The Effectiveness of Infrared Thermography in Patients with Whiplash Injury

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 (DeltaT) in the neck and shoulder and changes in the thermal differences (DeltadT) before and after treatment were analyzed. Pain after injury was evaluated using visual analogue scale (VAS) before and after treatment (DeltaVAS). The correlations between DeltadT and DeltaVAS 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 1-2degrees C hyperthermia than normal. After two weeks, the skin temperature was normal range. DeltaT after immediately injuy was higher than normal value, but it was gradually near the normal value after two weeks. DeltadT 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 DeltadT and reduced DeltaVAS (the neck; r=0.412, p<0.007) (the shoulder; r=0.648, p<0.000). 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.

Thermatomal changes in cervical disc herniations

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.

Correlation between Pain Scale and Infrared Thermogram in Lumbar Disc Herniations

Back pain and radiating leg pain due to compression of the nerve root by the lumbar disc herniation are subjective symptoms. Objective evaluation of pain site and severity is important for the diagnosis and the treatment. We evaluate the correlation between the severity of pain and the temperature changes in the patients of lumbar disc herniations using infrared thermograms. 174 consecutive patients who underwent operation or chemonucleolysis for single level unilateral disc protrusion with ipsilateral leg pain were included in this study. Subjective pain was divided four groups(Group I: mild pain, Group II: moderate pain, Group III: severe pain, Group IV: intractable pain). Thermal differences of each group were as follows: Group I was 0.26degreesC, Group II was 0.39degreesC, Group III was 0.60degreesC and Group IV was 0.98degreesC. Disc protrusions were divided three groups. Thermal differences of each group were as follows; mild protrusion group was 0.52degreesC, moderate protrusion group was 0.79degreesC and severe protrusion group was 0.95degreesC. Duration of symptom was divided four groups and each thermal differences were as follows: under 2 months was 0.87degreesC, 2 to 6 months was 0.71degreesC, 6 to 12 months was 0.50degreesC and more than 12 months was 0.47degreesC. All these data were statistically significant in p<0.01. In conclusion, infrared thermal imaging can demonstrate the subjective pain objectively. The discogenic pain is the more severe, or the disc herniation is the more protruded, or the symptom duration is the shorter, the thermal difference between the both legs is the more significantly prominent. Thermal difference between both legs is a useful pain scale in the herniated lumbar disc patients. Infrared thermal imaging is effective in the evaluation of lumbar discogenic pain.

Can DITI Predict a Sequestered Lumbar Disc?

The purpose of this study is to assess the usefulness of digital infrared thermographic image(DITI) in patients with surgically treated lumbar disc disease. A series of 480 patients with lumbar herniated disc was studied. The mean age of the patients was 37 years, with a range of 18 to 64 years. Of which 126 cases of chemonucleolysis. 18 cases of percutaneous endoscopic laser discectomy, and 336 cases of laminectomy with discectomy were performed. Among these patients, 336 cases of laminectomy were assessed by DITI preoperatively. The thermal differences(delta T) between the symptomatic and asymptomatic limbs were evaluated. We have categorized the types of herniations into 3 classes: 200 protruded, 99 extruded, and 37 sequestered. The thermal differences were classified into 3 groups: 177 patients had delta T or = 0.8 degrees C. Among the group of patients with the sequestered disc, 30(i.e. 80%) had delta T > or = 0.8 degrees C. Among the surgically treated 336 patients, non-visualization of a part of the sciatic limb on preoperative DITI was the condition used to coin the term amputation sign by the authors. In the sequestered group, the "amputation sign" was observed in 28 cases(75%). We conclude that DITI can predict a sequestered disc disease, and it allows more precise indication regarding open surgery.