Thermography

Thermography is also called thermal imaging or digital infrared imaging or even computerized thermal imaging. Thermography is a non-invasive tool that produces infrared images of the body part examined - specifically the minute variations in temperatures. Thermal imaging maps the heat on the surface of the affected part using special heat sensing cameras. It shows the patterns of heat and blood flow on or near the body. Amongst other things, Thermography can detect elevated temperatures associated with infections and changes in cellular metabolic variations.

While thermography has been around for more than half a century, it has been put to medical use, especially breast cancer detection much later. FDA has stated that it is not as effective as mammogram in detecting breast cancer at an early stage. Therefore it must not be used instead of mammogram. The thermal imaging process does not involve any invasive, painful procedures or any risks associated with radiation. Thermography can detect more metabolically active areas as there is increased blood flow to that area. It is used in the case of fibrocystic breast disease, mastitis and cancer risk. This is because cancer tissue is more metabolically active.

Reflex Sympathetic Dystrophy

Reflex Sympathetic Dystrophy (RSD) involves severe pain, inflexibility, inflammation and discoloration of the hand or leg. Women are more likely to suffer this complex regional pain syndrome or RSD. They experience burning pain, spasms and weakness in the limbs and are unable to move them. It can affect any limb but it is commonly associated with the hand thereby severely restricting shoulder-hand movement.

In the initial stage (Stage 1), there is increased warmth and inflammation accompanied with excessive sweating and pain of that particular part/limb. Stage 2 or dystrophic Stage involves increased swelling, brittle nails and wrinkled appearance of the affected part. During the atrophic stage or Stage 3, there is a dehydrated and pale appearance in the affected limb.

Injuries to the soft tissue, bone or nerves, surgery or other health conditions can trigger this kind of dystrophy. Bone scans and X-rays help in diagnosis. Thermography is also used to check blood flow to the affected limb. This condition must be differentiated from other similar syndromes such as rheumatoid arthritis and scleroderma.

Mild cases of RSD are treated with NSAIDs. As the condition worsens, stronger medication must be supplemented with suitable pain management such as physical therapy. Bisphosphonates, calcitonin, regional nerve blocks and dorsal column stimulation can provide relief.

Neurotmesis

Neurotmesis etymology: Neurotmesis refers to most serious and severe nerve injury. Neurotmesis is brachial plexus injury. These brachial plexus injuries can occur in live births. The type of injury to the brachial plexus and the stretch damage will determine where the injury takes place. Various types of injuries can occur once the nerve rootlets form mixed nerve root. In some instances, the extent of the nerve damage may not be fully apparent but complete loss of motor, sensory and autonomic functions occurs. This type of complete rupture of the brachial plexus is called Neurotmesis. Neurotmesis is part of Seddon's classification scheme used to classify nerve damage. Seddon classified the nerve injury based on the extent of damage to the nerves on the basis of structural changes in cut nerves. The Seddon classification divides nerve injuries into three types namely:

Neurotmesis: Complete anatomic division of the nerve fibers with obvious discontinuity of the nerve sheath.

Axonotmesis: Microscopic division of nerve fibers without obvious discontinuity of nerve sheath.

Neuropraxia: There is injury without any anatomical discontinuity but resulting in functional disruption or nerve concussion. This is short term or sometimes lasts months with severe compression.

Neuropraxia Symptoms : Nerve Damage Symptoms: Common symptoms of Neurotmesis include loss of sensation and change in taste, expression and speech. There might be emotional and psychological disturbances. In the final stages, there could be a complete loss of motor, sensory and autonomic functions.

Diagnosis of Nerve Injury: There are many ways to diagnose the extent of the nerve injury. One of the common ways is Nerve conduction Velocity Test which tests the speed and strength of a signal being transmitted by nerve cells. Testing these factors can reveal the nature of nerve injury, such as damage to nerve cells or to the protective myelin sheath (protective coating on axons). The test Electroneurography (EneG) which is also known as nerve conduction study or usually as a Nerve Conduction Velocity test(NCV) will help determine the nerve damage and further explore the choice of treatment. Other than Peripheral nerve injuries, NCV is also helpful for the diagnosis of the following conditions:

Guillain Barré syndrome
Herniated disc disease
Charcot Marie Tooth disease

Special tests for assessment of Neurotmesis include electromyography, Strength duration curve, nerve conduction study and thermography. EMG test will be able to determine the presence, location and access the extent of diseases that caused the damage to the nerves and muscles. In some cases, a nerve biopsy may be needed where a small minute portion of the damaged nerve is surgically removed and analyzed.

Prognosis: Recovery from trauma is dependent on the age of the patient, type of injury and degree of injury. Without surgical intervention and repair this injury has very poor prognosis. Even with surgical repair, there could be significant loss of motor and sensory neurons which are responsible for normal conduction.