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DiagnosticsClinical services

Clinical measurement

Clinical measurement and imaging is a means to assess a patient’s condition in order to identify the most appropriate treatment. A wide range of the most up-to-date techniques is used to aid our diagnoses. We offer a range of specialist tests, which are available via a referral by a consultant or other healthcare specialist. Our diagnostic imaging services are also provided to support the care of existing RNHRD patients. These include X-ray, musculoskeletal ultrasound, ultrasound guided injections, echocardiology, photography and wound measurement diagnostic imaging.

Infra-red thermography

This technique allows us to map a patient’s skin temperature distribution. The measurements are made in a temperature-controlled room. Electronic images are taken using a thermal-imaging camera. This detects the infra-red radiation which people emit continuously. The radiation detected depends on the temperature of the surface viewed and the images are colour-coded to show the temperature distribution.

Skin temperature is affected by a variety of rheumatological conditions; anything which changes the supply of blood to the skin will affect the temperature pattern observed. Although the camera only measures to a depth of about 1mm, deeper blood flow changes can also affect the skin temperature pattern as the heat diffuses outwards. The non-invasive nature of thermography makes it particularly suitable for use with children and for repeated measurements.

Nailfold capillary microscopy

Patients with connective tissue diseases including dermatomyositis, scleroderma and systemic lupus erythematosus (SLE) demonstrate changes in the nailfold capillaries (small blood vessels in the folds of skin around the nail). Capillary microscopy allows these changes to be investigated. The nailbed of a finger is painted with liquid paraffin oil, which ensures that the capillaries below the skin surface can be seen. It is then placed under an optical microscope and images of each section of the nailbed are digitally recorded. We have processing techniques which allow us to enhance the images to enable a good view of the capillaries.

Laser doppler measurements

Laser doppler imaging is a technique that allows measurement of nutritional blood flow in capillaries and small blood vessels that are close to the skin surface and are involved in the regulation of skin temperature. This is useful in assessing microvascular circulation in conditions such as connective tissue disorders or complex regional pain syndrome.

Compartmental pressure studies

Chronic exertional compartment syndrome (CECS) is a condition in which high pressure builds up within a muscle during exercise, and causes pain. CECS usually occurs in the lower limbs, and is most frequently seen in very active people who undergo periods of intense physical training.

Compartment pressure studies are performed jointly by a clinician and a clinical scientist. The procedure takes around 45 minutes and involves the insertion of a catheter (a small plastic tube) into the affected muscle following injection of a local anaesthetic. The patient is then asked to run for 10-15 minutes while the pressures are recorded. The procedure is quite straightforward and patients can return to normal activities later that day, provided they avoid prolonged periods of standing and intensive physical exercise for 24 hours.

For further references and information, please check http://emedicine.medscape.com/ (registration to this information service is free). Take care when searching to note the difference between the chronic and acute conditions. This test relates to the chronic exertional compartment syndrome only.

How to access our service

Medical consultants may refer patients for infra-red thermography or nailfold capillaroscopy to investigate connective tissue diseases, or in exceptional cases for laser doppler imaging. Please send referral letters to:

Clinical measurement department, RNHRD, Upper Borough Walls, Bath, BA1 1RL. For more information or referral advice, contact 01225 473414. 

Consultants wishing to refer patients for compartmental pressure studies to investigate chronic exertional compartment syndrome should refer to:

Dr Tim Jenkinson, RNHRD, Upper Borough Walls, Bath, BA1 1RL. For more information or referral advice, tel. 01225 473428.