Temperature Changes in Superficial and Deep Tissue Layers with Respect to Time of Cold Gel Pack Application in Dogs

Despite the widespread clinical use of cryotherapy, there is only limited and inconsistent data on application times. The aim of this study was to determine the changes in tissue temperature and the duration of this effect. In this experimental study, five adult dogs were used. A cold gel pack (10 x 20 cm) was applied transversally over the right leg femoral region. Temperatures were recorded simultaneously: rectal by a mercury thermometer; right leg skin by probe of Nihon Kohden 6000 polygraph; and right leg subcutaneous, intramuscular, and periosteal, and left leg intramuscular temperatures by a fluorooptic biomedical fiber optic (0.6 mm diameter) thermometer connected to a computer system. Total system accuracy was 0.01 degreesC Cold gel packs were applied for 10, 15, 20, 25, and 30 minutes duration. The results can be summarized as cooling and rewarming data. 1) The superficial tissues such as skin and subcutaneous demonstrated the most rapid and profound cooling effect. The deeper tissues such as bone and muscle exhibited a smaller and more gradual decline in temperature. 2) There was a prolonged rewarming period in all tissues after the removal of the cold gel pack but this period was longer in deeper tissues. According to cold gel pack application time, the rewarming time in intramuscular layers to baseline or plateau temperatures was about: 60 +/-3 minutes for 10 minutes application, 100 +/-4 for 15, 130 +/-5 for 20, 140 +/-7 for 25, and 145 +/-8 for 30. It can be concluded from these results that with increased cold gel pack application time, deep tissue temperature decreased and the duration of cooling effect increased. However, the data indicated that the length of application time and the duration of cooling effect were not linearly related. Especially after 20 minutes of application this ratio decreased progressively. There may be implications of these results for clinical practice.

The Diagnostic Value of Magnetic Resonance Imaging in Subacromial Impingement Syndrome

The aim of this study was to assess the diagnostic ability of magnetic resonance imaging (MRI) in subacromial impingement syndrome (SIS), using a physiological standard of reference. MRI of the rotator cuff (RC) and subacromial injection test (SIT), a reference standard for SIS diagnosis, were performed in 125 painful shoulders. MRI diagnostic accuracies were determined using a 2 x 2 table and the percentage values of SIS diagnosis in patients with the three Zlatkin MRI stages were determined. Shoulder function was evaluated using the Constant Scale, and results were compared for stages. The sensitivity, specificity, accuracy, positive and negative predictive values of MRI for SIS diagnosis were 98.85%, 36.84%, 80%, 78.18% and 93.33% respectively. Of the 32 patients with Zlatkin stage 1 changes in MRI, 20 (62%) had SIT approved SIS diagnosis, while 47 (79%) of the 59 patients with Zlatkin 2 and all of the 19 (100%) patients with Zlatkin 3 changes were diagnosed with SIS by SIT. Mean Constant scores were 78.04 +/- 18.3, 65.0 +/- 19.9 and 54.52 +/- 20.7 in patients with Zlatkin stages 1, 2 and 3, respectively (p < 0.05). The MRI of RC did not prove to be an excellent tool for SIT based SIS diagnosis, with its low specificity. However, the technique can give important clues, as its sensitivity and negative predictive values are high.