Thermography

Based on the data of Knutsson.

LR, likelihood ratio; Sens, sensitivity; Spec, specificity.

Thermography measures heat emission from the body surface and displays it photographically. The heat measured is that emanating from skin. Thermography does not measure heat from muscles. Any utility of thermo-graphy in the investigation of pain depends on the relationship between cutaneous blood flow and pain. Since there is no direct relationship, thermography does not measure or depict pain; it depicts only associated features that may or may not regularly occur with pain in various conditions.

Thermography correlates reasonably well with clinical examination and MR imaging findings in patients with radiculopathy.65 However, it adds nothing to the diagnosis. The presence of radiculopathy is readily established by clinical examination and does not require corrobora-tion by thermography. The causative lesion is demonstrated by CT or MR imaging.

Thermography can objectively and quantitatively determine temperature changes in limbs affected by complex regional pain syndromes.66 Its use in these conditions is attractive, in that it seems to offer an objective diagnosis, but it is essentially superfluous. Temperature changes are only one of the lesser features of these conditions. The cardinal diagnostic criteria are inordinate pain, allodynia, and a history, at some time, of swelling and color changes, apart from temperature changes. The diagnosis can be made clinically without resort to thermography.

Moreover, it has been shown that thermographic changes correlate only weakly with clinical features; and the correlation is with temperature asymmetries on clinical examination.43 Thermography is unlikely to be positive unless there are already evident temperature asymmetries clinically.

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