Abnormal bone scintigraphy and silent radiography in localized reflex sympathetic dystrophy syndrome

Typical, definite forms of the reflex sympathetic dystrophy syndrome present no diagnostic problems, but the diagnosis of localized or very localized forms is very difficult. In the absence of characteristic roentgenographic evidence of acute, patchy, bony demineralization in the affected extremity, scintigraphy has proven to be a valuable examination. A retrospective analysis of 6 patients with a partial form of reflex sympathetic dystrophy with negative roentgenogram results who were evaluated by bone scintigraphy is presented. In the initial clinical stages, the predominant scintigraphic pattern was a very localized and intense hyperactivity in the internal femoral condyle and/or tibial plate of the affected joint on both blood pool and static images. The increased periarticular activity showed a marked decrease in association with remission of the clinical symptoms. In conclusion, bone scintigraphy was found to be a useful tool in the diagnosis and assessment of the therapeutic response genograms and increased periarticular radionuclide activity on scintigrams in the affected extremity are characteristic findings (Intenzo et al. 1989). Cases of reflex sympathetic dystrophy syndrome involving the hip (Lequesne and Mauger 1982) and the knee (Doury et al. 1987) have been reported, although the diagnosis at these sites is more difficult due to the absence of characteristic external signs. Localized or very localized forms of reflex sympathetic dystrophy (mainly involving the knee) with no radiological abnormalities throughout the course of the disease have been documented (Doury et al. 1979; Doury 1982). In these cases, bone scintigraphs proved to be a valuable examination to confirm the diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)