Stress infrared telethermography is useful in the diagnosis of complex regional pain syndrome, Type I (formerly reflex sympathetic dystrophy)

Abstract

The objective of this paper is to assess the sensitivity, specificity, and predictive value (PV) of stress infrared telethermography (IRT) in the Complex Regional Pain Syndrome, Type I (CRPS-I). One hundred eighty-five consecutive patients (47 men, 138 women) with 205 pairs of chronically painful limbs (upper, lower, or both) were examined by pain specialists in neurology, physiatry, and anesthesia, who then reached a consensus diagnosis. A clinical diagnosis of CRPS-I required at least two of the following observations: burning pain, vasomotor changes, diaphoresis, trophic changes, allodynia. Patients with only one criterion were classified as possible CRPS-I; those with none were judged not to have CRPS-I. Patients and 24 asymptomatic control subjects underwent stress IRT, which was considered positive for CRPS-I if it showed three of the following: quantitative thermal emission of >1.00 degrees C, abnormal distal thermal gradient patterns, presence of a "thermal marker", and abnormal response to functional cold water autonomic stress testing. By clinical criteria, CRPS-I was diagnosed in 73 pairs of limbs; not CRPS-I was diagnosed in 70; and 62 pairs had possible CRPS-I. Excluding possible CRPS-I cases, there were 5 false-negative stress IRTs (sensitivity 93%) and 7 false-positive results (specificity 89%). Based on estimated 50% prior probability for our population, the positive PV is 90% and the negative PV 94%. None of the control subjects exhibited thermographic evidence of CRPS. It is concluded that the stress IRT is a sensitive and specific indicator of CRPS-I.

Computer-assisted skin videothermography is a highly sensitive quality tool in the diagnosis and monitoring of complex regional pain syndrome type�I

“…In another study, 185 patients who were considered to have CRPS1 were subjected to thermal stress, after which temperature patterns were evaluated and probability of CRPS1 was compared with clinical diagnostic criteria (Gulevich et al 1997). Based on clinical criteria and an estimated 50% prior probability, the positive predictive value was 90% and the negative predictive value was 94%.…”

Early assessment of the efficacy of digital infrared thermal imaging in pediatric extremity trauma

“…It has probably been most investigated for breast cancer [6][7][8][9][10][11][12][13], but growing literature reports its use in a variety of other medical conditions [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. To the best of our knowledge, however, there are only two reports of the use of DITI in skeletal trauma.…”

Digital Rewarming Patterns After Median and Ulnar Nerve Injury

“…11,15 In patients exposed to vibration tools (e.g., forestry workers, construction workers), Raynaud's disease, complex regional pain syndrome, or digital replantations and amputations, several laboratory tests have been used to study digital blood flow and skin temperature, for example, laser Doppler flowmetry, 31,40 -47 plethysmography to measure the amount of blood inflow, 27,34,43 finger systolic blood pressure, 26,33,48 -50 thermocouples on the skin, 4,44,45,51,52 and infrared thermography. 23,36,43,[53][54][55][56][57][58][59] However, to our knowledge, rewarming has been evaluated in nerve injury patients only by Ruch 40 in recent injuries (Ͻ3 months old) using laser Doppler flowmetry and thermocouples and by Pulst 59 in recent injuries (1-19 months) using infrared thermography at 7 and 15 minutes after immersion of the hands in ice water. During the first 6 months after nerve repair, they observed vasodilatation of the area supplied by the nerve at room temperature and after cold stress testing because of loss of sympathetic activity.…”