Symmetry of Skin Temperature Comparing

One Side of the Body to the Other

Sumio Uematsu, M.D.. F.A.C.S.
Skin temperature measurements were carried out in 32
healthy subjects and 24 patients with peripheral nerve
trauma (8) and lumbar disc herniation (16). Temperature
measurements were obtained in 32 sensory segments,
using a computer interfaced, color telethermographic instrument with the capability of obtaining average temperatures in corresponding areas of interest on both sides of
the body. In healthy control subjects the overall average
difference was only 0.24C. In symptomatic patients the
average temperature difference between the normal side
and the side with nerve damage was 1.55C. Computerized
telethermography established the normal temperature
variations and demonstrated a statistically significant
change in response to injury.

Applicability of thermography to the evaluation of

peripheral nerve injury depends heavily on the stability of thermal symmetry in normal subjects and
distortion of thermal symmetry following injury. This
paper reports the results of multiple skin temperature measurements in normal controls and patients
with nerve impairment.
Materials and Methods

All studies were performed with a computer interfaced, color telethermographic instrument which has
the capability of providing mean temperatures in the
area of interest. The skin surface area to be measured
was divided into 32 sensory segments approximating
the areas of innervation of major peripheral nerves
(Figure 1). This division was by no means complete.
We arbitrarily excluded some areas of innervation
because they are not large enough for precise sampling with our present equipment. We also avoided
hair-covered areas such as eyebrows and moist areas
such as lips and nostrils because hair and moisture
may cause unpredictable temperature changes.
The skin temperature of each sensory segment was
measured in 32 healthy subjects and 24 patients with
peripheral nerve impairment. There were eight cases
with peripheral nerve trauma and 16 cases with
lumbar disc herniation. Ages ranged from 12 to 65
years. Average temperatures in the 32 sensory segments on the normal subjects were compared on the
left and right sides of the body (Table 1). The degree
From the Department of Neurosurgery, Johns Hopkins University School
of Medicine; Baltimore, Maryland.

of temperature difference between the sides of the

body was then determined for controls and patients.
Absolute temperature differences between nerve
damaged segments and contralateral, intact segments
were contrasted with differences between anatomically matched segments in normal, asymptomatic
controls, using the Students t-test for correlated
means.
Results
OVERALL
SKIN
TEMPERATURE : W e d e t e r m i n e d a v erage temperature measurements for the 32 healthy
persons and found that the highest average skin temperature on the body was 34.5C 0.73C on the
forehead. The lowest average skin temperature was
27.1C 4.03C on the toes. Fingers and toes were
colder than the forehead. Temperatures of fingers
and toes were not stable relative to that of other parts
of the body, and fluctuated in any one individual
from day to day (Figure 2).

average temperature (AT) in the left calf

(I-AT) is 30.60 C, in the right (2-AT) is 30.55. The differences is 0.05 C. The differences over the heels, (3-AT and
4-AT) is also 0.05 C. By using this technique, a total of 64
segments (32 per side) were studied to establish normal
range of the temperature differences on the 32 normal
healthy persons.
Figure 1. The

Table 1. Skin-temperature Differences between Sides of the Body

Body segment

Cutaneous sensory
nerves and segments
measured

Mean average
temperature
differences
(C)

S.D.

0.12
0.18
0.14
0.18
0.15
0.15
0.25
(0.17)
0.13

0.093
0.186
0.151
0.131
0.091
0.092
0.201
(0.042)
0.108

Forehead
Cheek
Chest
Abdomen
Neck (Posterior)
Thoracic, paraspinal
Lumbar (Back)
(Trunk Average)
Scapula

Trigeminal Nerve (V-l)

Trigeminal Nerve (V-2)
Intercostal (T1-T7)
Intercostal (T7-T1O)
Cervical (C2-C5)
Post-Cutaneous (T2-T12)
Dorsal div.spinal (T11,12,L1,2,3,S1,2,3)

Arm (Biceps)
(Triceps)

Med. antebrachial (C8,T1)

Dorsal antebrachial, axillary (C5-6)

0.13
0.22

0.119
0.155

Forearm (Medial)
(Lateral)

Med. antebrachial (C8,T1)

Lat. antebrachial (C5-6)

0.32
0.23

0.158
0.198

Palm (Lateral)
(Medial)

Median (C6,7.8)
Ulnar (C8,T1)

0.25
0.23

0.166
0.197

Thigh (Anterior)
(Posterior)
Knee (patellar)
Popliteal

Ant. fem. cutaneous (L2-3)

Posterior cutaneous (S1,2,3)
Ant. fem. cutaneous (L2,3)
Post. fem. cut., Corn. Peron. (L4-5,S1-2,3)

0.11
0.15
0.23
0.12

0.085
0.116
0.174
0.101

Leg (Anterior)
Calf
Foot (dorsal)
Heel
(Extremities, Average)
Finger (Tips), *Average
Toe (Tips), **Average

Saphenous, sup. Peroneal (L3,4,5,S1)

Sural, Saphenous (L3,4,S1-2)
Peroneals (L4-5, S1)
Tibial (S1-2)

0.31
0.13
0.30
0.20
(0.20)
(0.38)
(0.50)

0.277
0.108
0.201
0.220
(0.073)
(0.064)
(0.143)

Dorsal div. spinal (T1,5)

Median & ulnar (C5,6,7,8,T1)

Median, lateral, plantar, (L4,5,S1-2)

* Five segments, but only average is given here.

** Five segments (big toe and four others), but only average is given here.

SKIN
TEMPERATURE
DIFFERENCES : Skin temperature
differences from one side of the body to the other
are extremely small and very stable throughout the
body. For example, the side-to-side difference was
only 0.12C at the forehead and 0.25C at the lumbar
back (Table 1).
Temperature differences between the sides of the
body remain essentially the same during repeated
temperature measurements during a 12 month period. This confirms repeatability of the minute difference of the skin temperature between the sides of
the body (Figure 3).

SKIN TEMPERATURE DIFFERENCES COMPARING IPSILATERAL SENSORY SEGMENTS : Temperature differ-

ences were measured between sensory segments on

the same side of the body (Table 2). The biceps
muscle segment, representative of innervation of the
medial antebrachial cutaneous nerve, was consistently

warmer than the triceps muscle segment, innervated

by axillary and dorsal antebrachial cutaneous nerves.
The great toe and the thumb tend to be warmer than
the little toe or little finger, although these findings
lack the consistency noted in other measurements.
SIGNIFICANT SKIN TEMPERATURE CHANGE IN THE
SEGMENT
OF
AN
IMPAIRED
N E R V E: I n 2 4

SENSORY

consecutive cases of impaired peripheral nerves, skin

temperatures were markedly altered in the sensory
segments of the impaired nerves. The value was significantly larger than seen in the control group. The
correlated mean t-test between normal controls and
patients on consecutive, anatomically matched samples yielded P < 0.001 (t = 6.6, N = 24), indicating
a significant temperature change in the skin area innervated by a damaged nerve.
Patients can be divided into two groups based on
the status of their sympathetic nerve functions:
5

Figure 2. Temperature gradient from the head, hip and

Figure 3. Temperature differences comparing between

the forehead were measured during 12 month period. The

temperature differences remained within 0.2 C in all of the
cases and except one control, who had 0.4 C temperature
difference. It was retrospectively found that he sustained
fractured frontal bone 30 years earlier.
1.4
N:29
MEAN:O.12
S. DEV:0.093

0.8

0.2
0
0.2

0.8

25

JUNE.

JAN.

FOOT

HIP

DEC.

1.4

HEAD

Table 2. Skin-temperature Differences between Sensory Segments

Sensory segments compared

(N)

Biceps-triceps
Forearm, inner-outer
Palm, inner-outer
Thumb-little finger
Big toe-little toe

(16)
(19)
(19)

Mean Difference
(C)

S.D.

1.25
0.37
0.36
0.53
1.03

0.792
0.279
0.247
0.420
0.885

(18)
(22)

of sympathetic nervefunction):
These patients had complete loss of sensitivity in
Group A (loss

the sensory distribution of the damaged nerve, resulting from proximal nerve transection by surgery
or trauma. The skin temperature on the damaged
side average 1.92 0.939C higher than the contralateral intact limb. This degree of temperature
elevation, contrasted with that in normal asymptomatic controls, is statistically significant (P <
0.001).

(overactive sympathetic nerve function):

In this group, the nerve was partially traumatized
either by fractured bone fragments or by a herniated disc in the spine. The area of distribution of
the damaged nerve segment is typically numb but
has not suffered complete loss of sensibility. Skin
temperature in the area of the damaged nerve
averaged 0.83 0.411C colder than the opposite intact segment of the limb. This difference is
Group B

Number
warmer/total (%)
16/16
28/38
22/39
29/36
14122

(100)
(74)
(57)
(81)
(64)

Table 3. Skin Temperature Change in the

Sensory Segments of an Impaired Nerve*
Sympathetic
nerve
function
Group A: Complete loss
Group B: Over-active
(only slipped disc)
Control

Mean
Temperature
Difference

1.92

0.939 **

16
24

0.83
0.21

0.411 **
0.096

SD

* Patients with complete loss include 7 cases of surgical

section of the nerve (6 of these were cases of sural nerve
biopsy) and one case of gunshot injury to the sciatic nerve.
Only sixteen cases of lumbar disc herniation are included for
statistical analysis of the group with over-active sympathetic
nerve function. The remaining cases not included are two
cases of compression neuropathy of the median and ulnar
nerve and 6 cases of reflex sympathetic dystrophy.
** P < 0.001 compared with controls.

statistically significant when contrasted to the temperature difference of the controls (P < 0.001) (Table 3).

Table 4. Distal Coldness Comparing with Forehead Temperature

Little
Finger
(N:34)
Average coldness in little finger
Normal
Upper limit of normal
Suggest pathology
Strongly suspect pathology
Abnormal

COLDNESS ( FINGERS
ANDTOES ): In this study,
forehead temperature was compared with that of the
fingers and toes to establish normal and abnormal
range of distal coldness. Results are shown in Table
4. The mean difference between the temperature of
the forehead and little finger was 2.8 2.72C.
Adding the value of one, two and three standard deviations to the mean value, one can estimate the
normal limit and the severity of the distal coldness
relative to the value of the healthy individual.

DISTAL

Summary

Skin temperature was measured in 32 segments of

the body in normal asymptomatic controls and in selected areas on patients with nerve impairment. Average temperatures were obtained in corresponding
areas of interest on both sides of the body. In controls, the overall average temperature difference be-

2.8 2.72
<2.8
5.5
5.6 - 8 . 2
8.3 11.0
>11.O

Big
Toe
(N:13)
4.2 1.72
<4.2
5.9
6.0 7.6
7.7 9.4
>9.4

tween sides of the body was only 0.24C. In symptomatic patients the average temperature difference between the normal side and the side with nerve
damage was 1.55C, a difference six times higher
than that found in controls (P < 0.001). Computerized telethermography established the normal temperature variations and demonstrated a statistically
significant change with injury.
Address single copy reprint requests to Sumio Uematsu, M.D.; Department of Neurosurgery, Johns Hopkins University School of Medicine, 600
North Wolfe Street; Baltimore, Maryland 21205

References
1. Clark RP. The European Association of Thermology, Third
International Congress of Thermology, (Abstracts) pp. l-3,
1983.
2. Uematsu S. in Pain Therapy, R Rizzi and M Visentin, Eds.
(Elsevier, Amsterdam, 1983), pp. 63-72.