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Combination of Infrared Thermal Imaging and Musculoskeletal Ultrasound Examinations
The knee, the intermediate joint in the kinematic chain of the lower extremity, is a very loaded anatomical region from a biomechanical and vascular point of view. Pain of the knee is one of the most frequently mentioned complaints when patients consult their doctor. As knee pain show the tendency to become aggravated with ongoing symptoms, it is important to provide clinicians with accurate information required for decisions in terms of adequate treatment. According to the Philadelphia Panel it is not sufficient to apply or segregate thermotherapy, ultrasound, electric stimulation, exercise, massage, EMG-biofeedback or combined rehabilitation interventions in the treatment protocol for knee disorders such as osteoarthritis patellofemoral chondropathy or tendinopathies of the knee joint. In rehabilitation studies, it is important to specify the nature, intensity and duration of the intervention, and modify the intervention according to specific patient outcome. The information needed to make these decisions can be obtained from infrared thermal imaging and musculoskeletal ultrasound imaging.
Figure 1. Thermographic images of knees with juvenile rheumatoid arthritis (JRA).
In recent years, infrared thermal imaging technology has made remarkable progress, and its image quality has been significantly improved. Thermography is a non-contact, non-invasive diagnostic imaging method, which provide on the basis of temperature patterns and the evaluation of temperature asymmetry in different regions of the body, physiopathological pain information and therefore establish precisely the type of pain. Thermography assists the differentiation of pain induced by inflammation from neuropathic pain modified by the sympathetic nervous system. By using the recent generation of thermography systems with high spatial and thermal resolution, site differences of 0.2℃±0.15°C become apparent.
Figure 2． Thermographic images of a patient with high temperature activity over the growth plate.
The authors describe various thermographic and musculoskeletal ultrasound images of the painful knee syndrome, using the images for differential diagnosis of various types of injuries and diseases of the knee soch as socalled “growth pain”, rheumatoid and other types of arthritis, aseptic necrosis, hydrops or haemarthrosis of the knee joint due to distorsion, distension or ligament rupture, bursopathy, cysts, enthesiopathy or sympathetically maintained pain. The combination of both methods seems to be most accurate in assisting diagnosis. Musculoskeletal ultrasound images inform about the structural changes of a painful knee. Thermographic images provide information on the pathophysiology of the pain by recording the temperature distribution on the knee surface. The level of temperature may be related to inflammatory reactions or to the activity of efferent nociceptive sympathetic nerve fibers. Information obtained via thermographic and musculoskeletal ultrasound examinations are important in making decisions ont adequate treatment and rehabilitation.
Figure 3. Thermographic images of the knee and shank of a patient with signs of tumour growth in the tibia and fibula on the left side.
Combined thermographic and musculoskeletal ultrasound examinations provide information for 1. localisation of the pain's origin; 2.establishing the type of the painful lesion; 3. differentiating individual pain syndromes according to temperature patterns; 4. differentiating types of structural damage; 5. specifying themagnitude andrange of structural damage; 6. It offers assistence for a quick diagnosis and supports early decision with regard to the adequate method of treatment and rehabilitation.
Gabrhel J, Popracová Z, Tauchmannová H., et al. The relationship between thermographic and musculoskeletal ultrasound findings in the “painful knee syndrome”. Thermology International. 22(2), 2012.