a means of early detection of foot disorders in diabetes. The aim is to describe the technologies and to summarize experiences from experimental use. Studies show that regular monitoring of foot temperature may limit the incidence of disabling conditions such as foot ulcers and lower-limb amputations. Infrared thermometry and liquid crystal thermography were identified as the leading technologies in use today. Both technologies are feasible for temperature monitoring of the feet and could be used as a complement to current practices for foot examinations in diabetes.

http://www.ncbi.nlm.nih.gov/pubmed/20822392

The application of infrared thermography in the assessment of patients with coccygodynia before and after manual therapy combined with diathermy.

Wu CL¹, Yu KL, Chuang HY, Huang MH, Chen TW, Chen CH.

Author information

Abstract

OBJECTIVE:

This study examines the potential usefulness of a novel thermal imaging technique in the assessment of local physiologic responses before and after conservative therapies for coccygodynia.

METHODS:

Patients with coccygodynia were selected on the basis of detailed history taking, clinical examination, and dynamic series radiography. They underwent therapeutic modalities consisting of 6 to 8 sessions of manual medicine treatments (massage of the levators followed by Maigne’s manipulative technique) and external physiotherapy (short-wave diathermy) 3 times a week for 8 weeks. We performed the assessments with numeric pain rating scale (NPRS) and infrared thermography (IRT) before treatment and at 12 weeks.

RESULTS:

A total of 53 patients (6 males and 47 females) ranging from 18 to 71 years of age and clinically diagnosed with coccygodynia received the full course of therapy and assessments. There were significant differences in both NPRS and surface temperature obtained by IRT in the 12-week follow-up (P < .05). The correlation between NPRS improvement and temperature decrement was significantly high (r = 0.67, P < .01).

CONCLUSIONS:

The study shows that IRT can objectively show the decrement of surface temperatures correlating with changes in subjective pain intensity after treatment of coccygodynia. With the advantages of being painless, noninvasive, and easy to repeat, IRT appears to be useful as a quantifiable tool for monitoring the dynamics of the disease activity in coccygodynia.

http://www.ncbi.nlm.nih.gov/pubmed/19447265

Using Noncontact Infrared Thermography for Long-term Monitoring of Foot Temperatures in a Patientwith Diabetes Mellitus.

Staffa E, Bernard V, Kubíček L, Vlachovský R, Vlk D, Mornstein V, Staffa R.

Abstract

Foot complications in persons with diabetes mellitus (DM) are associated with substantial costs and loss of quality of life. Increasing evidence suggests changes in skin temperature, measured using an infrared thermographic system (IRT), may be a predictor of foot ulcer development in patients with DM. The purpose of this case study is to describe the long-term IRT findings and overall clinical outcomes of apatient with DM and peripheral vascular disease. Foot temperature measurements using IRT were obtained slightly more than 1 year before and immediately following endovascular treatment of a 76-year-old man, a nonsmoker with type 2 DM, hypertension, and ischemic heart disease with cardiac arrhythmia. Although he was otherwise asymptomatic, the infrared measurement showed an average temperature difference of 2.3˚ C between the left and right foot until he developed a small, trauma-induced wound on the left foot, at which time left foottemperature increased. He was diagnosed with rectosigmoid adenocarcinoma, underwent surgery and chemotherapy, and subsequently was evaluated for peripheral vascular disease. Before undergoing peripheral angiography and percutaneous transluminal angioplasty, IRT evaluation showed a hot spot on the left heel. Immediately following endovascular treatment, the mean temperature difference between the right and left foot was low (0.2˚ C), but a Stage I pressure ulcer was visible on the left heel. Skin breakdown in that area was observed 2 months later, and the wound continued to increase in size and depth. The patient died shortly thereafter due to complications of cancer. In this case study, a series of infrared images of foot skin temperatures appeared to show a relationship with blood circulation and wound/ulcer development and presentation. IRT has the ability to instantaneously measure the absolute temperature of the skin surface over a large area without direct skin contact. However, the devices are very sensitive and prospective clinical studies to determine the validity, reliability, sensitivity, and specificity of these measurements for routine use in patients who are at risk for vascular disease and/or foot ulcers are needed.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Using+Noncontact+Infrared+Thermography+for+Long-term+Monitoring+of+Foot+Temperatures+in+a+Patient+with+Diabetes+Mellitus.

Using Noncontact Infrared Thermography for Long-term Monitoring of Foot Temperatures in a Patient with Diabetes Mellitus.

Staffa E, Bernard V, Kubíček L, Vlachovský R, Vlk D, Mornstein V, Staffa R.

Abstract

http://www.ncbi.nlm.nih.gov/pubmed/?term=Using+Noncontact+Infrared+Thermography+for+Long-term+Monitoring+of+Foot+Temperatures+in+a+Patient+with+Diabetes+Mellitus.

Use of smartphone attached mobile thermography assessing subclinical inflammation: a pilot study.

Kanazawa T¹, Nakagami G¹, Goto T¹, Noguchi H², Oe M³, Miyagaki T⁴, Hayashi A⁵, Sasaki S⁶, Sanada H¹.

Author information

Abstract

OBJECTIVE:

To verify the reliability and validity of FLIR ONE, a device connected to a smartphone, for the assessment of inflammation based on relative temperature increase compared with the thermography routinely used in pressure ulcer (PU) and diabetic foot assessment.

METHOD:

Participants in this pilot cross-sectional observational study were recruited from the patients in the PU team rounds and the diabetic foot outpatient clinic at the university hospital in January 2015. Cohen’s kappa coefficient with its 95% confidence intervals was used to evaluate the criterion-related validity and inter- and intra-rater reliability for the thermal imaging assessment. For assessing criterion-related validity, a hand-held high-end infrared thermography device was used to provide reference data. Comparison of thermal images between the smartphone-connected device and the hand-held device was performed with both a ‘predetermined range’ and an ‘automatically-set range.’ For assessing inter-rater reliability, two assessors evaluated the thermal images taken by the mobilethermography. For assessing intra-rater reliability, one assessor evaluated the thermal images twice. The thermal images were shown to the assessors at random.

RESULTS:

Among 16 thermal images obtained from eight patients, kappa coefficients for each value were as follows: for the predetermined range and automatically-set range, respectively, the criterion-related validity was 1.00 (95% confidence interval 1.00-1.00) and 1.00 (95% confidence interval 1.00-1.00); the inter-rater reliability was 1.00 (95% confidence interval 1.00-1.00) and 1.00 (95% confidence interval 1.00-1.00); and the intra-rater reliability was 1.00 (95% confidence interval 1.00-1.00) and 1.00 (95% confidence interval 1.00-1.00).

CONCLUSION:

This pilot study suggests that FLIR ONE can work as an alternative device for assessing subclinical inflammation in PUs and the diabetic foot in clinical settings. Our results may facilitate clinicians in accepting the routine use of thermal imaging assessment at the patients’ bedside.

KEYWORDS:

chronic wound; diabetes mellitus; thermal imaging; wound assessment

http://www.ncbi.nlm.nih.gov/pubmed/?term=Using+Noncontact+Infrared+Thermography+for+Long-term+Monitoring+of+Foot+Temperatures+in+a+Patient+with+Diabetes+Mellitus.

The Use of Thermal Imaging in the Evaluation of the Symmetry of Muscle Activity in Various Types of Exercises (Symmetrical and Asymmetrical).

Chudecka M¹, Lubkowska A², Leźnicka K¹, Krupecki K³.

Author information

Abstract

In order to achieve higher efficiency of training and thus better athletic performance, new research and diagnostic methods are constantly being developed, particularly those that are non-invasive. One such a method is thermography, suitable for quantitative and therefore objective evaluation of variables, such as changes in the temperature of the skin covering working muscles. The aim of this study was to use a thermal imaging infrared camera to evaluate temperature changes of symmetric body surfaces over symmetrically working muscles of male scullers after exercising on a two-oared rowing ergometer and compare these to asymmetrically working muscles of handball players after an endurance training session containing elements of an actual game. In the scullers, the mean temperature of body surfaces was always lower post than pre exercise, with no significant differences in an average temperature drop between the opposite sides, indicating that the work of the muscles involved in the physical exertion on the rowing ergometer was symmetrical. In contrast, in the handball players, skin temperatures in symmetric areas over the asymmetrically working muscles showed statistically significant differences between sides, which was associated with the functional asymmetry of training. This study indicates that thermal imaging may be useful for coaches in the evaluation of technical preparations in sports in which equal involvement of symmetric muscles is a condition of success, e.g. in scullers.

KEYWORDS:

anthropometry; coaching; symmetry of muscle activity; thermal imaging

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723162/

Application of Infrared Thermal Imaging in a Violinist with Temporomandibular Disorder.

Clemente M¹, Coimbra D, Silva A, Aguiar Branco C, Pinho JC.

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Abstract

Temporomandibular disorders (TMD) consist of a group of pathologies that affect the masticatory muscles, temporomandibular joints (TMJ), and/or related structures. String instrumentalists, like many orchestra musicians, can spend hours with head postures that may influence the biomechanical behavior of the TMJ and the muscles of the craniocervicomandibular complex (CCMC). The adoption of abnormal postures acquired during performance by musicians can lead to muscular hyperactivity of the head and cervical muscles, with the possible appearance of TMD. Medical infrared thermography is a non-invasive procedure that can monitor the changes in the superficial tissue related to blood circulation and may serve as a complement to the clinical examination. The objective of this study was to use infraredthermography to evaluate, in one subject, the cutaneous thermal changes adjacent to the CCMC that occur before, during, and after playing a string instrument.

http://www.ncbi.nlm.nih.gov/pubmed/26614980

Trigger points–ultrasound and thermal findings.

Cojocaru MC¹, Cojocaru IM², Voiculescu VM³, Cojan-Carlea NA¹, Dumitru VL⁴, Berteanu M⁴.

Author information

Abstract

RATIONALE:

Muscle pain can be elicited by any irritation of the nociceptors in the muscle or central sensitization in the central nervous system. The most frequently described muscle pain syndromes are myofascial pain syndrome and fibromyalgia syndrome. Myofascial pain syndrome has a more localized manifestation, the trigger points.

OBJECTIVE:

If there is a correlation between the clinical findings, the ultrasound examination and the thermal pattern of trigger points exist.

MATERIAL AND METHOD:

The presence of trigger points can be identified by using clinical criteria. An ultrasound examination was performed to evaluate the trigger point dimensions. The ultrasound showed an ellipsoidal hypoechogenic area in the muscle. Athermography of the low back region was performed in order to observe the thermal pattern of the area.

RESULTS:

Trigger points are represented by a higher temperature area surrounded by a cooler area, probably caused by a deficit in the blood flow around those points.

DISCUSSION:

Infrared thermography could be a great asset for the monitoring of neuromusculoskeletal disorders and their dynamics, as well as an important aid for the initial diagnosis of conditions associated with tissue temperature alterations.

KEYWORDS:

muscle pain; muscle ultrasound; myofascial pain syndrome; thermography; trigger points

http://www.ncbi.nlm.nih.gov/pubmed/26351532

Thermographic Assessment of Eccentric Overload Training Within Three Days of a Running Session.

Sanz-López F¹, Martínez-Amat A, Hita-Contreras F, Valero-Campo C, Berzosa C.

Author information

Abstract

Sanz-López, F, Martínez-Amat, A, Hita-Contreras, F, Valero-Campo, C, and Berzosa, C. Thermographic assessment of eccentric overload training within three days of a running session. J Strength Cond Res 30(2): 504-511, 2016-The aim of this study was to analyze the changes in patellar and Achilles tendons between a group trained using eccentric overload and an untrained group within 3 days of a running session. To this end, infrared thermography (IRT) will be used. Twenty healthy male subjects were divided into 2 groups. One group performed a 6-week squat training in the flywheel before the running session. During the running intervention, both groups ran in 3 different days, for 1 hour each, at 80% maximal heart rate. Before, just after, and after 10 minutes of the running intervention, participants were assessed using IRT. Eccentrically trained groups showed a statistically significant difference (analysis of variance, p = 0.0049) expressed as a smaller bilateral increase in temperature in the patellar tendon just before the first running day (right side, 0.11° C; left side, 0.29° C). On the other days of running and in the Achilles tendon groups, similar changes were observed: an increase in the temperature after running and no significant difference between contralateral limbs. Our results point at eccentric overload training providing a better adaptation for the first day of running. IRT is an easy-to-apply noninvasive tool to analyze and compare the effects of performance on tendon tissues.

http://www.ncbi.nlm.nih.gov/pubmed/26110350

The effectiveness of infrared thermography in patients with whiplash injury.

Lee YS¹, Paeng SH¹, Farhadi HF², Lee WH¹, Kim ST¹, Lee KS¹.

Author information

Abstract

OBJECTIVE:

This study aims to visualize the subjective symptoms before and after the treatment of whiplash injury using infrared (IR)thermography.

METHODS:

IR thermography was performed for 42 patients who were diagnosed with whiplash injury. There were 19 male and 23 female patients. The mean age was 43.12 years. Thermal differences (ΔT) in the neck and shoulder and changes in the thermal differences (ΔdT) before and after treatment were analyzed. Pain after injury was evaluated using visual analogue scale (VAS) before and after treatment (ΔVAS). The correlations between ΔdT and ΔVAS results before and after the treatment were examined. We used Digital Infrared Thermal Imaging equipment of Dorex company for IR thermography.

RESULTS:

The skin temperature of the neck and shoulder immediately after injury showed 1-2℃ hyperthermia than normal. After two weeks, the skin temperature was normal range. ΔT after immediately injuy was higher than normal value, but it was gradually near the normal value after two weeks. ΔdT before and after treatment were statistically significant (p<0.05). VAS of the neck and shoulder significantly reduced after 2 week (p=0.001). Also, there was significant correlation between ΔdT and reduced ΔVAS (the neck; r=0.412, p<0.007) (the shoulder; r=0.648, p<0.000).

http://www.ncbi.nlm.nih.gov/pubmed/25932296

Infrared thermal imaging in patients with medial collateral ligament injury of the knee – a retrospective study.

Yang H¹, Park H¹, Lim C¹, Park S², Lee K¹.

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Abstract

OBJECTIVES:

Digital infrared thermographic imaging (DITI) has been used widely for various inflammatory diseases, circulatory diseases, skin diseases, musculoskeletal diseases and cancers. In cases of ligament injury, obviously the temperature of the damaged area increases due to local inflammation; however, whether the temperature also increases due to DITI has not been determined. The purpose of the present study was to identify whether or not the changes of temperature in patient’s with medial collateral ligament injury were really due toinfrared thermography and to determine the applicability of DITI for assessing ligament injuries.

METHODS:

Twenty patient’s who underwent DITI for a medial collateral ligament injury from September 2012 to June 2014 were included in the current study. The thermographic images from the patient’s knees were divided to cover seven sub-areas: the middle of the patella, and the inferomedial, the inferolateral, the superomedial, the superolateral, the medial, and the lateral regions of patella. The temperatures of the seven regions were measured, and the temperature differences between affected and unaffected regions were analyzed by using the Wilcoxon signed rank test.

RESULTS:

The 20 patient’s were composed of 14 women (70%) and 6 men (30%), with a mean age of 62.15 ± 15.71 (mean ± standard deviation (SD)) years. The temperature of the affected side, which included the middle of the patella, and the inferomedial, the superomedial, the superolateral, and the medial regions, showed a significant increase compared to that of the unaffected side (P < 0.05). The inferolateral and the lateral regions showed no significant changes.

CONCLUSION:

Our study results suggest that DITI can show temperature changes if a patient has a ligament injury and that it can be applied in the evaluation of a medial collateral ligament injury.

KEYWORDS:

digital infrared thermographic imaging; knee joint; medial collateral ligament; thermography

http://www.ncbi.nlm.nih.gov/pubmed/25780719

Women with more severe degrees of temporomandibular disorder exhibit an increase in temperature over the temporomandibular joint.

Dibai-Filho AV¹, Costa AC², Packer AC², de Castro EM³, Rodrigues-Bigaton D².

Author information

Abstract

AIM:

The purpose of the present study was to correlate the degree of temporomandibular disorder (TMD) severity and skin temperatures over the temporomandibular joint (TMJ) and masseter and anterior temporalis muscles.

MATERIALS AND METHODS:

This blind cross-sectional study involved 60 women aged 18-40 years. The volunteers were allocated to groups based on Fonseca anamnestic index (FAI) score: no TMD, mild TMD, moderate TMD, and severe TMD (n = 15 each). All volunteers underwent infrared thermography for the determination of skin temperatures over the TMJ, masseter and anterior temporalis muscles. The Shapiro-Wilk test was used to determine the normality of the data. The Kruskal-Wallis test, followed by Dunn’s test, was used for comparisons among groups according to TMD severity. Spearman’s correlation coefficients were calculated to determine the strength of associations among variables.

RESULTS:

Weak, positive, significant associations were found between FAI score and skin temperatures over the left TMJ (rs = 0.195, p = 0.009) and right TMJ (rs = 0.238, p = 0.001). Temperatures over the right and left TMJ were significantly higher in groups with more severe TMD (p < 0.05).

CONCLUSION:

FAI score was associated with skin temperature over the TMJ, as determined by infrared thermography, in this sample. Women with more severe TMD demonstrated a bilateral increase in skin temperature.

KEYWORDS:

Skeletal muscle; Skin temperature; Temporomandibular joint disorders; Thermography

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273257/

Injury. 2015 Nov;46 Suppl 6:S36-9. doi: 10.1016/j.injury.2015.10.044. Epub 2015 Nov 18.

Medical thermography (digital infrared thermal imaging – DITI) in paediatric forearm fractures – A pilot study.

Ćurković S¹, Antabak A², Halužan D², Luetić T², Prlić I³, Šiško J³.

Author information

Abstract

Trauma is the most common cause of hospitalisation in children, and forearm fractures comprise 35% of all paediatric fractures. One-third of forearm fractures are distal forearm fractures, which are the most common fractures in the paediatric population. This type of fracture represents an everyday problem for the paediatric surgeon. The three phases of fracture healing in paediatric trauma are associated with skin temperature changes that can be measured and then compared with standard plain radiographs of visible callus formation, and eventually these methods can be used in everyday practice. Thermographic assessment of temperature distribution within the examined tissues enables a quick, non-contact, non-invasive measurement of their temperature. Medical thermography is used as a screening method in other parts of medicine, but the use of this method in traumatology has still not been researched.

KEYWORDS:

DITI; Forearm fractures; Medical thermography; Paediatric trauma

http://www.ncbi.nlm.nih.gov/pubmed/26603613

Ann Rehabil Med. 2013 Jun;37(3):355-63. doi: 10.5535/arm.2013.37.3.355. Epub 2013 Jun 30.

Skin temperature changes in patients with unilateral lumbosacral radiculopathy.

Ra JY¹, An S, Lee GH, Kim TU, Lee SJ, Hyun JK.

Author information

Abstract

OBJECTIVE:

To clarify the relationship of skin temperature changes to clinical, radiologic, and electrophysiological findings in unilateral lumbosacral radiculopathy and to delineate the possible temperature-change mechanisms involved.

METHODS:

One hundred and one patients who had clinical symptoms and for whom there were physical findings suggestive or indicative of unilateral lumbosacral radiculopathy, along with 27 normal controls, were selected for the study, and the thermal-pattern results of digital infrared thermographic imaging (DITI) performed on the back and lower extremities were analyzed. Local temperatures were assessed by comparing the mean temperature differences (ΔT) in 30 regions of interest (ROIs), and abnormal thermal patterns were divided into seven regions. To aid the diagnosis of radiculopathy, magnetic resonance imaging (MRI) and electrophysiological tests were also carried out.

RESULTS:

The incidence of disc herniation on MRI was 86%; 43% of patients showed electrophysiological abnormalities. On DITI, 97% of the patients showed abnormal ΔT in at least one of the 30 ROIs, and 79% showed hypothermia on the involved side. Seventy-eight percent of the patients also showed abnormal thermal patterns in at least one of the seven regions. Patients who had motor weakness or lateral-type disc herniation showed some correlations with abnormal DITI findings. However, neither pain severity nor other physical or electrophysiological findings were related to the DITI findings.

CONCLUSION:

Skin temperature change following lumbosacral radiculopathy was related to some clinical and MRI findings, suggesting muscle atrophy. DITI, despite its limitations, might be useful as a complementary tool in the diagnosis of unilateral lumbosacral radiculopathy.

KEYWORDS:

Electrodiagnosis; Magnetic resonance imaging; Muscle atrophy; Radiculopathy; Thermography

http://www.ncbi.nlm.nih.gov/pubmed/23869333

Emerg Radiol. 2012 Jun;19(3):203-9. doi: 10.1007/s10140-012-1027-2. Epub 2012 Feb 24.

Early assessment of the efficacy of digital infrared thermal imaging in pediatric extremity trauma.

Silva CT¹, Naveed N, Bokhari S, Baker KE, Staib LH, Ibrahim SM, Muchantef K, Goodman TR.

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Abstract

Young children or those with intellectual disability with trauma to an extremity often undergo radiographs of the whole limb. The objective of the study was to assess the efficacy of digital infrared thermal images (DITI) in pediatric extremity trauma. We hypothesized fractures to be associated with local hyperthermia, detectable with DITI, which could direct focused radiographs. In this exploratory study, patients seen over a 2-month period in a pediatric emergency department for limb trauma were included if an extremity radiograph was taken on the same day. Patients had DITI of symptomatic and contralateral limbs. The warmest area of each image was compared to the site of pain and/or fracture on the radiograph. Fifty-one patients were enrolled. DITI matched 73% of pain sites. Fractures were seen in 11 patients. DITImatched 7 of 11 (64%) fracture sites. DITI performance in pinpointing the site of injury, although suboptimal, is encouraging for further evaluation.

http://www.ncbi.nlm.nih.gov/pubmed/22362422

J Hum Kinet. 2015 Dec 30;49:141-7. doi: 10.1515/hukin-2015-0116. eCollection 2015.

The Use of Thermal Imaging in the Evaluation of the Symmetry of Muscle Activity in Various Types of Exercises (Symmetrical and Asymmetrical).

Chudecka M¹, Lubkowska A², Leźnicka K¹, Krupecki K³.

Author information

Abstract

KEYWORDS:

anthropometry; coaching; symmetry of muscle activity; thermal imaging

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723162/

J Shoulder Elbow Surg. 2007 Sep-Oct;16(5):548-54. Epub 2007 Jun 8.

The effectiveness of digital infrared thermographic imaging in patients with shoulder impingement syndrome.

Park JY¹, Hyun JK, Seo JB.

Author information

Abstract

We prospectively evaluated 100 patients with unilateral impingement syndrome, before they underwent an arthroscopic subacromial decompression, to detect the relationship between clinical and operative findings and digital infrared thermographic imaging (DITI) findings in patients with shoulder impingement syndrome. The DITI system was used to measure the temperature of each patient’s upper body, and the relative temperature values between involved and the uninvolved sides were used for analysis. A control group of 30 subjects without impingement syndrome was also evaluated. In DITI findings, 73% of patients had abnormal thermal changes in more than 1 of the 4 regions of interest: 51% displayed hypothermia, and 22% had hyperthermia. In the hypothermic group, limitation of shoulder motion was more prominent than in the hyperthermic and normal groups (P < .05). Other clinical findings did not correlate with the DITI findings, however.DITI can be used to reflect shoulder stiffness objectively in impingement syndrome, especially in those cases with a hypothermic thermal pattern.

http://www.ncbi.nlm.nih.gov/pubmed/17560803

J Med Life. 2015 Jul-Sep;8(3):315-8.

Trigger points–ultrasound and thermal findings.

Cojocaru MC¹, Cojocaru IM², Voiculescu VM³, Cojan-Carlea NA¹, Dumitru VL⁴, Berteanu M⁴.

Abstract

RATIONALE:

OBJECTIVE:

If there is a correlation between the clinical findings, the ultrasound examination and the thermal pattern of trigger points exist.

MATERIAL AND METHOD:

RESULTS:

Trigger points are represented by a higher temperature area surrounded by a cooler area, probably caused by a deficit in the blood flow around those points.

DISCUSSION:

Infrared thermography could be a great asset for the monitoring of neuromusculoskeletal disorders and their dynamics, as well as an important aid for the initial diagnosis of conditions associated with tissue temperature alterations.

KEYWORDS: muscle pain; muscle ultrasound; myofascial pain syndrome; thermography; trigger points

http://www.ncbi.nlm.nih.gov/pubmed/26351532

Thermographic Assessment of Eccentric Overload Training Within Three Days of a Running Session.

Sanz-López F¹, Martínez-Amat A, Hita-Contreras F, Valero-Campo C, Berzosa C.

Author information

Abstract

Sanz-López, F, Martínez-Amat, A, Hita-Contreras, F, Valero-Campo, C, and Berzosa, C. Thermographic assessment of eccentric overload training within three days of a running session. J Strength Cond Res 30(2): 504-511, 2016-The aim of this study was to analyze the changes in patellar and Achilles tendons between a group trained using eccentric overload and an untrained group within 3 days of a running session. To this end, infrared thermography (IRT) will be used. Twenty healthy male subjects were divided into 2 groups. One group performed a 6-week squat training in the flywheel before the running session. During the running intervention, both groups ran in 3 different days, for 1 hour each, at 80% maximal heart rate. Before, just after, and after 10 minutes of the running intervention, participants were assessed using IRT. Eccentrically trained groups showed a statistically significant difference (analysis of variance, p = 0.0049) expressed as a smaller bilateral increase in temperature in the patellar tendon just before the first running day (right side, 0.11° C; left side, 0.29° C). On the other days of running and in the Achilles tendon groups, similar changes were observed: an increase in the temperature after running and no significant difference between contralateral limbs. Our results point at eccentric overload training providing a better adaptation for the first day of running. IRT is an easy-to-apply noninvasive tool to analyze and compare the effects of performance on tendon tissues.

http://www.ncbi.nlm.nih.gov/pubmed/26110350

J Korean Neurosurg Soc. 2015 Apr;57(4):283-8. doi: 10.3340/jkns.2015.57.4.283. Epub 2015 Apr 24.

The effectiveness of infrared thermography in patients with whiplash injury.

Lee YS¹, Paeng SH¹, Farhadi HF², Lee WH¹, Kim ST¹, Lee KS¹.

Author information

Abstract

OBJECTIVE:

This study aims to visualize the subjective symptoms before and after the treatment of whiplash injury using infrared (IR)thermography.

METHODS:

RESULTS:

CONCLUSION:

The skin temperature of sites with whiplash injury is immediately hyperthermia and gradually decreased after two weeks, finally it got close to normal temperature. These were highly correlated with reduced VAS. IR thermography can be a reliable tool to visualize the symptoms of whiplash injury and the effectiveness of treatment in clinical settings.

KEYWORDS:

Infrared thermography; Pain; Thermal difference; Visual analogue scale; Whiplash injury

http://www.ncbi.nlm.nih.gov/pubmed/25932296

J Pharmacopuncture. 2014 Dec;17(4):50-4. doi: 10.3831/KPI.2014.17.036.

Infrared thermal imaging in patients with medial collateral ligament injury of the knee – a retrospective study.

Yang H¹, Park H¹, Lim C¹, Park S², Lee K¹.

Author information

Abstract

OBJECTIVES:

METHODS:

RESULTS:

CONCLUSION:

Our study results suggest that DITI can show temperature changes if a patient has a ligament injury and that it can be applied in the evaluation of a medial collateral ligament injury.

KEYWORDS:

digital infrared thermographic imaging; knee joint; medial collateral ligament; thermography

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4332010/

Saudi Dent J. 2015 Jan;27(1):44-9. doi: 10.1016/j.sdentj.2014.10.002. Epub 2014 Dec 13.

Women with more severe degrees of temporomandibular disorder exhibit an increase in temperature over the temporomandibular joint.

Dibai-Filho AV¹, Costa AC², Packer AC², de Castro EM³, Rodrigues-Bigaton D².

Author information

Abstract

AIM:

MATERIALS AND METHODS:

RESULTS:

CONCLUSION:

KEYWORDS:

Skeletal muscle; Skin temperature; Temporomandibular joint disorders; Thermography

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273257/