Abstract
Introduction
Carpal tunnel syndrome (CTS) is a condition caused by chronic compression of the median nerve. The diagnosis is made mainly on the basis of clinical image and confirmed with electrodiagnostic testing (electromyography and nerve conduction study); however, these methods do not always aid in reaching the diagnosis of CTS. Moreover, they are invasive examinations, unpleasant for the patient and have to be performed by a qualified physician.
Aim
An evaluation of the usefulness of dynamic thermography in the diagnosis of CTS.
Material and methods
Forty patients were included in the study group. CTS was diagnosed based on clinical examination and electromyography. Forty healthy volunteers were included in the control group. Each of the participants was examined thrice with dynamic thermography. The patient’s hands were first cooled down and then a thermal camera measured their return to normal temperature. The measurement was repeated on the dorsal and volar aspects of each hand.
Results
The results obtained in the study show that a relief of symptoms after carpal tunnel release does not correlate with thermal image. Moreover, the return to normal hand temperature was faster in the control group. In patients with unilateral CTS, no difference was observed in thermographic images of the affected and healthy hands.
Conclusions
Dynamic thermography can be useful in confirming CTS diagnosis.
Dynamic thermography does not allow for objective assessment of patient’s complaints in the postoperative period.
This method has currently limited clinical application. Due to complexity, it presently serves mainly scientific purposes.
1 Introduction
Carpal tunnel syndrome (CTS) is caused by chronic compression of the median nerve within the carpal tunnel. It is one of the most common peripheral mononeuropathies and the most common upper extremity neuropathy. Prevalence in general population is estimated at 0.1–1%. Risk factors include female gender and physical labour. Ten percent of patients have bilateral CTS [1,2,3].
The diagnosis is based on clinical image. Patients complain about nocturnal pain and paresthesia, which wake them up during the night and as the disease progresses, the symptoms increase in severity and begin to appear during the day. In advanced cases of CTS, motor disorders occur in the form of grip precision and strength loss. It makes handling small items (such as a pen or keys) more difficult. Thenar muscle atrophy is observed on examination. Due to decreased or abundant sensitivity, some patients develop wounds on fingertips from repetitive trauma [4,5,6,7].
Clinical presentation is not always obvious. In some cases, one group of symptoms can dominate for years. There are patients with considerable motor deficits without pain or sensitivity impairment and patients with positive electrophysiological results who, despite being in severe pain for years, have no muscle atrophy. This varying clinical image could be a result of overlap syndromes, multifocal compression on the median nerve (“double crush” syndrome) or substitution of lost median nerve functions by the ulnar nerve [8].
Electrodiagnostic testing plays a key role in diagnosing peripheral nerve disorders. Nerve conduction study (NCS) and electromyography (EMG) are mostly used when CTS is suspected. NCS directly measures the sensory and motor fibre conduction speed and amplitude, while with EMG it is possible to register and assess the function of thenar muscles (it has a lower sensitivity than NCS). Many clinicians consider these electrodiagnostic examinations as gold standard to diagnose CTS; however, it has been proved that approximately 18% of patients with clinical signs of median nerve compression have unimpaired nerve conduction in a classic NCS examination. Both NCS and EMG are invasive, unpleasant for the patient and a qualified physician must perform them. Moreover, according to many authors, they are not more sensitive than physical examination combined with medical history [8,9,10,11].
In search of new objective CTS diagnostic tests, researchers have recently taken interest in thermography.
Infrared thermography (IRT, IR) records a map of surface temperature of an examined area. Skin temperature indirectly reflects blood supply to a given area, which changes in response to various stimuli. Such measurements are easy, non-invasive, inexpensive and quick. These features make IRT a promising diagnostic test [12,13,14] (Tables 1 and 2).
Skin temperature change in the study group (volar and dorsal side) on days −1, 1 and 14 after 3 min cold exposure expressed as area under the curve
Study group | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Dorsal aspect (d) | Volar aspect (V) | ||||||||||
Right (R) | Left (L) | Right (R) | Left (L) | |||||||||
Day −1 [cm2] | Day 1 [cm2] | Day 14 [cm2] | Day −1 [cm2] | Day 1 [cm2] | Day 14 [cm2] | Day −1 [cm2] | Day 1 [cm2] | Day 14 [cm2] | Day −1 [cm2] | Day 1 [cm2] | Day 14 [cm2] | |
1 | 5738.7954 | 7661.8318 | 5247.0674 | 5830.4074 | 7809.6044 | 5044.512 | 5733.7871 | 7407.9383 | 5139.8895 | 5588.9585 | 7955.766 | 4949.2093 |
2 | 6788.1167 | 6406.5961 | 5278.8475 | 6001.192 | 6048.0365 | 5677.8629 | 6696.8626 | 6618.3152 | 6134.609 | 6148.8008 | 7393.307 | 6040.4161 |
3 | 7047.3592 | 6509.9462 | 6942.9268 | 6964.1448 | 6306.3424 | 6891.9942 | 7077.0337 | 6199.914 | 6981.5185 | 7094.2211 | 6912.317 | 6540.6793 |
4 | 7172.5313 | 7559.0131 | 7628.7504 | 7416.5034 | 7743.7833 | 7604.5627 | 7005.7044 | 7346.557 | 7493.6902 | 7381.5325 | 7581.901 | 7526.9028 |
5 | 7407.8042 | 7601.5353 | 7517.0499 | 7430.2092 | 7605.3407 | 7595.3287 | 7709.701 | 7397.9859 | 7515.4516 | 7735.8987 | 7873.257 | 7565.0939 |
6 | 6817.0816 | 7593.8763 | 7474.5757 | 6558.6345 | 7540.5374 | 7370.4258 | 6687.5851 | 7295.9813 | 6926.9493 | 6494.2285 | 7620.692 | 7109.7913 |
7 | 8015.8948 | 6642.3724 | 7418.5549 | 8067.7989 | 7265.3256 | 7310.884 | 7934.782 | 6723.329 | 7081.0221 | 7946.9858 | 7759.517 | 7324.1033 |
8 | 7309.7887 | 7367.0289 | 4256.9423 | 6955.7899 | 7163.2455 | 4254.8952 | 6534.5163 | 7515.998 | 4194.0041 | 6346.3395 | 7142.091 | 4337.0405 |
9 | 7582.8238 | 6414.475 | 6377.498 | 7258.309 | 6216.576 | 5503.479 | 6910.09 | 6295.712 | 5788.669 | 6437.497 | 7375.88 | 5323.079 |
10 | 7466.418 | 7371.716 | 6050.844 | 7289.279 | 6507.579 | 5578.934 | 6941.636 | 7108.365 | 5826.119 | 6324.852 | 7215.417 | 5412.285 |
11 | 5566.186 | 5214.194 | 7282.395 | 5348.346 | 4986.756 | 7250.772 | 5536.749 | 5125.916 | 7612.315 | 5254.351 | 6564.692 | 7540.743 |
12 | 7333.067 | 7260.516 | 7506.669 | 7447.416 | 7341.889 | 7426.07 | 7426.768 | 7736.378 | 7506.669 | 7626.45 | 6309.18 | 7552.422 |
13 | 5784.216 | 6162.626 | 7575.474 | 6053.251 | 5746.267 | 7581.58 | 6743.047 | 6050.695 | 7499.184 | 6991.285 | 5785.055 | 7293.785 |
14 | 7711.548 | 6727.103 | 7468.428 | 7621.656 | 6704.846 | 7495.8 | 7666.691 | 6510.624 | 7646.282 | 7675.845 | 7615.244 | 7687.339 |
15 | 6903.785 | 7140.782 | 7581.512 | 6908.295 | 7040.08 | 7675.327 | 7107.863 | 7051.307 | 7629.842 | 7255.583 | 6771.736 | 7769.634 |
16 | 7760.978 | 0 | 0 | 7660.777 | 0 | 0 | 7579.234 | 7522.356 | 0 | 7632.886 | 7931.145 | 0 |
17 | 7720.041 | 7547.857 | 7649.1 | 7807.966 | 7597.292 | 7653.915 | 7435.501 | 7735.052 | 7708.1 | 7581.559 | 7378.262 | 7799.344 |
18 | 6552.423 | 5099.829 | 0 | 6583.997 | 4957.659 | 0 | 5284.565 | 5811.949 | 0 | 5579.183 | 6486.184 | 0 |
19 | 7378.214 | 7450.177 | 6580.865 | 7493.246 | 7627.63 | 6927.553 | 6337.277 | 7625.306 | 6572.66 | 6579.345 | 7543.51 | 6909.17 |
20 | 6925.756 | 7307.599 | 7673.456 | 6658.792 | 6635.398 | 7319.403 | 7591.466 | 6981.113 | 7636.585 | 6018.125 | 7854.768 | 7572.801 |
21 | 7377.338 | 7467.43 | 7931.33 | 7212.892 | 7619.24 | 7897.262 | 6986.53 | 6553.641 | 7629.767 | 7159.964 | 7601.74 | 7608.069 |
22 | 6823.587 | 7226.326 | 7692.785 | 6554.609 | 7292.132 | 7522.476 | 7097.08 | 7210.87 | 7736.019 | 7088.723 | 7770.488 | 7575.838 |
23 | 7188.357 | 5547.25 | 8012.986 | 7049.089 | 5376.11 | 7894.202 | 7118.68 | 5604.277 | 7858.293 | 6936.609 | 7138.907 | 7633.78 |
24 | 7384.856 | 7384.335 | 8043.201 | 7368.208 | 7416.252 | 8101.438 | 7368.408 | 7385.482 | 8052.101 | 7433.914 | 7325.788 | 8068.624 |
25 | 7641.064 | 7615.568 | 8147.866 | 7619.311 | 8019.349 | 8167.685 | 7561.372 | 7561.845 | 8023.069 | 7609.731 | 7192.348 | 8051.5709 |
26 | 7363.349 | 0 | 7491.52 | 7365.141 | 0 | 7581.078 | 7217.851 | 0 | 7649.151 | 7358.705 | 6068.448 | 7719.987 |
27 | 7465.357 | 7229.305 | 7940.297 | 7385.472 | 7322.485 | 7896.825 | 7453.162 | 7255.292 | 7536.237 | 7450.363 | 6928.541 | 7611.418 |
28 | 7453.065 | 7723.253 | 7597.0091 | 7583.082 | 7777.943 | 7660.194 | 6325.129 | 7698.297 | 7341.56 | 6549.858 | 7325.788 | 7342.615 |
29 | 6189.559 | 7204.995 | 7194.602 | 6348.549 | 7094.84 | 7054.25 | 6312.377 | 7321.995 | 6186.51 | 6041.102 | 5812.128 | 5834.426 |
30 | 7292.017 | 7177.755 | 7637.219 | 7352.46 | 7318.195 | 7731.399 | 6794.774 | 7168.356 | 7498.795 | 6947.294 | 7592.575 | 7562.134 |
31 | 7536.452 | 0 | 6345.166 | 6345.166 | 0 | 6102.38 | 7163.624 | 0 | 6445.802 | 7217.876 | 6748.843 | 6327.314 |
32 | 7443.36 | 7578.313 | 7383.942 | 7383.942 | 7691.162 | 7571.457 | 7481.491 | 7562.951 | 7472.296 | 7558.933 | 7940.122 | 7614.151 |
33 | 7584.729 | 6402.215 | 6326.16 | 6326.16 | 6266.061 | 5480.812 | 6925.2831 | 6424.963 | 5771.308 | 6470.631 | 7479.213 | 5372.737 |
34 | 7245.426 | 7352.746 | 4117.947 | 4117.947 | 7099.679 | 4322.886 | 6658.887 | 7597.089 | 4210.107 | 6492.073 | 7073.213 | 4488.695 |
35 | 6734.632 | 5518.511 | 6959.144 | 6959.144 | 5773.442 | 6953.582 | 6343.529 | 5743.148 | 7357.987 | 6001.186 | 7445.154 | 7240.555 |
36 | 6926.741 | 7615.272 | 7182.663 | 7182.663 | 7598.465 | 7139.323 | 6628.539 | 7448.668 | 7266.991 | 7091.038 | 7361.571 | 7425.18 |
37 | 6928.644 | 7549.101 | 7618.502 | 7618.502 | 7602.188 | 7586.2975 | 7028.173 | 7303.756 | 7498.523 | 7421.219 | 6441.04 | 7516.028 |
38 | 6607.199 | 6165.755 | 6805.185 | 6805.185 | 6474.394 | 6896.919 | 5455.211 | 6185.663 | 6499.905 | 6386.031 | 7575.476 | 6100.129 |
39 | 5617.811 | 5752.141 | 6222.673 | 6222.673 | 6836.857 | 6986.948 | 5754.189 | 5461.753 | 5198.507 | 5922.529 | 7862.005 | 6047.83 |
40 | 5505.797 | 5750.37 | 5240.434 | 5240.434 | 6015.909 | 6184.999 | 5572.637 | 5892.825 | 5199.465 | 5368.412 | 7594.724 | 6065.676 |
Skin temperature change in the control group (volar and dorsal side) on days −1, 1 and 14 after 3 min cold exposure expressed as area under the curve
Control group | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Dorsal aspect (d) | Volar aspect (V) | ||||||||||
Right (R) | Left (L) | Right (R) | Left (L) | |||||||||
Day −1 [cm2] | Day 1 [cm2] | Day 14 [cm2] | Day −1 [cm2] | Day 1 [cm2] | Day 14 [cm2] | Day −1 [cm2] | Day 1 [cm2] | Day 14 [cm2] | Day −1 [cm2] | Day 1 [cm2] | Day 14 [cm2] | |
1 | 7931.789 | 8018.725 | 7992.002 | 7944.69 | 8021.499 | 8001.998 | 7837.452 | 7958.452 | 7902.098 | 7818.496 | 7955.766 | 7880.987 |
2 | 7420.906 | 7807.555 | 7549.036 | 7157.381 | 7746.42 | 7730.55 | 6942.505 | 7507.791 | 7332.101 | 6824.457 | 7393.307 | 7540.394 |
3 | 7375.576 | 7242.062 | 7417.303 | 7275.891 | 7331.754 | 7442.08 | 7019.673 | 6717.26 | 7004.259 | 6846.933 | 6912.317 | 7107.129 |
4 | 7496.062 | 7470.305 | 7660.607 | 7506.423 | 7573.31 | 7646.501 | 7499.088 | 7363.305 | 7381.77 | 7420.631 | 7581.901 | 7322.57 |
5 | 7838.856 | 7801.766 | 7576.021 | 7928.603 | 7777.979 | 7605.85 | 7762.567 | 7867.767 | 7272.483 | 7799.8 | 7873.257 | 7269.62 |
6 | 7841.396 | 7797.629 | 7802.432 | 7831.478 | 7830.348 | 7830.986 | 7895.997 | 7592.659 | 7792.098 | 7955.076 | 7620.692 | 7823.987 |
7 | 7939.365 | 7956.175 | 8003.475 | 7902.297 | 7933.434 | 7974.1 | 8078.802 | 7840.773 | 7901.058 | 7968.235 | 7759.517 | 7858.535 |
8 | 7785.669 | 7395.189 | 5898.385 | 7814.308 | 7497.196 | 5924.191 | 7509.795 | 7032.656 | 5761.783 | 7491.527 | 7142.091 | 5779.267 |
9 | 7847.208 | 7481.591 | 6979.941 | 7851.236 | 7499.11 | 7029.309 | 7729.167 | 7280.531 | 6881.055 | 7716.017 | 7375.88 | 7043.586 |
10 | 8122.939 | 7690.557 | 7379.837 | 8006.076 | 7628.331 | 7241.683 | 7707.437 | 7308.749 | 7069.012 | 7691.005 | 7215.417 | 7027.306 |
11 | 5484.605 | 6107.246 | 5430.307 | 5578.629 | 6284.529 | 6148.846 | 5498.959 | 6392.72 | 6350.993 | 5658.332 | 6564.692 | 6441.04 |
12 | 7614.6 | 6932.045 | 6589.296 | 7349.413 | 6972.879 | 6887.417 | 7304.864 | 6614.023 | 6122.468 | 6625.497 | 6309.19 | 6307.162 |
13 | 5475.814 | 5996.919 | 5927.656 | 5434.092 | 6087.442 | 5353.154 | 5020.157 | 5820.822 | 5845.526 | 4909.604 | 5785.055 | 4855.228 |
14 | 7521.972 | 7581.084 | 7577.265 | 7556.966 | 7598.959 | 7548.5 | 7507.015 | 7598.077 | 7578.142 | 7461.083 | 7615.244 | 7592.575 |
15 | 7256.8412 | 7289.844 | 0 | 7198.52 | 7216.869 | 6171.461 | 6818.311 | 6876.332 | 6605.62 | 6775.314 | 6771.736 | 6455.032 |
16 | 7938.222 | 8006.154 | 0 | 7936.055 | 8003.07 | 0 | 7784.173 | 7977.427 | 0 | 7806.163 | 7931.145 | 0 |
17 | 7347.619 | 7810.582 | 7524.392 | 7047.287 | 7680.187 | 7691.494 | 6962.052 | 7474.044 | 7382.423 | 6835.164 | 7378.262 | 7476.944 |
18 | 5426.226 | 6037.146 | 5431.891 | 5520.76 | 6188.335 | 6262.346 | 5367.018 | 6289.378 | 6502.053 | 5541.145 | 6486.184 | 6518.376 |
19 | 7484.808 | 7475.43 | 7647.502 | 7493.637 | 7551.137 | 7526.288 | 7444.353 | 7392.796 | 7385.374 | 7386.396 | 7543.51 | 7359.638 |
20 | 7809.787 | 7750.991 | 7578.268 | 7884.112 | 7692.559 | 7567.222 | 7769.421 | 7822.063 | 7251.109 | 7747.183 | 7854.768 | 7287.472 |
21 | 7838.235 | 7819.318 | 7817.969 | 7838.25 | 7809.712 | 7774.923 | 7880.007 | 7587.374 | 7640.158 | 7659.061 | 7601.74 | 7714.518 |
22 | 7933.339 | 7914.865 | 8006.161 | 7916.831 | 7931.969 | 7957.458 | 8106.917 | 7829.728 | 7907.318 | 7986.147 | 7770.488 | 7871.523 |
23 | 7791.83 | 7408.545 | 8536.373 | 7808.404 | 7457.339 | 5828.149 | 7520.686 | 7102.784 | 5671.876 | 7466.99 | 7138.907 | 5686.76 |
24 | 7836.506 | 7447.504 | 6963.893 | 7791.804 | 7434.288 | 6945.826 | 7718.714 | 7251.486 | 6889.445 | 7733.469 | 7325.788 | 6995.476 |
25 | 8127.782 | 7681.88 | 7438.169 | 8095.436 | 7627.691 | 7347.806 | 7709.021 | 7287.42 | 7024.735 | 7681.524 | 7192.348 | 6954.057 |
26 | 7424.791 | 6589.296 | 6703.144 | 7033.306 | 6652.372 | 6710.664 | 6982.44 | 6296.018 | 6505.96 | 6307.162 | 6068.448 | 6200.716 |
27 | 7334 | 7250.992 | 7461.055 | 7421.676 | 7362.357 | 7411.68 | 7051.114 | 6795.498 | 7034.848 | 6856.861 | 6928.541 | 7088.462 |
28 | 7836.506 | 7447.504 | 6963.893 | 7791.804 | 7434.288 | 6945.826 | 7718.714 | 7251.486 | 6889.445 | 7733.469 | 7325.788 | 6995.476 |
29 | 5452.463 | 5983.178 | 5907.96 | 5353.154 | 6054.229 | 5218.644 | 4904.129 | 5845.526 | 5649.476 | 4869.233 | 5812.128 | 5166.471 |
30 | 7542.093 | 4577.265 | 7552.235 | 7548.5 | 7567.339 | 7516.741 | 7557.708 | .837 | 7560.877 | 7495.211 | 7592.575 | 7528.427 |
31 | 7290.9382 | 7252.433 | 6430.989 | 7153.462 | 7154.4 | 6097.115 | 6801.685 | 6807.516 | 6574.856 | 6748.019 | 6748.843 | 6446.622 |
32 | 7983.932 | 7998.098 | 7930.323 | 7789.432 | 8009.213 | 8013.3344 | 7839.432 | 7900.321 | 7889.423 | 7870.321 | 7940.122 | 7789.212 |
33 | 7400.433 | 7840.211 | 7398.321 | 7148.321 | 7534.432 | 7723.212 | 6930.213 | 7309.213 | 7430.21 | 6789.432 | 7479.213 | 7254.423 |
34 | 7349.234 | 7238.245 | 7381.23 | 7361.321 | 7382.234 | 6990.321 | 7092.543 | 6982.342 | 7150.543 | 6892.12 | 7073.213 | 7321.34 |
35 | 7564.423 | 7423.44 | 7790.21 | 7440.221 | 7543.133 | 7612.309 | 7545.234 | 7289.453 | 7432.432 | 7632.12 | 7445.154 | 7333.905 |
36 | 7203.645 | 7749.725 | 7626.76 | 7020.433 | 7614.456 | 7658.371 | 7014.062 | 7503.886 | 7374.112 | 6751.403 | 7361.571 | 7420.704 |
37 | 5430.307 | 6068.343 | 5415.025 | 5523.639 | 6148.846 | 6294.398 | 5415.601 | 6350.993 | 6472.183 | 5541.175 | 6441.04 | 6488.674 |
38 | 7516.488 | 7530.994 | 7674.995 | 7507.107 | 7589.853 | 7513.501 | 7444.353 | 7403.291 | 7425.145 | 7422.26 | 7572.476 | 7399.222 |
39 | 7804.203 | 7720.468 | 7577.005 | 7858.586 | 7680.731 | 7568.589 | 7803.775 | 7812.666 | 7276.477 | 7776.551 | 7862.005 | 7327.217 |
40 | 7817.696 | 7819.385 | 7817.696 | 7850.02 | 7776.581 | 7681.169 | 7894.325 | 7575.491 | 7727.383 | 7966.299 | 7594.724 | 7827.202 |
Few studies evaluating thermography in CTS have been published. Furthermore, no measurement standard is presently available [15].
2 Aim
An evaluation of the usefulness of dynamic thermography in the diagnosis of CTS.
3 Material and methods
3.1 Material
Out of 84 patients who underwent carpal tunnel release in our department in years 2014–2016, 40 were included in the study group – 32 females and 8 males aged 32 to 68 (mean age 54 years). Diagnosis was based on clinical examination and EMG. Symptoms had to present for a minimum of one year, mean duration was 21 months. Ten patients had bilateral CTS. Right hand was affected in 29 cases, left hand in 11 patients. Thirty-two patients were right-handed, 8 patients left-handed.
Control group consisted of 40 healthy volunteers: 25 women and 15 men aged 27 to 63, mean age was 49 years. The right hand was dominant in 34 people, the left hand in 6. No member of the control group complained on any hand, cervical or thoracic spine disorders.
3.2 Methods
Study protocol was approved by the Pomeranian Medical University Ethics Committee (KB-0012/94/13). Patients included in the study had no significant comorbidities. Smokers and patients with carpal release or carpal tunnel injections were excluded from the study. Each patient was examined with dynamic thermography thrice. First examination was performed one day prior to the surgery, second a day after surgery and the third one 2 weeks after surgery.
All measurements were taken in a room with a steady temperature of 22°C and 65% humidity. Patient’s hands were placed on a table 20 cm away from the camera and fan, which acted as a cooling device. Hands were cooled down for 20 s. A FLIR T335 camera was used to obtain thermal images after the fan was stopped. Measurements were sampled every 5 s for 3 min. The dorsal aspect was assessed first, then after re-cooling, the volar side. To analyse the thermographic images, FLIR Research IR programme was used. Temperature values were sampled from the fingertips (on the volar side) and nails (on the dorsal side) of fingers I-III. Capillary circulation efficiency was measured as area under curve in a graph that showed temperature change in time.
4 Results
Patients from the study group had undergone carpal tunnel release. At 24 h postoperatively, 37 patients reported spontaneous pain mitigation (which previously woke them up), while 3 patients did not report any improvement. At 14 days postoperatively, symptoms subsided in 39 patients, while one reported an exacerbation of pain.
During dynamic thermography, it was observed that after the cold stimulus had been withdrawn, temperature rose during the first 2 min and then stopped. Therefore, only data gathered during these first 2 min were included in the statistical analysis (Figure 1).

A comparison of temperature change between the affected (operated) hand in the study group and both hands of control group.
5 Discussion
In patients with median nerve compression, it appears natural that apart from motor and sensory fibre damage, autonomic nerve fibres can also be affected. Clinical examination and electrophysiological testing both measure the extent of motor and sensory function loss. Some patients, however, complain about symptoms resembling Raynaud’s phenomenon. Trophic changes to the skin are rare, although possible [16,17]. Literature data show that even as many as 50% of patients with CTS may suffer from sympathetic dysfunction [18].
In the study group, 75% of patients reported symptoms related to the sympathetic system: sweating, dryness, pallor, rubor, swelling or cyanosis. Literature reveals many papers where the extent of sympathetic system damage in CTS is evaluated by plethysmography, capillaroscopy or Doppler ultrasound. Another method is sympathetic skin response (SSR), where the electric potential of the skin varies depending on surface temperature, which reflects the activity of sweat glands controlled by the sympathetic nervous system [19,20,21,22,23,24].
While analysing the results, a number of questions had been posed.
First, does the thermographic image of a healthy hand (control group) differ from the image of an affected hand prior to the surgery?
There was a statistically significant difference in thermographic images of hands of patients from both groups. In CTS, blood flow is higher, because the return to original temperature occurs quicker. Based on this observation, it can be assumed that dynamic thermography can be used to determine if a patient is suffering from CTS. Similar conclusions were made by other authors. Papez and Palfy compared the results of static thermography with NCS in patients with CTS. Control group was examined first to create a thermographic model of a healthy hand and then, using an artificial neural network, this model was compared with a thermographic image of patients affected by CTS. The results of that study were statistically significant – authors concluded that thermography is a tool with high sensitivity and is useful in diagnosing severe cases of CTS. When patients with less exacerbated CTS were included into the study group, the sensitivity, however, was lowered. In our study, most patients were diagnosed with moderate CTS (stage II, according to NCS). Papez also observed during his study that the sensitivity of the examination was higher on the dorsal side of the hand. [25,26,27]. Similar conclusions were made by Zivcak et al. [28]. Some authors examined only the volar aspect of the hand [29,30,31]. In our study, both the volar and dorsal sides of the hand were evaluated, and the results show a significant difference in blood flow for both sides between the study and the control group.
Secondly, do thermographic images of the unaffected hand in CTS patients in three examinations (a day before the surgery, one day after the surgery and 14 days after the surgery) differ among each other? In unilateral CTS, thermographic images of the unaffected hands did not differ in consecutive examinations. Similarly, 3 examinations of control group volunteers did not show any differences. Such stable thermographic images confirm the reproducibility of the method.
Thirdly, does the relief of symptoms during the first day after surgical carpal tunnel release correlate with changes in thermographic images?
Immediate relief of nocturnal pain after carpal tunnel release is seen in most patients with CTS. In this study, a similar postoperative observation was made in nearly all patients. It did not, however, correlate with thermographic images captured in 24 hours and 14 days after the surgery. In literature, there is scarce information on changes in blood circulation in patients with CTS after surgical release. A similar study had been conducted by Z. Ming and J. Sivola in 2007. Static thermography had been used to evaluate capillary flow. The diagnosis of CTS was made purely on NCS, without taking the clinical image into consideration. The first thermographic image was captured prior to the surgery, the second 6 months after. In our study, carpal tunnel was diagnosed mainly on signs and symptoms with NCS results only to confirm the diagnosis. A lack of NCS result with a clear clinical image of CTS did not exclude a patient from the study. Ming et al. in their study showed that an improvement in circulation follows a carpal tunnel release within 6 months. Immediate relief of nocturnal symptoms is related to an increase of blood flow to the nerve itself, while full healing is achieved after 6 months due to reinnervation [29].
Lastly, does a thermal image of the affected and unaffected hand differ in the same patient with CTS?
A comparison of the affected and unaffected hand in the same patient with CTS did not reveal statistically significant differences in hand temperature. This may be a result of many overlapping factors. CTS is diagnosed with clinical image. NCS is an additional examination to confirm the already suspected diagnosis and to evaluate the extent of nerve damage. Healthy limbs in patients with CTS were described as those showing no clinical symptoms, not ones with a negative NCS result. Out of 40 study group patients, as few as 12 people had a bilateral NCS, and in that group, only 2 patients had CTS excluded. Literature data estimate the prevalence of bilateral CTS at 50%. Not all symptoms of early CTS could be noticed by a patient. Thus, it may be possible that among 23 healthy limbs, some may be in an early stage of the disease. Most researchers compared hands with confirmed CTS with healthy limbs from the control group. Few authors focused on looking upon both hands of the same patient. The majority assessed the temperature difference of two corresponding points on the volar and dorsal aspect and then compared the results to the control group [25,26,27,28].
6 Results
Our research shows that:
Dynamic thermography can be useful in confirming CTS diagnosis.
Dynamic thermography does not allow for objective assessment of patient’s complaints in the postoperative period.
This method has currently limited clinical application. Due to complexity, it presently serves mainly scientific purposes.
-
Conflict of interest: The authors declare no conflicts of interest. This study has not been presented previously. This study was financed by authors’ own resources
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© 2021 Piotr Bargiel et al., published by De Gruyter
This work is licensed under the Creative Commons Attribution 4.0 International License.
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- Comparison of multiple flatfoot indicators in 5–8-year-old children
- Early MRI imaging and follow-up study in cerebral amyloid angiopathy
- Intestinal fatty acid-binding protein as a biomarker for the diagnosis of strangulated intestinal obstruction: A meta-analysis
- miR-128-3p inhibits apoptosis and inflammation in LPS-induced sepsis by targeting TGFBR2
- Dynamic perfusion CT – A promising tool to diagnose pancreatic ductal adenocarcinoma
- Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches
- Review Articles
- The ambiguous role of mannose-binding lectin (MBL) in human immunity
- Case Report
- Membranous nephropathy with pulmonary cryptococcosis with improved 1-year follow-up results: A case report
- Fertility problems in males carrying an inversion of chromosome 10
- Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature
- Metastatic renal Ewing’s sarcoma in adult woman: Case report and review of the literature
- Burkitt-like lymphoma with 11q aberration in a patient with AIDS and a patient without AIDS: Two cases reports and literature review
- Skull hemophilia pseudotumor: A case report
- Judicious use of low-dosage corticosteroids for non-severe COVID-19: A case report
- Adult-onset citrullinaemia type II with liver cirrhosis: A rare cause of hyperammonaemia
- Clinicopathologic features of Good’s syndrome: Two cases and literature review
- Fatal immune-related hepatitis with intrahepatic cholestasis and pneumonia associated with camrelizumab: A case report and literature review
- Research Articles
- Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study
- Significance of nucleic acid positive anal swab in COVID-19 patients
- circAPLP2 promotes colorectal cancer progression by upregulating HELLS by targeting miR-335-5p
- Ratios between circulating myeloid cells and lymphocytes are associated with mortality in severe COVID-19 patients
- Risk factors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation
- Clinical features of hypertensive patients with COVID-19 compared with a normotensive group: Single-center experience in China
- Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis
- Decreased chromobox homologue 7 expression is associated with epithelial–mesenchymal transition and poor prognosis in cervical cancer
- FGF16 regulated by miR-520b enhances the cell proliferation of lung cancer
- Platelet-rich fibrin: Basics of biological actions and protocol modifications
- Accurate diagnosis of prostate cancer using logistic regression
- miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
- Prognostic significance of TRIM28 expression in patients with breast carcinoma
- Integrative bioinformatics analysis of KPNA2 in six major human cancers
- Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
- A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
- Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
- Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
- Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
- COVID-19 severity in relation to sociodemographics and vitamin D use
- Clinical analysis of 11 cases of nocardiosis
- Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
- Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
- Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
- Relation between IL-8 level and obstructive sleep apnea syndrome
- circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
- Nomogram prediction model for renal anaemia in IgA nephropathy patients
- Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
- NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
- A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
- Clinical and prognostic features of MMP-2 and VEGF in AEG patients
- The value of miR-510 in the prognosis and development of colon cancer
- Functional implications of PABPC1 in the development of ovarian cancer
- Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
- Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
- Prediction of improvement after anterior cruciate ligament reconstruction
- Effluent Osteopontin levels reflect the peritoneal solute transport rate
- circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
- Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
- Association between hair cortisol concentration and metabolic syndrome
- Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
- Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
- Knee alterations in rheumatoid arthritis: Comparison of US and MRI
- Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
- lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
- Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
- Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
- Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
- Travelers’ vaccines and their adverse events in Nara, Japan
- Association between Tfh and PGA in children with Henoch–Schönlein purpura
- Can exchange transfusion be replaced by double-LED phototherapy?
- circ_0005962 functions as an oncogene to aggravate NSCLC progression
- Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
- Serum intact fibroblast growth factor 23 in healthy paediatric population
- Algorithm of rational approach to reconstruction in Fournier’s disease
- A meta-analysis of exosome in the treatment of spinal cord injury
- Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
- Dexmedetomidine may decrease the bupivacaine toxicity to heart
- Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
- Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
- External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
- miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
- HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
- Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
- Cell population data in identifying active tuberculosis and community-acquired pneumonia
- Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
- Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
- 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
- Association of gene polymorphisms with women urinary incontinence
- Influence of COVID-19 pandemic on stress levels of urologic patients
- miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
- miR-519d downregulates LEP expression to inhibit preeclampsia development
- Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
- Fluorescent light energy modulates healing in skin grafted mouse model
- Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
- Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
- Severe postoperative hyperbilirubinemia in congenital heart disease
- Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
- Clinical factors predicting ureteral stent failure in patients with external ureteral compression
- Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
- Triple-Endobutton and clavicular hook: A propensity score matching analysis
- Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
- Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
- miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
- Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
- The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
- Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
- No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
- circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
- Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
- Educational program for orthopedic surgeons’ influences for osteoporosis
- Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
- GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
- lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
- Anticoagulation is the answer in treating noncritical COVID-19 patients
- Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
- Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
- VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
- Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
- Treatment of osteoporosis with teriparatide: The Slovenian experience
- New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
- Superenhancer–transcription factor regulatory network in malignant tumors
- β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
- Clinical features of atypical tuberculosis mimicking bacterial pneumonia
- Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
- Effect of electromagnetic field on abortion: A systematic review and meta-analysis
- miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
- MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
- Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
- miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
- Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
- MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
- Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
- circATP2A2 promotes osteosarcoma progression by upregulating MYH9
- Prognostic role of oxytocin receptor in colon adenocarcinoma
- Review Articles
- The function of non-coding RNAs in idiopathic pulmonary fibrosis
- Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
- Role of cesarean section in the development of neonatal gut microbiota: A systematic review
- Small cell lung cancer transformation during antitumor therapies: A systematic review
- Research progress of gut microbiota and frailty syndrome
- Recommendations for outpatient activity in COVID-19 pandemic
- Rapid Communication
- Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
- Use of microspheres in embolization for unruptured renal angiomyolipomas
- COVID-19 cases with delayed absorption of lung lesion
- A triple combination of treatments on moderate COVID-19
- Social networks and eating disorders during the Covid-19 pandemic
- Letter
- COVID-19, WHO guidelines, pedagogy, and respite
- Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
- COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
- What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
- Case Report
- Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
- CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
- Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
- Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
- Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
- Pulmonary parenchymal involvement caused by Tropheryma whipplei
- Mediastinal mixed germ cell tumor: A case report and literature review
- Ovarian female adnexal tumor of probable Wolffian origin – Case report
- Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
- Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
- Primary orbital ganglioneuroblastoma: A case report
- Primary aortic intimal sarcoma masquerading as intramural hematoma
- Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
- Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
- Chondroblastoma of mandibular condyle: Case report and literature review
- Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
- Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
- Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
- High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
- Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
- Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
- Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
- Retraction
- Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
- Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
- An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
- Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning