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Use of thermography inthe diagnosis of plant thorn synovitis.

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In 1977, Sugarman et a1 (1) reported 5 cases of a
chronic inflammatory monarthritis caused by retained
fragments of plant thorns. The clinical presentation of
their patients was usually a transient episode of acute
synovitis followed by a relatively asymptomatic period,
and later by a chronic arthritis, perhaps after the thorn
had been forgotten. Another similar case which involved a retained wooden splinter fragment has recently
been reported (2). Here we wish to report an additional
case in which thermography was used in the diagnosis.
Case report. In September 1977, a previously
well 13-year-old boy was injured while playing baseball.
As he tried to catch a fly ball he collided with a thornbush and a thorn entered his midpalm approximately 5
cm distal to the flexion crease. His fingers were flexed at
the time and, as he straightened them out, he removed a
From the General Electric Corporate Research and Development Center and Ellis and Sunnyview Hospitals, Schenectady, New
York, and Albany Medical College, Albany, New York.
John F. Schenck, MD, PhD: General Electric Corporate Research and Development Center and Albany Medical College; James
M. Strosberg, MD, FACP Ellis and Sunnyview Hospitals and Albany
Medical College.
Address reprint requests to Dr. John F. Schenck, General
Electric Coiporate Research and Development Center, P.O. Box 8,
Schenectady , NY 12301.
Submitted for publication October 4, 1978; accepted May 11,
Arthritis and Rheumatism, Vol. 22, No. 9 (September 1979)
thorn and believed that the entire piece had been removed. The bush was later identified as a cockspurn
thorn (Crutuegus crus-gulli). The patient was then
asymptomatic until January 1978, when he noted swelling in the right ring finger and some also in the distal
palm. On examination, the patient had a small punctate
discoloration of the palm in the region of the flexor tendon of the ring finger (entrance wound). There was
swelling and minimal tenderness to palpation from the
distal flexorpalmar crease to the distal interphalangeal
(DIP) joint. He had full extension of the joint, but there
was some limitation of flexion at the mediophalangeal
(MP), proximal interphalangeal (PIP), and DIP joints.
There was no instability or pain with motion. X-ray
findings were normal.
Thermography was done to study the surface
temperature of the right hand. As noted in Figure 1,
there was a striking temperature gradient with the right
palm and right ring finger as far as the PIP joint, being
noticeably warmer, although this temperature difference could not be appreciated at physical examination.
The right ring finger and the palm were explored surgically. Four cubic centimeters of cloudy yellow fluid
were found in the tendon sheath of the finger, and
chronic inflammatory changes were noted in the palm.
A one centimeter fragment of thorn in granulation tissue was removed from the ulnar side of the proximal
Figure 1. Thermographic image of the right hand taken 4 months after the injury. The elevated temperature of the proximal right ring finger and of a triangular region in the right palm area is evident.
middle phalanx. The pathology report noted chronic inflammatory changes and villous hypertrophy. The elevated temperature of the palmar region was attributed
to residual inflammation associated with the entry
wound. The elevated temperature of the finger was attributed to the presence of the foreign body. Postoperatively, the patient has had complete recovery of
Discussion. The clinical course is completely
similar to the 5 cases reported by Sugarman et a1 who
emphasized the importance of removing all foreign
plant matter, which can stimulate a chronic foreign
body reaction. Furthermore, this case demonstrates the
utility of thermography in localization of the lesion.
Thermography has been tried as a diagnostic
technique for a variety of clinical disorders, particularly
breast cancer. However, this later application has been
found to have limited utility (3). On the other hand, Bacon and his colleagues (4) have argued for the use of
thermography in the diagnosis of arthritic conditions.
Winsor and Winsor (5) have shown triangular patterns
of palmar temperature elevation associated with synovial infections. In the present case, the region of the inflammatory process was clearly and quickly visualized
although there was no palpable temperature difference
noted on clinical examination. The instrument used was
Model 750 Thermographic Unit (AGA Corp., Infrared
Instruments, Secaucus, New Jersey). Although not specifically designed for medical imaging; this instrument
accurately demonstrated the patient’s lesion. The present case supports the utility of thermography in the
rapid assessment of inflammatory lesions of uncertain
Acknowledgments. It is a pleasure to acknowledge the cooperation of G. R. Cooley, MD, and W. T.
Winne, PhD, and the technical help of M. A. Esposito
and G. Narbone of the General Electric Apparatus
Service Division, Schenectady Instrumentation Services, Schenectady, New York.
I . Sugarman M, Stobie DG, Quismorio FP, Terry R, Hanson
V: Plant thorn synovitis. Arthritis Rheum 2 0 1 126-1128,
2. Solomon SD: Splinter induced synovitis. Arthritis Rheum
21:279, 1978
3. Moskowitz M, Milbrath J, Gartside P, Zermeno A, Mandel
D: Lack of efficacy of thermography as a screening tool for
minimal and stage I breast cancer. N Engl J Med 295x249252, 1976
4. Bacon PA, Collins AJ, Ring FJ, Cosh JA: Thermography
in the assessment of inflammatory arthritis, Clinics in
Rheumatic Diseases. Vol. 2. Edited by MIV Jayson. Philadelphia, WB Saunders and Co., 1976, pp 5 1-66
5. Winsor T, Winsor D: Thermography in cardiovascular disease, Medical Thermography, Theory and Clinical Applications. Edited by S Uematsu. Los Angeles, Brentwood
Publishing Corporation, 1976, pp 121-142
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thorn, thermography, synovitis, inthe, use, plan, diagnosis
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