Detection of skin temperature differences using palpation by manual physical therapists and lay individuals

Objectives—To evaluate the accuracy of detection of temperature differences among skin sites of lay individuals and manual physical therapists.Methods— Forty-four manual physical therapists and 44 lay individuals were recruited. Subjects palpated two temperature-controlled surfaces that ranged in temperature between 30 and 35 °C and varied randomly by 1, 2, 3, 4, or 5 °C for 10 s. The subjects were then asked to identify the warmer pad.Results— Accuracy increased with larger temperature differences. Accuracy of detection of 1 and 3 °C temperature differences was higher in manual physical therapists than lay individuals.Discussion— Palpation can be used to accurately detecting temperature differences between sites and is more accurately performed by an experienced practitioner.

Level of Evidence: 3b     

Metabolic disturbances identified by SPECT-CT in patients with a clinical diagnosis of sacroiliac joint incompetence

Purpose

To establish the sensitivity and specificity of cross-sectional scintigraphy [single photon emission computed tomography (SPECT)] combined with computed X-ray tomography (CT) in the detection of sacroiliac joint (SIJ) mechanical dysfunction and evaluate reproducibility of reporting.

Methods

Patients with pelvic girdle pain either on the basis of peri-partum SIJ dysfunction or trauma were included. These patients were imaged with bone scintigraphy with hybrid imaging with SPECT/CT.

Results

The study group comprised 100 patients (72 females, 28 males). Trauma accounted for 52 % and the remainder were patients with peri-partum pain. Average age was 43 years and average length of history was >2 years. The major finding was increased uptake in the upper SIJ and posterior soft-tissues/ligaments. Hybrid imaging had a sensitivity of 95 % and specificity of 99 %. Positive predictive value was 99 % and negative predictive value 94 %. Power of the test was 1.0. Reproducibility of the test was good with kappa values of 0.85.

Conclusion

Hybrid imaging with SPECT/CT reproducibly demonstrates metabolic alterations around the SIJ in patients with SIJ dysfunction, which we have termed SIJ incompetence. The condition is more common than previously recognised and frequently occurs after trauma, which has not been reported previously.     

Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines?

The line joining the superior aspect of the iliac crests posteriorly (the intercristal line) is commonly stated to cross the midline at the L4 or L4-5 spinal level on imaging. This study aimed to assess the spinal level identified through palpation of surface anatomy (iliac crests and posterior superior iliac spines) in adults and the level of agreement compared with the intercristal line identified through imaging. The study participants included consecutive adult patients undergoing prone fluoroscopically guided spinal injections for chronic low back pain at the Royal Orthopaedic Hospital, Birmingham, between April and July 2004. Prior to fluoroscopic imaging, each patient's surface anatomy was palpated by two examiners and lines created to form the palpated intercristal line and the posterior superior iliac spine line. Following imaging, the mid-line spinal levels identified by these palpated lines were recorded and the level of agreement (kappa coefficient) with the intercristal line formed by imaging of the iliac crests was assessed. The results showed that although the L4 or L4-5 spinal levels were identified on imaging of the intercristal line in 86.7% of 75 patients (49 female), the intercristal line formed through palpation tended to identify higher levels; the L3 or L3-4 spinal levels in 77.3% of cases and more commonly in females than in males (85.7 vs. 61.5%) and in patients with higher body mass indices. The level of agreement between the two lines was poor (kappa = 0.05). The posterior superior iliac spine line identified the S2 spinous process in 51% and the S1 in 44% of 60 (45 female) patients. The results suggest that formation of the intercristal line by palpation of the iliac crests identifies different spinal levels to those identified by imaging and that both methods should be regarded as different instruments. In the clinical situation, it may be more appropriate to consider that palpation of the intercristal line is a guide for identifying the L3 or L3-4 spinal levels rather than the L4 or L4-5 levels, particularly in females and patients with higher body mass indices.     

超声引导下麦默通旋切术在BI-RADS3级临床触诊阴性乳腺病灶中的临床应用价值

目的探讨B超引导下麦默通旋切术在BI-RADS 3级临床触诊阴性乳腺病灶中的临床应用价值。方法175例临床触诊阴性的乳腺肿瘤患者,BI-RADS分级为3级的肿块共425个,分析其手术时间、术后并发症、术后复发、≥35岁及<35岁不同年龄段的病理结果、恶性率等。结果425个临床触诊阴性病灶均被完全切除,平均手术时间小于15 min。术后病理结果显示,良性病灶共405个(95.29%),恶性病灶共6个(1.41%),癌前病变共14个(3.29%);术后出现瘀斑4例(2.29%),局部血肿2例(1.14%);术后随访1年,其中3人局部复发(1.71%)。≥35岁患者103例,其中乳腺癌有5例(4.84%),不典型增生有4例(3.88%),良性乳腺疾病患者有94例(91.3%);<35岁患者72例,其中乳腺癌为0(0%),不典型增生有2例(2.78%),良性乳腺疾病患者有70例(97.2%)。结论超声引导下麦默通旋切术可对BI-RADS 3级临床触诊阴性的乳腺病灶进行早期诊治,且美观、微创、安全,值得推广应用;≥35岁患者推荐微创手术活检以早期诊断及降低乳腺癌漏诊率。     

高频超声联合声触诊弹性超声在冻结肩治疗效果评估中的作用

目的 探讨超声测量盂肱关节囊厚度及硬度在冻结肩（FS）治疗效果评估中的价值。方法 收集2021年6月—2022年8月自贡市第四人民医院收治的68例FS患者,根据临床特征分为三期,所有患者进行超声引导下注射联合液压松解关节囊治疗,治疗前1天和治疗后2周进行肩关节评估,临床评估使用肩关节功能Constant-Murley(CMS)评分及肩关节活动度,超声评估采用测量盂肱关节囊厚度和硬度,然后对两类评估方法进行相关性分析。结果 不同分期冻结肩患者治疗后较治疗前,关节囊厚度及硬度均降低（P＜0.05）,CMS评分及肩关节活动度均升高（P＜0.05）。治疗前、治疗后及治疗前后改善值的关节囊厚度、硬度与CMS评分和肩关节活动度均呈负相关（P<0.05）。结论 利用超声测量盂肱关节囊厚度及硬度评估冻结肩治疗效果,其测值与临床评分具有相关性,评估结果一致,评估方式更加客观,具有临床诊断价值     

Force‐sensitive tactile sensor for minimal access surgery

A new approach to detecting abnormalities in organ tissue, particularly in relation to minimal access surgery, is presented. Prototype sensors, based on piezoresistive material, were developed and assembled into a forceps for evaluation on simulated diseased tissue. Data on the resilience and location of phantom tumours were recorded and displayed visually for ease of interpretation. Both single sensor and multiple sensor arrays (one‐ and two‐dimensional) were manufactured and tested.