Assessment of the upper trapezius muscle temperature in women with and without neck pain

Evaluation of Thermography as a Diagnostic Technique in Asymptomatic or Incipient Onychomycosis

Onychomycosis is usually diagnosed symptomatically due to the very clear signs caused by the fungus on the nail surface and structure, although the growth of the infecting agent must also be verified by culture in an enriched medium. This procedure is normally lengthy (four weeks), and samples can be contaminated, delaying the prescription of appropriate and effective treatment. Only one previous study has addressed the possibility of using thermography as a diagnostic method for onychomycosis in older people (31-70 years). The present study confirms this use but in individuals aged 18-31 years with incipient mycosis and no pathological signs. Using an FLIR E60 BX camera in a study with 214 samples, we found that men had more onychomycosis than women. We observed a relation between the presence of infection and nail temperature, with a higher temperature in yeast infections (+1 °C) and a lower temperature in dermatophyte infections (-2 °C). A higher temperature by almost 1 °C was also observed in older participants. Thermography can be viewed as a new diagnostic method in asymptomatic or incipient onychomycosis, providing the thermographic camera is sufficiently sensitive and the appropriate procedure is followed, although fungal culture is always necessary to confirm recovery after treatment.

Effect of Vocal Therapy Associated With TENS in Women With Behavioral Dysphonia

PURPOSE

This study aimed to investigate the effect of transcutaneous electrical nerve stimulation (TENS) associated with vocal therapy in women with behavioral dysphonia.

METHOD

Seventeen women with behavioral dysphonia were divided into an experimental group (n = 8) and a placebo group (n = 9). All were submitted to six sessions of vocal therapy, according to the Comprehensive Voice Rehabilitation Program. In the experimental group, therapy was associated with TENS (30 minutes) and in the placebo group, the electrodes were placed and the equipment remained off. The vocal handicap, the voice through the acoustic and auditory perception evaluation, the electrical activity, and the superficial temperature of the suprahyoid and infrahyoid muscles were evaluated. Pre and post data were compared by parametric and nonparametric tests.

RESULTS

There was a decreased in vocal handicap of the placebo group (P = 0.002) and a decreased in the percentage of electrical activity of the right (P = 0.036) and left (P = 0.017) infrahyoid muscles of the experimental group in vowel emission and sequential speech (P = 0.036). There was an increase in temperature in the right infrahyoid region in vowel emission (P = 0.027) and the temperature difference decreased quantitatively between the supra and infrahyoid regions in the experimental group.

CONCLUSION

TENS associated with vocal therapy reduced the electrical activity of the infrahyoid muscles and balance the temperature between the supra- and infrahyoid regions in women with behavioral dysphonia.

Thermal imaging ruled out as a supplementary assessment in patients with fibromyalgia: A cross-sectional study

BACKGROUND

The diagnosis of fibromyalgia syndrome (FMS) syndrome is often complicated and relies on diagnostic criteria based mostly on the symptoms reported by patients. Implementing objective complementary tests would be desirable to better characterize this population.

OBJECTIVE

The purpose of this cross-sectional study was to compare the skin temperature at rest using thermography in women with FMS and healthy women.

METHODS

Eighty-six women with FMS and 92 healthy controls volunteered to participate. The temperature of all participants was measured by infra-red thermography, registering the skin surface temperature (minimum, maximum and average) at rest in different areas: neck, upper and lower back, chest, knees and elbows. In order to analyze the differences in the skin temperature between groups, inferential analyses of the data were performed using Mann-Whitney U test.

RESULTS

The results showed no significant difference in skin temperature between groups in the neck, upper back, chest and elbows (p>0.05). The lower back and knees areas showed significant differences between groups (p<0.05), although these differences did not reach a minimum of clinically detectable change.

CONCLUSIONS

Women with fibromyalgia presented no clinically meaningful reduction or difference in skin temperature at rest when compared with a group of healthy women. The infra-red thermography is not an effective supplementary assessment tool in women with fibromyalgia.

Role of thermography in the assessment of temporomandibular disorders and other musculoskeletal conditions: A systematic review

The aim of this review was to evaluate whether thermal imaging may constitute a reliable assessment method of musculoskeletal and temporomandibular disorders (TMD/MSD). A systematic review was conducted in the Pubmed, Scopus, Cochrane library, Web of Science, and Lilacs databases. The search terms were "musculoskeletal disorders,""temporomandibular disorders,""infrared thermography,""thermography," and "infrared imaging." The inclusion criteria were: studies published between January 1985 and January 2021, performed in humans, with sample size equal or greater than 20 patients, written in English, Portuguese, French and/or Spanish, and full text available. The exclusion criteria were: systematic reviews, case studies, and/or studies focused on pathologies beyond the review's domain. The risk of bias was evaluated using CASP 2018. A total of 2032 articles were retrieved. Of these, 25 studies met the inclusion criteria and were included to withdraw the following information: title, type of study, first author and year of publication, objective, number of participants, comparisons, and principal conclusions. No RCT were found. Despite some disparity, points of convergence among the majority of authors could be found. In general, healthy individuals show subtle thermal differences between contralateral homolog areas. Concerning orofacial structures, unilateral symptomatic individuals may show thermal differences equal or greater than 0.4°C. Infrared thermography accuracy in diagnosing TMD/MSD is still considered low to moderate. Despite some limitations, IRT might constitute a valuable supporting diagnostic tool in the medical field of TMD and MSD.

Analysis of peak plantar pressure and center of pressure oscillation in individuals with chronic neck pain: A cross-sectional study

BACKGROUND

Baropodometric evaluation has been used in research and clinical environments by professionals who are working on the physical rehabilitation of patients. However, to date, there is no published data on the use of baropodometry in patients with chronic neck pain.

OBJECTIVE

To analyze peak plantar pressure and center of pressure oscillation in individuals with chronic neck pain compared to a control group.

METHODS

This was a blind cross-sectional study. It included 44 participants of both genders, between 18 and 45 years old, distributed into a chronic neck pain group (n= 22) and a control group (n= 22). Participants were assessed by means of baropodometry, the Numeric Rating Scale, the Neck Disability Index, and the Pain-Related Self Statement Scale. The Mann-Whitney test was used for comparison of baropodometric variables between the two groups, and the Spearman correlation coefficient was used to check possible associations between the variables.

RESULTS

No significant differences (p> 0.05) in peak plantar pressure or center of pressure oscillation were detected in the comparisons between the chronic neck pain and control groups. In addition, no significant correlation was observed (p> 0.05) between baropodometric variables and neck pain.

CONCLUSION

Individuals with chronic neck pain with mild disability did not differ from a control group in terms of peak plantar pressure or center of pressure oscillation.

Computer aided diagnosis of diabetic foot using infrared thermography: A review

Diabetes mellitus (DM) is a chronic metabolic disorder that requires regular medical care to prevent severe complications. The elevated blood glucose level affects the eyes, blood vessels, nerves, heart, and kidneys after the onset. The affected blood vessels (usually due to atherosclerosis) may lead to insufficient blood circulation particularly in the lower extremities and nerve damage (neuropathy), which can result in serious foot complications. Hence, an early detection and treatment can prevent foot complications such as ulcerations and amputations. Clinicians often assess the diabetic foot for sensory deficits with clinical tools, and the resulting foot severity is often manually evaluated. The infrared thermography is a fast, nonintrusive and non-contact method which allows the visualization of foot plantar temperature distribution. Several studies have proposed infrared thermography-based computer aided diagnosis (CAD) methods for diabetic foot. Among them, the asymmetric temperature analysis method is more superior, as it is easy to implement, and yielded satisfactory results in most of the studies. In this paper, the diabetic foot, its pathophysiology, conventional assessments methods, infrared thermography and the different infrared thermography-based CAD analysis methods are reviewed.

Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders

Background

This study systematically summarizes quantitative imaging biomarker research in non-traumatic neck and shoulder musculoskeletal disorders (MSDs). There were two research questions: 1) Are there quantitative imaging biomarkers associated with the presence of neck and shoulder MSDs?, 2) Are there quantitative imaging biomarkers associated with the severity of neck and shoulder MSDs?

Methods

PubMed and SCOPUS were used for the literature search. One hundred and twenty-five studies met primary inclusion criteria. Data were extracted from 49 sufficient quality studies.

Results

Most of the 125 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. Only half controlled for potential confounders via exclusion or in the analysis. Approximately one-third reported response rates. In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. The literature synthesis suggested that neck muscle size may be decreased in neck pain, and trapezius myalgia and neck/shoulder pain may be associated with reduced vascularity in the trapezius and reduced trapezius oxygen saturation at rest and in response to upper extremity tasks. Reduced vascularity in the supraspinatus tendon may also be a feature in rotator cuff tears. Five of eight studies showed an association between a quantitative imaging marker and MSD severity.

Conclusions

Although research on quantitative imaging biomarkers is still in a nascent stage, some MSD biomarkers were identified. There are limitations in the articles examined, including possible selection bias and inattention to potentially confounding factors. Recommendations for future studies are provided.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-017-1694-y) contains supplementary material, which is available to authorized users.

Evolution of Skin Temperature after the Application of Compressive Forces on Tendon, Muscle and Myofascial Trigger Point

Some assessment and diagnosis methods require palpation or the application of certain forces on the skin, which affects the structures beneath, we highlight the importance of defining possible influences on skin temperature as a result of this physical contact. Thus, the aim of the present study is to determine the ideal time for performing thermographic examination after palpation based on the assessment of skin temperature evolution. Randomized and crossover study carried out with 15 computer-user volunteers of both genders, between 18 and 45 years of age, who were submitted to compressive forces of 0, 1, 2 and 3 kg/cm2 for 30 seconds with a washout period of 48 hours using a portable digital dynamometer. Compressive forces were applied on the following spots on the dominant upper limb: myofascial trigger point in the levator scapulae, biceps brachii muscle and palmaris longus tendon. Volunteers were examined by means of infrared thermography before and after the application of compressive forces (15, 30, 45 and 60 minutes). In most comparisons made over time, a significant decrease was observed 30, 45 and 60 minutes after the application of compressive forces (p < 0.05) on the palmaris longus tendon and biceps brachii muscle. However, no difference was observed when comparing the different compressive forces (p > 0.05). In conclusion, infrared thermography can be used after assessment or diagnosis methods focused on the application of forces on tendons and muscles, provided the procedure is performed 15 minutes after contact with the skin. Regarding to the myofascial trigger point, the thermographic examination can be performed within 60 minutes after the contact with the skin.

Assessment of the Sensitivity, Specificity, and Accuracy of Thermography in Identifying Patients with TMD

Background

The purpose of the present study was to evaluate the sensitivity, specificity, and accuracy of thermography in identifying patients with temporomandibular dysfunction (TMD).

Material/Methods

The study sample consisted of 50 patients (27 women and 23 men) ages 19.2 to 24.5 years (mean age 22.43±1.04) with subjective symptoms of TMD (Ai II–III) and 50 patients (25 women and 25 men) ages 19.3 to 25.1 years (mean age 22.21±1.18) with no subjective symptoms of TMD (Ai I).

The anamnestic interviews were conducted according to the three-point anamnestic index of temporomandibular dysfunction (Ai). The thermography was performed using a ThermaCAM TMSC500 (FLIR Systems AB, Sweden) independent thermal vision system. Thermography was closely combined with a 10-min chewing test.

Results

The results of our study indicated that the absolute difference in temperature between the right and left side (ΔT) has the highest diagnostic value. The diagnostic effectiveness of this parameter increased after the chewing test. The cut-off points for values of temperature differences between the right and left side and identifying 95.5% of subjects with no functional disorders according to the temporomandibular dysfunction index Di (specificity 95.5%) were 0.26°C (AUC=0.7422, sensitivity 44.3%, accuracy 52.4%) before the chewing test and 0.52°C (AUC=0.7920, sensitivity 46.4%, accuracy 56.3%) after it.

Conclusions

The evaluation of thermography demonstrated its diagnostic usefulness in identifying patients with TMD with limited effectiveness. The chewing test helped in increasing the diagnostic efficiency of thermography in identifying patients with TMD.

Reliability of different methodologies of infrared image analysis of myofascial trigger points in the upper trapezius muscle

BACKGROUND:

Infrared thermography is recognized as a viable method for evaluation of subjects with myofascial pain.

OBJECTIVE:

The aim of the present study was to assess the intra- and inter-rater reliability of infrared image analysis of myofascial trigger points in the upper trapezius muscle.

METHOD:

A reliability study was conducted with 24 volunteers of both genders (23 females) between 18 and 30 years of age (22.12±2.54), all having cervical pain and presence of active myofascial trigger point in the upper trapezius muscle. Two trained examiners performed analysis of point, line, and area of the infrared images at two different periods with a 1-week interval. The intra-class correlation coefficient (ICC_2,1) was used to assess the intra- and inter-rater reliability.

RESULTS:

With regard to the intra-rater reliability, ICC values were between 0.591 and 0.993, with temperatures between 0.13 and 1.57 °C for values of standard error of measurement (SEM) and between 0.36 and 4.35 °C for the minimal detectable change (MDC). For the inter-rater reliability, ICC ranged from 0.615 to 0.918, with temperatures between 0.43 and 1.22 °C for the SEM and between 1.19 and 3.38 °C for the MDC.

CONCLUSION:

The methods of infrared image analyses of myofascial trigger points in the upper trapezius muscle employed in the present study are suitable for clinical and research practices.

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

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.

Evaluation of myofascial trigger points using infrared thermography: a critical review of the literature

OBJECTIVE

The aim of this study was to review recent studies published on the use of infrared thermography for the assessment of myofascial trigger points (MTrPs).

METHODS

A search of the MEDLINE, CINAHL, PEDro, and SciELO databases was carried out between November 2012 and January 2013 for articles published in English, Portuguese, or Spanish from the year 2000 to 2012. Because of the nature of the included studies and the purpose of this review, the analysis of methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool.

RESULTS

The search retrieved 11 articles, 2 of which were excluded based on language (German and Chinese). Three were duplicated in different databases, 1 did not use infrared thermography for diagnostic purposes, and the other did not use infrared thermography to measure the skin temperature. Thus, the final sample was made up of 4 observational investigations: 3 comparative studies and 1 accuracy study.

CONCLUSION

At present, there are few studies evaluating the accuracy and reliability of infrared thermography for the diagnosis and assessment of MTrPs. Of the few studies present, there is no agreement on skin temperature patterns in the presence of MTrPs.

The chronicity of myogenous temporomandibular disorder changes the skin temperature over the anterior temporalis muscle

The aim of the present study was to investigate the correlation between the chronicity of myogenous temporomandibular disorder (TMD) and skin temperature over the masseter and anterior temporalis muscles. A blind, cross-sectional study was carried out involving 30 women with myogenous TMD, aged 18-40 years (mean of 23.60 ± 5.12 years). The volunteers were recruited from the university community. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used for the diagnosis of TMD and the determination of chronicity. The volunteers were also submitted to infrared thermography to measure absolute skin temperature over the masseter and anterior temporalis muscles and determine their temperature asymmetries. A significant association was found between duration of TMD and temperature asymmetry of the anterior temporalis muscle (rs = 0.224, p = 0.034). The present findings demonstrate that chronicity of myogenous TMD changes the skin temperature over the anterior temporalis muscle.

Accuracy of infrared thermography of the masticatory muscles for the diagnosis of myogenous temporomandibular disorder

OBJECTIVE

The purpose of this study was to evaluate the accuracy of infrared thermography of the central point of the masseter and anterior temporalis muscles for the diagnosis of myogenous temporomandibular disorder (TMD).

METHODS

This is an observational study of university women with and without TMD. Through the use of the Research Diagnostic Criteria for Temporomandibular Disorders, 104 women were divided into a TMD group (n = 52) and control group (n = 52). All volunteers had their masseter and anterior temporalis muscles evaluated by infrared thermography. The receiver operating characteristic (ROC) curve was used to determine the accuracy of diagnosis (area under the ROC curve), the best cut-off point, sensitivity, and specificity.

RESULTS

No significant differences were observed (P > .05) in the skin surface temperature of the masticatory muscles, when the groups were compared. With regard to the ROC curve, the area under the curve was lower than the recommended for all the muscles tested, ranging from 0.433 to 0.502.

CONCLUSION

The findings of this study suggest that infrared thermography of the masticatory muscles is not an accurate instrument for the myogenous TMD diagnosis.