BY DR. W.N. DUDLEY, D C.
Howell, Michigan and
G L. MILLER, D, C.
Ann Arbor, Michigan
We are in a period of time when vast advances are being made in technology. How does this affect the constant structural findings of the doctor I of chiropractic?
To date the chiropractic profession has explored the internal bony system to the point where some feel the cause is at the top of the mountain; others look to the base, and of course, there are some who go between and look at the middle and both ends. To evaluate the body we need a system that will show the internal bony skeleton and the external physiological system. No single system as yet can do that.
The internal solution is of x-ray which we are utilizing for the restoration of health. The external solution seems to be the thermograph. This instrument takes away the application of touch and feel of the applicator, much in the same sense as the x-ray indicates internal abnormalities, Thermography gives a true pattern of body temperature never before pictured.
Body temperature is produced by metabolism and is distributed by blood and lymph to the rest of the body and particularly to the overlying skin for loss by radiation and convection to the surrounding air. The disparity between unequal distribution of this heat may well define the malfunction of the nervous system when compared to other findings on the opposite side of the body.
The equipment that is available to analyze the radiation of the heat of the body is either infra-red scanners or thermography.
The original equipment was slow and tedious. The time necessary to scan the body could be in excess of 30 minutes.' But with additional electronics and indium antimonide, as a fast detector, the time has become lessened to a near instant pictorial display. The Swedish-AGA produced an instrument incorporating a rapid scanner with a rapid detector, coupled with a cathode screen presentation from which photographs can be made. The rapid scanner and fast detector make it possible to use short time. Therefore photographs may be made with high quality resolution and acceptable definition. The result is a thermogram.
The AGA system has a patented system of isotherm display which is variable by the operator. This enables the observer to note thermal variance within a selected temperature range. The total amount of temperature variance within adjacent parts can be noted with a selector to the isotherm. Thereby, a thermogram may be reproduced on the same patient and a scan that would show an altering of the thermal pattern. As a sir~simplification, the AGA system then can show thermal pa~t;patterns an object patient and also display that the pattern has remained or altered. Application of thermography has to date been in the field of carcinoma and other problems of the breast, vascular disease, in demonstration of the placenta, and in infections. There has not been, to the knowledge of the authors, any investigation by the chiropractic field in the application of thermography. One college2 did have an instrument for display and there was some hint of clinical evaluation. But so far there has been no publication of any data.
We had use of a manufacturer's lab for a day to initially evaluate the possibility that the instrument was effective for our use. There was no desire on the part of the company to permit us the equipment. It was at this point the AGA corporation was contacted through Mr. C. Warren and it ' was agreed to utilize the black and white model for a period of time to determine what changes if any, an adjustment had on the thermal display of humans. A Polaroid camera was mounted on the screen to reproduce the displayed material, Adjustments were made and their alteration of thermal pattern then evaluated.
The method of study was a gross screening of all patients with no regard to symptomatic complaint or physical defect. The viewing was done with both before and after pictures. And here there is an admission of ineptitude for the function of the instrument. In some cases certain findings were seen and the patient adjusted and reviewed and for varying reasons the retakes or original pictures did not produce.
At any rate the findings were obvious, almost instantly, that vascular change could be made, and that the changes were extremely rapid after adjustment.
The back was used often to determine what may be an indicator of nerve pressure. But as the screenings proceeded, the frontal and not dorsal aspect of the patient began to be utilized. Also the limbs and abdomen. In fact the whole individual was screened most often although only those portions of interest were photographed.
The question whether reduced vascular markings also showed decreased neurologic ability is one question we attempted to answer. The most readily available area to test was the median nerve due to the lesser density of the hand--and it would display thermographically. The patient was examined to determine if a weakness existed in the median distribution and, if found, the hands were compared on the thermograph. The patient was asked to return in several days to determine if the finding was consistent. It proved to be repeatable and quite constant. The hand showing the greatest heat was the one with a marked weakness in that median nerve. Another frequent finding was that Adson's sign was usually positive on that side also. The patient was generally unaware of weakness and seldom was there a pain complaint.
In a great number of cases there were cervical films available and some showed a decrease of anterior cervical curve and/or rotation of the cervical spine. If correction was made to the patient and he was reviewed on the thermogram, the disparity of the circulation in the hands would arrest. The speed of the alteration was amazing. It became a test of speed to see if we could view the patient as having the problem, adjust, and then review, the time lapse was insignificant. The alteration was nearly immediate. Not a significant finding when using muscle test to delineate nerve restoration, but the obvious consequences that vascular alterations accompanied the weakened muscular area. The outcome being that vascular alteration may be an exhibitor of nerve pressure too subtle for muscle tests.
Malfunction of the muscular system as an indicator of neurologic malfunction needs no documentation,3 but the display of a weakened or nonoperative muscle can be displayed on thermography. Only careful testing can confirm this. However, when a patient displays a weakness of muscle, the depth of the muscle, i.e., the overlying muscle, may dissipate the heat and not show a display. If this is a complication then there should be signs of the problem when comparisons are made.
Thermography, coupled with testing of the muscles, has shown that the origin of the muscle will suddenly show an elevated temperature not noted when the opposite muscle is used as a comparative.
The latissimus dorsi is one prime example. When the muscle tests show a weakness a thermal scan may not show such on the patient unless origin of the muscle is viewed. As example:
On these photos of two cases it must be bore in mind that white represents heat in the body and that comparatively blacker areas are cooler, Case #1 of the patient, portions not exposed show the comparatively cooler sections due to covering by means of a heavy towel. The exposed parts of the body are of immediate interest. If the left shoulder area is noted it can be seen that there are two white areas. This patient did not test weak on the left latissimus dorsi muscle.
The back does not express the same cool areas that;would outline the fact that the latissimus dorsi is weak, But the important point may well be that it is difficult to evaluate relative weakness. The variables are many, whereas, the thermograph is not. We have seen it occur often that a muscle may not test weak; and if scanned by thermography the origin shows a hot spot, The patient is allowed to continue and in a day or two the muscle becomes weak. And an adjustment is necessary to reestablish the neurological integrity. This then negates the hot spot shown on a thermogram.
Case #2
Typical heat distribution in a patient's hands. She displayed a left radial carpal tunnel syndrome; the left teres major tests weak, positive left Adson's sign, evident weakness in the left median nerve distribution, The second photo shows an even distribution of heat. The patient then tests strong in all areas previously weak. Time lag here was less than two minutes. This particular example is quite repeatable with either hand showing the variable in heat pattern. Handedness has no bearing on the side of involvement. More detailed thermograms are seen but this was a typical example of the often recurring problem in patients.
References
1. Intonational Review of Chiropractic; Adelman, G, 1964, Volume 1, #1, 2. Palmer Chiropractic College Lyceum, 1971.
3. Correlative Neuroanatomy & Functional Neurology; Joseph G. Chusid, Lange Medical Publications, 1970, edition ~4.
Acknowledgment: My profuse thanks for much additional labor both in the research done, and effort expended, must be given to my capable assistant, Diane Diver.
THE ACA JOURNAL OF CHIROPRACTIC, APRIL 1973