Patent Publication Number: US-2019175097-A1

Title: An apparatus and method to locate, measure, monitor, and treat inflammation of the skin&#39;s soft tissue and fascia layers

Description:
FIELD OF THE INVENTION 
     The present method relates to a method and apparatus for locating, assessing, treating and evaluating treatment outcomes for soft tissue inflammations as manifested by pain and disease in the tissue of human beings and animals. 
     BACKGROUND 
     It is known that the electrical resistance of skin is controlled largely through the nervous system. Canadian Patent No. 1,254,269 issued May 16, 1989 to Woodley et al. discloses a diagnostic device based upon resistance measurements of the skin which is used to detect abnormal areas of the body where there is pain or sympathetic dysfunction. U.S. Pat. No. 4,966,158 issued to Honma et al. discloses a device having two probes which measures the moisture content retained in the skin both in the keratinous layer and also in the deeper layer so as to provide information as to the condition of the skin. Patent Cooperation Treaty Application No. PCT/GB90/01991 discloses a device having a common probe and a reference probe. The measurement of resistance is switched between a common probe applied to an area of skin under test and a reference probe located on the identical area on the other side of the body. A difference in the readings indicates a damaged area of the skin. Thus, known devices measure only one parameter of the skin. 
     Cellular damage can occur due to prolonged stress, which increases build-up of metabolites and tissue ischemia. The latter build-up directly excites pain receptors and causes cellular degeneration or necrosis. Lack of use, poor posture, over use, a blow or hyperextension will cause inflammation. Inflammatory by products include histamine, bradykinin, acids, etc. are released into the capillary bed. The five cardinal signs and symptoms of inflammation-rubor, tumor, calor, and dolor, functio laesa (redness, swelling, heat, pain and loss of function) date back to Celus. 
     Pain causes a reflex response of muscle hoarding and/or spasms. Such a response leads to immobility and eventual wasting away or atrophy due to loss of the alternating relaxing and contracting of muscles. The muscles provide a circulatory pumping action during normal relaxation and contracting which will be ineffective on areas affected by atrophy. Ordinarily, painful areas in the skin are associated with abnormalities such as changes in temperature, and moisture, tenderness, swelling or edema, inflammation, stringiness due to fibrous tissue changes, nodules or small knotted areas, fatigue or lack of tone in the tissues, and metabolite retention characterized by crystal-like formations in the tissue. Such areas of abnormality are conventionally located by palpation. 
     Manual compressions, such as applied by acupressure or massage, remove the stimuli causing pain and stop the stimulation of the sweat glands and arterial vessel constriction, the primary cause of pain and degenerative tissue disorders. Such compression and massage are accompanied by the sound of the breaking up processes of metabolite and tissue by-products. Thus, factors such as moisture, sound, temperature, electrical conductivity, edema are all a function of the condition of the skin and can be used to measure the presence of areas of pain of inflammation. 
     In order to be able to cross correlate different types of measurements of a given area and thus obtain confirmation of the condition and a more accurate diagnosis, it would be useful to be able to measure several different parameters simultaneously. 
     Ultimately without controls for discrepancies data would be corrupted, for example more or less force applied when achieving a reading would change the reading of each and or any given sensor in our application. 
     Technically, one could first apply a device to measure resistance to a particular area and then one designed to measure moisture. However, such an approach would be impractical because not only could the condition of the area under test change from one measurement to the other, but positioning the probe on precisely the same area for both measurements would be difficult if not impractical. Secondly, many such measuring devices require measurements to be made using two separate probes applied to two separate but corresponding sides of the body. 
     A number of problems must be overcome in order to achieve a probe which is capable of providing measurements of a workable accuracy. For example, if one were to use infrared sensors to measure temperature, an area of the size of a quarter would be the minimum size achievable with current sensors. Thermistors would also have a limit to the area of detectability that is greater than the focal point of conductivity, which is approximately 1 millimeter (mm). 
     The time required to measure body temperature depends on the mass of the probe. Consequently, it is important to limit the mass of the probe in order to minimize this time. ( FIG. 7 ) 
     Improved sensing of sound is also important and the shape of the sensor and how it is used is vital in detecting tissue sounds associated with crepitus and taut tendinous bands. ( FIG. 8 )
     1) Historically massage is an empirical, tried, tested, and true practice. The applicant spent 30 years of her career relieving pain and suffering. She researched and authored numerous scientific papers. In her practice, she uses the art of massage and gets extraordinary results in the treatment of pain, disease, and trigger and acupressure point.   2) Traditionally medical practitioners are trained in palpation; they use their fingers and thumbs to detect soft tissue damage. Massage therapists palpate and massage simultaneously.   3) Devices like ultrasound, x-ray, MRIs, and CAT scans are not able to measure or localize pain causing soft tissue inflammations at its origin.   1) “Pain is the most common reason Americans turn to complementary and integrative health practices,” said Josephine P. Briggs, M.D., Director of NCCAM.   2) The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, described in terms of such damage.   3) IASP supports the study of pain and translates that knowledge into improved pain relief worldwide; according to the IASP, biologists recognize that those stimuli, which cause pain, are liable to damage tissue. Since pain perception is influenced by psychosocial factors, pain that is experienced is also associated with actual or potential tissue damage. Pain is generally assessed by subjective reports, using visual analogy scales (Price et al. 1983), questionnaires, which can be converted to numeric scores (McGill, 1975) or discrete numeric scales (Price et al. 1994).   4) Early disease detection relied on the use of one&#39;s hands to evaluate the soft tissues; skilled hands can detect indications of inflammation/pain causalgia.   5) Current measurement devices do not provide sufficient evidence for measuring soft tissue inflammations that cause pain. Subjective reports of pain perception alone are considered unreliable.   6) Because there are no tools to measure pain independently, we have relied on a patient&#39;s verbal confirmation of pain, which has proven to be under evaluated. There are many obstacles to diagnose soft tissue inflammatory parameters associated with pain accurately.   7) The unifying law of pain states that the biochemical origin of all pain is inflammation and the inflammatory responses. When there is significant damage to tissue, several chemicals are released resulting in an inflammatory soup, an acidic mixture that stimulates and sensitizes the nociceptors. This is called hyperalgesia, which is Greek for super pain. Irrespective of the type of pain whether it is acute or chronic pain, peripheral or central pain, nociceptive or neuropathic pain, the underlying origin is inflammation and the inflammatory response.   8) Active signs of inflammation include the following:
       Calor-heat is created from inflammation or lack of heat as in fibrosis   Dolor-pain is created when pressure is applied.   Functio laesa-loss of function or muscle withdrawal reflexes   Maturation and remodeling phase fibrosis   Rubor-redness is due to histamine and inflammatory chemicals   Sweat is how the body dissipates heat from inflammation and creates sympathetic skin response causing sweat used by the body to dissipate heat GSR measurements are used in Biofeedback and lie detectors test sympathetic skin response   Tissue sounds crepitus and taut muscle bands   Tumor-swelling oedema/tropho-edema creates a visual denting.   
       9) It is well known that pain is felt when pressure is applied manually or by tissue algometry. For a fibromyalgia diagnosis, a force of 4 kg or 10 lbs for a tender point to be considered “positive” the subject must state that palpation was painful. Tender is not considered painful. Studies suggest that a trigger point for myofascial pain has a reliable and reproducible pain-pressure threshold. This measure of pain still requires a subjective input patient response to indicate whether pressure stimulus is painful and is still not an objective means of determining severity of soft tissue injury.   10) Another approach to locating sites of injury is skin thermography. Skin temperature, assessed by thermography, has been found to be a sensitive test for myofascial pain syndrome. At myofascial trigger points, temperature is higher than that of surrounding locations on the skin. It has also been suggested that electrical conductivity of the skin can be used as a diagnostic measure to locate tender areas in soft tissue. Acupuncture points, known to be tender areas, appear to have higher conductivity than that of surrounding tissue. Thus, it might be possible to combine these two measures to detect the presence or absence of soft tissue injury in a more objective fashion than pain threshold or pain scores.   11) Objective measurements are difficult to obtain because skin temperature and electrical resistance of healthy tissue vary moment by moment and are not the same between individuals and both environmental and psychological factors play a role. There is no known stable norm parameter from which to obtain a base comparative measure in using existing equipment.   12) The Galvanic Skin Response (GSR) equipment measures electrical conductance in the skin, associated with the activity of the sweat glands. A very slight electrical current runs through the skin and the GSR machine measures changes in moisture produced from sweat gland ducts. The more emotionally aroused the persons the more active sweat glands and greater electrical conductivity of skin.   13) A German Professor named Tarchanoff first discovered skin conductivity around 1888. In the early 1900s, Dr. Carl Jung established that GSR measurements could track physiological arousal or stress in the body. In the 1930&#39;s Dr. Hans Selye began sharing information that could tell us about the body. These discoveries have led to the creation of many common devices, such as the polygraph. Later in the 20th century, Dr. Reinholt Voll and others identified further uses for GSR, including the monitoring of acupuncture points to determine the condition of the body&#39;s energy meridians.   14) Biofeedback and lie detection tests use GSR as emotions affect the skin&#39;s conductivity.   15) Psycho-galvanometer, biofeedback, Electro Dermal Testing (EDT), Electro Dermal Analysis (EDA), and/or GSR devices have a known potential for artifacts and spikes in the sweat and or temperature. Stable room temperature should be obtained with the bias being slightly on the warmer side 22-24-degrees Celsius. Physiological body actions like coughing, deep respiratory movements (deep sighs), sneezes, and excessive talking can all generate sweat production and thus a rest period and patient calming should happen before testing.   16) Sweat is how the body dissipates heat from inflammation creates sweat caused by sympathetic skin responses. Electro dermal activity is the property of the human body that causes continuous variation in the electrical characteristics of the skin. Since the body is in a continual state of adapting to stress and external elements there is no normal or base on which to compare either people or points of soft tissue.   17) Historically, EDA has also been known as skin conductance, GSR, Electro Dermal Response (EDR), Psychogalvanic Reflex (PGR), Skin Conductance Response (SCR), and Skin Conductance Level (SCL). The long history of research into the active and passive electrical properties of the skin by a variety of disciplines has resulted in an excess of names, now standardized to electro dermal activity.   18) The traditional theory of EDA holds that skin resistance varies with the state of sweat glands in the skin. Sweating is controlled by the sympathetic nervous system, sympathetic skin response and skin conductance is an indication of psychological or physiological arousal.   19) Electrical resistance of skin was studied with the aid of a specially designed meter that compared the resistance per surface area of small skin points with that of the surrounding skin. In a systematic study of the hands, face and ears in five subjects&#39; low-resistance skin points were repeatedly found in characteristic loci, comparable in different individuals and symmetric about the body midline. The low-resistance skin points had diameters of 1.5+/−0.5 mm and their borders were abrupt. On dry skin, resistance values were around 10 kilo-ohms at the center of the points but around 3 mega-ohms in the surrounding skin. Voltages could also be recorded at these points, but they proved to be result of electrode polarization reflected at these points because of their low electrical resistance. The distribution of the low points in the hands, face, and ears resembled that of classical acupuncture points.   20) If the sympathetic branch of the autonomic nervous system is highly aroused, then sweat gland activity also increases, which in turn increases skin conductance. In this way, skin conductance can be a measure of emotional and sympathetic responses.   21) More recent research and additional phenomena (resistance, potential, impedance, and admittance, sometimes responsive and sometimes apparently spontaneous) suggest this is not a complete answer, and research continues into the source and significance of EDA. The study of EDA has led to such important and vital tools the electrocardiograph (ECG) and the electroencephalograph (EEG).   22) The sympathetic branch of the autonomic nervous system is easily aroused, increasing sweat gland activity, which increases skin conductance.   23) Physiological and psychological influences on the sympathetic nervous system affect blood flow.   24) The traditional theory of Galvanic Skin Responses holds that skin resistance varies with the state of sweat glands in the skin. Sweating is controlled by the sympathetic nervous system, and skin conductance is an indication of psychological or physiological arousal.   25) More recent research and additional phenomena are sometimes apparently spontaneous.   

     To account for changes that occur during the taking of measurements the soft tissue (including the examination process itself), we purpose a multimodal biosensors uses the concept of differential comparatives to normative tissues so that these measurement changes can be interpreted accurately. 
     Accordingly, it is an object of the invention to provide an improved method and apparatus for simultaneous and accurate measuring of at least two different points of the skin and at least two parameters in those points. 
     SUMMARY OF THE INVENTION 
     According to the invention there is provided apparatus for diagnosing the skin condition of a human being or animal, which includes two probes for contacting the desired area of skin. The probe has means for measuring the conductivity of the skin at the area and means for measuring the sound produced by probes running over the skin at that area, the force applied by the probes to the skin and the temperature of the skin. The moisture content is related to the electrical resistance of the skin. 
     Means for measuring the conductivity or resistance of the skin may be an electrical resistance measuring device with an electrode configuration interconnecting a plurality of thermistors. For measuring the sound, a pick-up microphone is located in the probe tip ( FIG. 11 ) skin as the probe passes over a protrusion inflammation area. 
     The temperature sensor for measuring the temperature of the skin may be a plurality of thermistors spaced apart over a number of probes, thermocouple located at a tip of the probe. ( FIG. 6 ) 
     A pressure sensor may include a strain beam coupled to the probe operative to measure applied force applied to the probe as it passes over the skin. ( FIG. 4 ) 
     
       
         
           
               
               
             
               
                   
               
             
            
               
                 FIG. 1 
                 Overall ABATE Qr System 
               
               
                   
                 Colored line represent data in the display 
               
               
                   
                 Galvanic Skin Response GSR-blue 
               
               
                   
                 Sound-Yellow 
               
               
                   
                 Force-Green 
               
               
                   
                 Heat-Red-heat 
               
               
                   
                 Purple-Patient Response Module PRM 
               
               
                   
                 Blue Tooth/wireless communicates to software 
               
               
                 FIG. 2 
                 Miniaturized design meant to mimic fingers and/or 
               
               
                   
                 thumbs in clinical palpation. Probes are portable and 
               
               
                   
                 can be placed in any receptacle. 
               
               
                   
                 Probe tips are portable be integrated into a number of 
               
               
                   
                 various receptacle and as wearable monitor and small 
               
               
                   
                 enough to be worn under compression garments. 
               
               
                   
                 Pen receptacle probe with sensor tip. 
               
               
                   
                 Option for multiple bio-sensor probes design pen 
               
               
                   
                 probe design and or into other ergonomic design, 
               
               
                   
                 Probe#1 and Probes #2 options for Probes #3, #4, 
               
               
                   
                 #5 etc . . . Finger and or Pen Probe sample design 
               
               
                   
                 sensor tip is movable 
               
               
                 FIG. 3 
                 Probe assembly illustrates ceiling floor for pressure 
               
               
                   
                 transducer 
               
               
                   
                 Force sensor sits between floor ceiling and tip of 
               
               
                   
                 probe pushes the sensor floor up to ceiling, pressure 
               
               
                   
                 transducer is activated. 
               
               
                 FIG. 4 
                 Pressure transducer for detection of force applcaitions 
               
               
                 FIG. 5 
                 Interdigitated grid pattern for GSR covers a larger 
               
               
                   
                 area of skin making GSR easier to locate 
               
               
                   
                 Position traces so few as possible are cut/isolated by 
               
               
                   
                 the centre hold for thermistor 
               
               
                 FIG. 6 
                 Thermistor protrudes slightly from head, which allows 
               
               
                   
                 for indenting of the skin creating pitting edema 
               
               
                 FIG. 7 
                 Flower pot shape to house the heat sensor decreasing 
               
               
                   
                 thermal mass. Note infrared sensor sits in from of the 
               
               
                   
                 sensor probe set. 
               
               
                   
                 A- thermistor slightly protruds for pitting edematous 
               
               
                   
                 tissues. 
               
               
                 FIG. 8 
                 Size and of the heat sensor tip creates visual pitting. 
               
               
                   
                 FIG. 8- 
               
               
                 FIG. 9 
                 Conically shaped sensor head for eliciting a pain 
               
               
                   
                 response, mobilizing crepitus, and showing visual dents 
               
               
                   
                 from edematous tissue. 
               
               
                 FIG. 10 
                 Foam padding enables the GSR sensor to lay flat on 
               
               
                   
                 the skin surface while foam pads mimic the padding of 
               
               
                 FIG. 11 
                 Conical shaped housing for the Microphone to act as an 
               
               
                   
                 eco-chamber for sounds from soft tissue 
               
               
                 FIG. 12 
                 LCD display 
               
               
                 FIG. 13 
                 Patient Response Module (PRM) numerical scale 1-10 
               
               
                 FIG. 14 
                 Facial expression muscle withdraw reflex 
               
               
                   
                 Patient Response Facial Haptic sensors move when 
               
               
                   
                 facial expressions scaled 1-10 
               
               
                 FIG. 15 
                 Infrared sensor sits ahead of the probe as to shoot 
               
               
                   
                 the sensor beam in front of the sensor tip head to 
               
               
                   
                 lead the way to the hot spots 
               
               
                 FIG. 16 
                 Patient plates with two reference points 
               
               
                   
                 Base compared to data collected from two reference 
               
               
                   
                 points 
               
               
                 FIG. 17 
                 Data is displayed simultaneously as a differential 
               
               
                   
                 comparison between a minimum of two points and then 
               
               
                   
                 is stored as a pressure point in a referential data base. 
               
               
                 Figure 
                 Schematic of basic functions 
               
               
                 FIG. 20 
                 Air cell is inflated either manually or automatically 
               
               
                   
                 Patient Response Module can control the force being 
               
               
                   
                 applied, the air cell will automatically release air 
               
               
                   
                 every 30 to 90 seconds to avoid ischemia (lack of 
               
               
                   
                 oxygen to cells) 
               
               
                   
               
            
           
         
       
         
         1) This device includes an apparatus and system to locate, measure, and treat soft tissue inflammations. 
         2) This device provides an objective means of determining the severity of soft tissue injury. 
         3) This device involves a wearable monitor and a treatment-outcome software system. 
       
    
     Further features include:
     1) In an attempt to minimize the influence of bias or prejudice on the part of the examiner, it would be effectual to provide several multi-modal parameters simultaneously between test sites to control for autonomic fluctuations. The use of two or more probes to test differences sites stabilizes for fluctuations of the soft tissues and accounts for the ever changing the base measurement by which to compare.   2) The origin of all pain is inflammation and the inflammatory response.   3) Nociceptive neurons translate certain stimuli into action potentials that are then transmitted to more central parts of the nervous system, such as the brain. Biochemical mediators of inflammation include cytokines, neuropeptides, growth factors, and neurotransmitters. Inflammatory chemical soup consists of prostaglandins, potassium, serotonin, bradykinin, and histamine.   4) By-products of inflammatory response create measurable factors such as: temperature changes, metabolic waste and scar tissue build up, sympathetic nervous functions all a function of the condition of the soft tissue be used to measure the presence of inflammation.   5) Inflammation is caused by an opening of thousands of tiny local blood vessels in response to the interaction between cellular and chemical components and the irritation of free nerve endings.   6) The inflammatory fluid contains a high concentration of protein. This fibrinogen-containing protein is a necessary part of the body&#39;s defence mechanism against infection.   7) Excessive formation of fibrin from fibrinogen will lead to excessive scar formation. Felt as thickening, palpation elicits tissue sounds mobilizing tissue waste, the sensor probe can hear amplify and record digitized data.   8) In addition, the presence of protein increases the osmotic pressure of the tissue fluid in the damaged area, thus drawing more fluid out of the local capillaries into the tissues, causing local oedema. Inflammatory swelling starts to develop approximately two hours after the injury and may last for days and or weeks. The immediate management to control the acute inflammatory response is important to minimize the undesirable effect of the natural healing process.   9) Circulatory by-products accumulate in capillaries creating crepitus and fluid retention. Crepitus is a medical term to describe the grating, crackling, or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue. Tissue sounds can also be attributed to taut muscle bands and fibrous density changes.   10) A soft tissue injury is an acute connective tissue injury that may involve muscle, ligament, tendon, capsular, and cartilaginous structures. In a sprain, strain, bruise or crush, the local network of blood vessels is damaged, and the oxygenated blood can no longer reach the tissues, resulting in cellular damage.   11) A soft tissue injury can involve muscle withdrawal reflexes a built in mechanism that allows the body&#39;s own muscles to pull away when pain is experienced by the nervous system, often with no awareness or control consciously.   12) Pain requires a conscious subject that is able to experience pain. The molecular, cellular, and systemic mechanisms that deal with the processing of pain-related information its amplification, or depression are called nociceptive, pro-nociceptive, and anti-nociceptive, respectively.   13) Pain is just one of many possible end-points of nociception. Others include but are not limited to withdrawal reflexes, vegetative and hormonal responses, and vocalization, all of which normally accompany pain experience but may under experimental and some pathological conditions be observed in the absence of pain experience, e.g., in the intact but deeply anesthetized subject or in inflammationed animals.   14) A patient can verbally express pain on a numerical scale however; studies have shown this is unreliable. Intensive care patients are people suffering from serious injuries or diseases. These people receive highly specialized care and medical attention, and are under continuous observation and monitoring.   15) It is important to note that ICU patients may not be able to respond to a voice or tactile stimulation. Many patients in the ICU are in breathing tubes, which prevents them from communicating the pain that they are experiencing as well.   16) Health care providers need to provide cost effective pain therapies that will enable the therapist to gain the information needed to deploy treatments and objectively monitor results. It quickly locates inflammation and any soft tissue damage. R.I.C.E. is the acronym for Rest, Ice, Compression, and Elevation; commonly prescribed for patient with acute soft tissue injury.   17) The purposed apparatus uses the complete thesis understanding bio physiological functions of the soft tissue to obtain a multiple sensors electronic measures to locate differential comparative areas that indicate inflammations.   18) A centralized database would enable analysis of outcomes from therapies. Data can also be exported in anonymous nationwide comparison outcomes analytics of pain therapies.   19) In order to overcome the physiologically adaptations to psychological and environment stress and factors including the applying pressure to pain points cause continual physiological adaptations and adjustment in the systemic and local measurements, so there is no such thing as normative data to compare to in the collection of the skins environmental adaptive attributes.   20) Physiological and psychological influences on the sympathetic nervous system controls the blood flow to the inflamed tissues as does systemic sympathetic nervous function creating the sympathetic branch of the autonomic nervous system is easily aroused increasing sweat gland activity increases, this in turn increases skin conductance and blood flow.   21) The traditional theory of Galvanic Skin Responses holds that skin resistance varies with the state of sweat glands in the skin. Sweating is controlled by the sympathetic nervous system, and skin conductance is an indication of psychological or physiological arousal.   22) More recent research and additional phenomena are sometimes apparently spontaneous.   

     To account for changes that occur during the taking of measurements the soft tissue, including the examination process itself, we purpose multimodal biosensors that use the concept of differential comparatives to normative tissues so that these measurement changes can be interpreted accurately.
     23) In order to overcome the physiologically adaptations to psychological and environment stress and factors including applying pressure to pain points which causes continual adaptation and adjusting, so there is no such thing as normative data to compare to in the collection of the skins environmental elements.   

    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Further features and advantages will be apparent from the following detailed description, given by way of example, of a preferred embodiment taken in conjunction with the accompanying drawings, wherein: 
         FIG. 1  is an elevation of a massage therapist wrist with an LCD display and the fingers of a hand holding the instrument, which carries a probe set for differential measurements of temperature, sound, moisture, and applied force 
         FIGS. 2 a  and 2 b    is a first perspective view of the probe miniaturized design that can be portable into other receptacles. 
         FIG. 3  is an exploded view of the sensor unit 
         FIGS. 4 a  and 4 b    is a first perspective view of the pressure transducer sensor unit 
         FIG. 5  is a perspective view of the GSR sensor and sensor unit with the concentric, interdigitated electrode array and temperature sensors 
         FIG. 6  is a perspective view of a thermistor that is mounted into the probe tips, it lies in a slight recess within the flower pot shape See  FIG. 7 ; 
         FIGS. 7 a  and 7 b    a function of probe for a non-thermal flower pot shape to eliminate the conductive temperature measurements being absorbed by a mass, this shows the protrusion shaped sensor tip that houses thermistors in the very central position, this also permits and or allows for pitting the tissue See  FIG. 8 ; 
         FIGS. 8 a  and 8 b    as it passes through a inflammation both before and after massage; as a function of the probe, when pressure and or friction massage is applied on the skin, the protruded shape tip elicits or helps create sounds from inflamed soft tissues, pitting is also a visible sign (camera can take an image and store it in patient file record) of inflamed soft tissue created by the protruded shape 
         FIG. 9  exact dimensions for conical shaped head of sensor for eliciting pain with pressure and crepitus sounds with massaging action 
         FIG. 10  is a foam padding that cushions the sensor tip to feel more like a finger, it also stops external sounds from entering the conical shaped housing for the microphone as a function of probe position as it passes over an inflammation both before and after massage 
         FIG. 11  is a conical shaped housing hosts a flower pot base where the microphone sits and is isolated from external sounds by a ceiling see  FIG. 3  and by foam pad see  FIG. 10 . 
         FIG. 12  is a LCD display 
         FIG. 13  is a Patient Response Module a handheld device in the patient&#39;s hand used blind to the sensor data that allows the patient to rate their pain as pressure is being applied without need for verbal communication 
         FIG. 14  is a facial expression showing how muscles react to pain whereby haptic sensors can be placed on said muscles to supplement the patient response module (see  FIG. 13 ) when a patient is unable to verbalize pain 
         FIG. 15  is an infrared sensor that sits in front of the probe tip to lead therapist toward the inflammation. 
         FIG. 16  is software that allows mapping of pain points on digitized images and stores data related those points. 
         FIG. 17  is software that allows data to be displayed as a differential from two or more probes and simultaneously displays input from the patient response module. 
         FIG. 18  is a schematic of the basic function of the probes and Bluetooth wireless communication 
         FIG. 19  is an air cell that sits on top of the miniaturized sensor tip and can be inflated manually or automatically and is controlled by the patient including using the patient response module wirelessly see  FIG. 15 . 
         FIG. 20  is a sectional view of a sensor with an inflatable air cell. 
     
    
    
     DETAILED DESCRIPTION WITH REFERENCE TO THE DRAWINGS 
     Referring to  FIGS. 1 and 2  there is shown a sensor instrument on the finger receptacle. The probe can be installed in the bottom any receptacle  FIG. 2 .  FIG. 1  shows an LCD display screen. A separate infrared sensor  FIG. 17  detects infrared Z(IR) radiation from the skin boundary forwardly of the sensor instrument. Such an arrangement has the advantage of increased IR sensitivity, a constant elevation reference, and no influence from lens warming or lens absorption of IR body energy. 
     The probe tips house a circuit board and other components including a strain beam  FIG. 4  that has downward force applied. This will exert a bending movement on beam  FIG. 4  and result in a strain that is recorded by load cells. Thus, the strain beam provides a measure of the force applied user or air cell  FIG. 20 . 
     The exploded view of  FIG. 3  shows the various components of the probe including thermistors on its tip  FIG. 7  located in the center. When the central thermistor is over an inflammation, it records the temperature of the point of inflammation while the other thermistors record a base temperature a short distance away from the inflammation. 
     A printed GSR sensor  FIG. 5  of interconnected silver conductive electrodes formed into a ring, fits over the rest of the sensor tip on top of foam pads (see  FIG. 10 ) the centre is left open to accommodate the thermistor sensor tip. When a voltage is applied across the silver the differences between probes is established. Typically the focal point of conduction on the skin is approximately 1 mm. Thus, using only a thermistor to find the focal point would be inaccurate due to the much larger dimensions of the thermistor. When the probe presses against the skin, any inflammation will usually be between a set of concentric electrodes. Thus the resistance between the inflammation electrodes will be the body resistance xR 1  of the skin on one side of the inflammation, the inflammation resistance R 2  of the inflammation and the body resistance yR 1  of the skin on the other side of the inflammation, where x+y=1. As the inflammation gets closer to the center of the concentric electrodes, and the body resistance of the skin therefore becomes less in inflamed areas. Thus, by monitoring the resistance as the probe moves over the skin, a user can tell if the inflammation is moving towards the center. When the point of inflammation is over the center of pain the display screen shows the difference. 
     An IR sensor receives filtered IR light passing through the lens  FIG. 15 . 
     A high sensitivity microphone ( FIG. 11 ) is mounted in the center of the probe tip under the top base printed circuit board (PCB). The microphone ( FIG. 11 ) detects the sound of the display screen moving over the skin. 
     The temperature component of the probe  FIG. 6  is formed by thermistors, which contact the skin and sense the temperature between probe tips. The precise center of the inflammation can be determined using the measurements mentioned above. 
     Prior to using the instrument ( FIG. 1 ), a massage therapist or other professional locates the point of inflammation manually and then measures the conductivity of the skin a few inches away from the point of inflammation. This measurement of the body resistance provides a base measurement for moisture content of the skin. Further measurements near the inflamed area are then compared to the base measurement to give a relative measure of moisture content. 
     The simultaneous development of signals which correspond to moisture content, temperature, and sound allow all three of these factors to be cross correlated to confirm an indicated condition by any one of them and to more accurately define the nature and extent of the condition. The strain beam measurement allows a user to monitor and control the amount of pressure being applied. Pressure must be equally applied between probes to maintain consistency for stabilizing other measures. This is extremely important otherwise pressure will alter the viability of other readings. 
     One may determine the pressure required to cause pitting edema, another sign of inflammations. As protrusion inflammations develop and become fibrous, they create a “speed bump” to the probe  FIG. 8  as it passes over the area of the protrusion inflammation. Applied pressure rises as the pressure sensor on the probe presses over inflammation pitting of soft tissue can be a result  FIG. 8 . Digital images can be imported into patient record. 
       FIGS. 16 and 17  show graphs of the readings of temperature, resistance, and sound as one progresses towards, over and then away from an inflammation. The same figures show readings of inflammation after applying massage. Thus, the probe allows the massage therapist to both apply massage and determine the effect of the massage on an inflammation to a quantifiable extent. A therapist can use the sound output to rapidly locate suspected damaged areas of the skin and then to confirm the damage using the other readings of temperature, moisture content and resistance. Any extraneous readings in any one or more of the factors of temperature, moisture, and sound can be checked as to their origin by comparing them to the readings for the other factors. 
       FIG. 20  shows an inflatable air cell that can be placed under a tensile bandage or other means of securing it on top of the sensor probe. The probe is used to locate the precise point of inflammation and then the air cell is secured in place to apply pressure to the probe and air cell by pumping compressed air through the valve. Expansion of the air cell against the tensile force of a bandage causes the tip of the probe to press against the point of inflammation. This function can be done automatically or manually and the patient can control the amount of force being applied by the air cell either manually or wirelessly via the patient response module. 
     Accordingly, while this invention has been described with reference to illustrative embodiments, this description is not intended to be construed in a limiting sense. Various modifications of the illustrative embodiments, as well as other embodiments of the invention, will be apparent to persons skilled in the art upon reference to this description. It is therefore contemplated that the appended claims will cover any such modifications or embodiments as fall within the true scope of the invention.