All studies were performed with a computer interfaced, color telethermographic instrument which has
the capability of providing mean temperatures in the
area of interest. The skin surface area to be measured
was divided into 32 sensory segments approximating
the areas of innervation of major peripheral nerves
(Figure 1). This division was by no means complete.
We arbitrarily excluded some areas of innervation
because they are not large enough for precise sampling with our present equipment. We also avoided
hair-covered areas such as eyebrows and moist areas
such as lips and nostrils because hair and moisture
may cause unpredictable temperature changes.
The skin temperature of each sensory segment was
measured in 32 healthy subjects and 24 patients with
peripheral nerve impairment. There were eight cases
with peripheral nerve trauma and 16 cases with
lumbar disc herniation. Ages ranged from 12 to 65
years. Average temperatures in the 32 sensory segments on the normal subjects were compared on the
left and right sides of the body (Table 1). The degree
From the Department of Neurosurgery, Johns Hopkins University School
of Medicine; Baltimore, Maryland.
Body segment
Cutaneous sensory
nerves and segments
measured
Mean average
temperature
differences
(C)
S.D.
0.12
0.18
0.14
0.18
0.15
0.15
0.25
(0.17)
0.13
0.093
0.186
0.151
0.131
0.091
0.092
0.201
(0.042)
0.108
Forehead
Cheek
Chest
Abdomen
Neck (Posterior)
Thoracic, paraspinal
Lumbar (Back)
(Trunk Average)
Scapula
Arm (Biceps)
(Triceps)
0.13
0.22
0.119
0.155
Forearm (Medial)
(Lateral)
0.32
0.23
0.158
0.198
Palm (Lateral)
(Medial)
Median (C6,7.8)
Ulnar (C8,T1)
0.25
0.23
0.166
0.197
Thigh (Anterior)
(Posterior)
Knee (patellar)
Popliteal
0.11
0.15
0.23
0.12
0.085
0.116
0.174
0.101
Leg (Anterior)
Calf
Foot (dorsal)
Heel
(Extremities, Average)
Finger (Tips), *Average
Toe (Tips), **Average
0.31
0.13
0.30
0.20
(0.20)
(0.38)
(0.50)
0.277
0.108
0.201
0.220
(0.073)
(0.064)
(0.143)
SKIN
TEMPERATURE
DIFFERENCES : Skin temperature
differences from one side of the body to the other
are extremely small and very stable throughout the
body. For example, the side-to-side difference was
only 0.12C at the forehead and 0.25C at the lumbar
back (Table 1).
Temperature differences between the sides of the
body remain essentially the same during repeated
temperature measurements during a 12 month period. This confirms repeatability of the minute difference of the skin temperature between the sides of
the body (Figure 3).
SENSORY
0.8
0.2
0
0.2
0.8
25
JUNE.
JAN.
FOOT
HIP
DEC.
1.4
HEAD
(N)
Biceps-triceps
Forearm, inner-outer
Palm, inner-outer
Thumb-little finger
Big toe-little toe
(16)
(19)
(19)
Mean Difference
(C)
S.D.
1.25
0.37
0.36
0.53
1.03
0.792
0.279
0.247
0.420
0.885
(18)
(22)
of sympathetic nervefunction):
These patients had complete loss of sensitivity in
Group A (loss
the sensory distribution of the damaged nerve, resulting from proximal nerve transection by surgery
or trauma. The skin temperature on the damaged
side average 1.92 0.939C higher than the contralateral intact limb. This degree of temperature
elevation, contrasted with that in normal asymptomatic controls, is statistically significant (P <
0.001).
Number
warmer/total (%)
16/16
28/38
22/39
29/36
14122
(100)
(74)
(57)
(81)
(64)
Mean
Temperature
Difference
1.92
0.939 **
16
24
0.83
0.21
0.411 **
0.096
SD
statistically significant when contrasted to the temperature difference of the controls (P < 0.001) (Table 3).
COLDNESS ( FINGERS
ANDTOES ): In this study,
forehead temperature was compared with that of the
fingers and toes to establish normal and abnormal
range of distal coldness. Results are shown in Table
4. The mean difference between the temperature of
the forehead and little finger was 2.8 2.72C.
Adding the value of one, two and three standard deviations to the mean value, one can estimate the
normal limit and the severity of the distal coldness
relative to the value of the healthy individual.
DISTAL
Summary
2.8 2.72
<2.8
5.5
5.6 - 8 . 2
8.3 11.0
>11.O
Big
Toe
(N:13)
4.2 1.72
<4.2
5.9
6.0 7.6
7.7 9.4
>9.4
tween sides of the body was only 0.24C. In symptomatic patients the average temperature difference between the normal side and the side with nerve
damage was 1.55C, a difference six times higher
than that found in controls (P < 0.001). Computerized telethermography established the normal temperature variations and demonstrated a statistically
significant change with injury.
Address single copy reprint requests to Sumio Uematsu, M.D.; Department of Neurosurgery, Johns Hopkins University School of Medicine, 600
North Wolfe Street; Baltimore, Maryland 21205
References
1. Clark RP. The European Association of Thermology, Third
International Congress of Thermology, (Abstracts) pp. l-3,
1983.
2. Uematsu S. in Pain Therapy, R Rizzi and M Visentin, Eds.
(Elsevier, Amsterdam, 1983), pp. 63-72.