Professional Papers
Dr W.N. Dudley, DC Howell, Michigan
Dr W.N. Dudley is a graduate of Palmer College of Chiropractic in Davenport, Iowa. A member of the American Chiropractic Association and the Michigan State Chiropractic Association, he has had several professional papers published in the ACA Journal, He is in private practice at 120 State St, Howell, Michigan 48843. Thermography is shown to display dermatomes and may also aid In deciding the method of vertebral subluxation correction.
Examination of the body by thermographic means has shown to display faulty circulation rapidly and accurately 1,2, 3, 4 along with some poorly understood sightings.5 However, circulatory investigation has caused a delay in understanding that the altered thermal pattern might be other than vascular faulting.6 The finding that a chiropractic adjustment does alter the thermographic picture has been noted 7,8 but it seemed this was only some neurologic effect upon the vascular system. 6 In thermographic examination there was often noted lines of cooled areas which did not lend themselves to be readily understood, but with current publication and clarification of these areas it has been noted that these are in fact dermatomes and are seen as cooler than adjacent temperatures in the body.l0
For some time photography of the presented oscilloscopic picture was the main method used to describe the parts scanned but the drawback with the film is that the film fades and there is a loss of detail. Along with the fading, no small thermal gradient recognizable in a black and white mode on film, unless a film is used that can be measured by densitometry. The color representations are visually graphic and can be defined easily to small thermal gradients but we have substituted charts, for when the subject is reviewed and a normalization or change in the part examined is seen the films become too bulky and do not lend themselves to rapid or specific measurement of normalization review. Especially in light of the many thermal measurements to be made in the examination. Pictorial charts 1 and 2 are constantly undergoing change and improvement but seem to suffice for the information that we need at present. Also there is enough area on the chart to make a record or memorandum of unusual or new information.
No figures have been complied to note the frequency of faulted dermatomes existence, but it would seem high. This may be prejudiced in a chiropractic practice in that the type of presenting complaints are primarily those of possible spinal and neurologic problems.
Examination
Thermographic dermatome examination can begin at any level but it seems more convenient to begin with the lower limbs as time must be allowed for the parts to equilibrate. Best accuracy is achieved when there is no exposure for five to six hours to smoking and often we find a fasting scan to be most informative. While some drugs have a bizarre effect upon the facial scans, they don't seem to alter dermatome definition as far as can be noted. First the patient is seated; the feet are placed on a carpeted surface; but care mustbe exercised that there is no movement as the emission is altered if the feet are moved. The first part examined is the toes to determine if they are thermally at variance. Often a single toe such as the first or second will be .50C cooler on one foot compared to the others. However, each toe should be compared singularly and totally.
However there is thermal variance of .50C or more that fact is recorded. The patient is then asked to kneel on the chair and display the plantar surface as the cool area may persist in that area. Often one heel will display cooler as part of that dermatome. The examination proceeds upwards and here we are continuously comparing each part to the opposite limb. All thermal variances plus or minus can be noted rapidly, recorded as to location and severity if more than .50C in its distribution. Herein, allowances can be made for, and records made of, distended veins, surface lesions, active arthritic states, and anomalous findings. Old fractures often retain elevated temperature and surgery alters the pattern to defy cataloging as known.
The next chart is used and each section on that chart has its numeric system for thermal comparison. We use expanded charts of each section if an interesting area is to be investigated more closely. As with the back, some areas are numbered for rapid evaluation although the numerals are by no means located at fixed areas but only those areas that seem to have the most value at this time. Additional numerals can be easily added in areas of special interest.
Leg Dermatome
Following a variation in the feet of at least .50C by moving upward, to define dermatome we may see the classic pattern emerge so the medial thigh and gluteal area also show. The chart has function in that the coolest contra-lateral area can be seen and noted. In clinical follow-up of possible recovery that area that was the coolest seems to be the most persistently painful for the patient. As example a dermatome is defined and the area of the calf shows a great deal more frank cooling. Upon care and adjustment of a patient this is often the final area to recover. It is usually described by the patient as the most painful. 11,12
Arms and Hands
Of course several disorders exist that cause variance in the hands which we will not discuss here. This area is very hard to describe. We will limit the description to only a dermatome. The same course must be followed here as with the lower limbs.
The exception is that we utilize a first surface mirror and the patient is seated while the arms are resting on several thickness of towel, After one surface is examined, the other follows. The towels are of course, turned over and a fresh unheated surface is available. The final examination of this area is the auxiliary area while the patient is standing, arms straight away, palmar surface displayed. Still the thermal interest is of .50C or more.
Neck and Face
The first four numbers are used as a base line for thermal criteria. They are the subclavians (1 and 2) and inner canthi (3 and 4). Measurements are taken here and compared to a certain normalcy of the circulation but the variations are complex and any discussion at this time would be inappropriate.
Those are as numbered 5-l0 are compared to define a variance for a dermatome displaying a loss of.50C When the dermatomes are seen they are presently thought to show the side of correction on whichever side is most cool. Application of alcohol to the area will define the dermatome sometimes more clearly and add a gradient to the normal and affected area.13 A bifurcation of the dermatome will be seen by the carotid artery on nearly all scans and we have seen such a severely frank dermatome exist that the carotid artery does not interfere. This would seem to be a severe nerve root damage as they are often bilateral.
An example of a common occurrence is that the 5,6, or 7 area shows to be faulted on the neck area chart; area 2 on the back chart shows heated when compared to the opposite side and the thumb or thenar pad is cooled by .50C. This is assumed to be a traction on the subclavian artery by the scalenii on that side as the Adsons sign will be noted at the right radial pulse.15,16 A variance for unknown reason is seen at 13-14.
This may show a .50C difference and a first cervical correction on the side of coolness seems appropriate to I correct the fault. Some correlation, to x-ray findings has been done to as certain the reason for the existence of the dermatome but few conclusions are forthcoming. As an example we may see an extensive cervical arthritis exist and only one small dermatome that is difficult to define maybe found. Also we have found several dermatomes to be found and x-ray findings are essentially negative. The point may be made that a great deal of examination of this information to date should be done 17 and it is a point that is surely supported.
No specific technic can be credited for there has not been a study to validate one approach as more efficacious than another. Generally accepted adjustment techniques are used and with limited application caused few if any new approaches to be found to subluxation correction. Often a lumbar dermatome and cervical dermatome are noted to be coexistent the lumbar dermatome seems more critical. We cannot ignore either one and this seems to reaffirm the concept of major and minor adjustment areas.
In scanning for dermatomes and locating their existence certain adjustments cause, their amelioration but those adjustments are not static, they change often so that if an adjustment course is pursued and improvement gained there is viable alteration and we must be aware and prepared for that change.
Discussion
Dermatomes can exist frequently in patients. While using thermography to objectively ascertain their existence, we may also use the equipment to evaluate that the correction is being or has been made. Previous workers' have stated that thermograms are constant 18,19,20,21 but find they are altered under chiropractic adjustment. We do not expect alterations in cases of permanent nerve injury, paralysis or surgery but in those cases of nerve root pressure caused by vertebral subluxation thermography can define a dermatome, evaluate it, as certain the correction and be a substantial aid.
References
1. Capistrant, T. A.: "Thermographic Patterns In Carotid Occlusive Disease, & quot; Radiology, Vol 1, 1, 85.
2, Windsor, T and Windsor, D: "Thermography in Cardiovascular Diseases," Applied Radiology, 11, 75.
3. Cooke, E.D.: Thermography in Great Britain, Deep Vein Thrombosis, Medical Thermography
Theory and Clinical Applications, Brentwood Publications, 1977.
4. Dudley, W.N.: "Extremity Thermography and Low Back Pain, "ACA Journal of Chiropractic,Vol XI S-29, 3, 77.
5. Dudley, W.N. and Miller. G.L.: "Thermography and the Body, ACA Journal of Chiropractic,"Vol 7, 1973, p S-30.
6. Dudley, W.N. "Thermography,"ACA Journal, Vol 8, 1974, pS-30.
7. Dudley, W.N.: "Facial Thermography and Adjustment." ACA Journal, August', 1974,p. 74.
8. Hobbins, W.B.: "Thermography in the Private Practice of Surgery, "Proc of Soc of
Amer Therm l973,67.
9. Dudley, W.N.: "Preliminary Findings in Thermography of the Low Back, "ACA Journal, Nov 1978, Vol 12, S-83.
10. Wexler, C.E., and Ching, C.:,"Peripheral Thermographic Manifestations of Lumbar
Disc Disease, Proc. American Thermographic Society, 10, 1977.
11. Hobbins, W.B.: Pain, Current Concepts on Pain and Analgesia, Vol 4, No 3, 1977.
12. Uematsu, S.: "Diagnostic Role of Thermography in Chronic Pain," Medical Thermography Theory and Clinical Applications, Brentwood Pub, 1977.
13. Samuels, BL: "Present Status of Parathyroid Thermography, "JAMA, Vol 233, No 8, 1975.
14. Samuels,B.I.,Dowdy,A.H.,Lecky,J.W.:"Parathyroid Thermography,"Radiology 104: 575, 1972.
15. Dudley, W.N.: "Findings Using the Adsons Sign," ACA Journal of Chiropractic, Vol
VI, S-87.
16. West. H.G.:"Physical Exam Procedures," Modern Develop in Principles & Practice of Chiropractic; Haldeman S. Ed; Appleton-Crofts, 1980.
17: Triano, J.J.: "Instrumentation & Laboratory Examination Procedures by the Chiropractor," Modern Develop in Principles & Practice of Chiropractic; Haldeman S. Ed; Appleton-Crofts, 1980.
18. Isard, H: "Breast Thermography, The Mammatherm," Med Thermography, Theory and Applications Brentwood Pub, l977.
19. Zohn, D.A., and Mennell, J.h~Z: Musculoskeletal Pain, Little, Brown and Co. 1976.
20. Mawdsley, C., et al: "Thermography in Occlusive Cerebrovascular Disease,"Brit
Med J 31, 3, 521.
21. Ryan, J: "Thermography,"Aust Radiology, 1323, 1969.
The ACA Journal of Chiropractic /April 1981