Thermal imaging – a hotspot for the future?: A case report

Ronald J Cook, Shobhan Thakore and Neil M Nichol

Accident and Emergency Department, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK

Case report:

A 6-year-old boy presented to accident and emergency with his mother complaining of a painful right elbow following a fall that day. He fell whilst walking up steps and gave a history of directly striking the elbow on the step. He had not been using the arm since. There was a recent history of a comminuted intra-articular fracture of the proximal ulna of the same elbow, and a cast had been removed just 5 weeks previously.

The patient was seen and examined by an experienced A&E senior house officer. He was difficult to assess and was complaining of pain in the entire arm. There was no swelling or deformity and no apparent bony tenderness to the limb. He was unwilling to actively move the elbow joint, however there was a good range of passive movement throughout the arm and good grip strength was noted. An X-ray of the elbow was performed and no bony injury or effusion of the elbow joint was apparent. The child was treated for a soft tissue injury of the elbow, advised regular analgesia and discharged.

The patient represented two days later complaining of persistent pain to the arm. He was now localising pain to the wrist and there was a corresponding area of tenderness over the distal radius. A thermal image was taken of the limb using a hand held FTI Mv thermal imager interfacing with LIPS Mini PC software. The image identified an obvious “hotspot” corresponding to the area of tenderness over the distal radius, which clearly differed from a thermal image of the normal wrist. Subsequent X-ray of the wrist revealed an undisplaced greenstick fracture of the distal radius. The child was treated with a plaster cast, referred to the orthopaedic fracture clinic and made an uneventful recovery.

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