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Three-phase bone scintigraphy in chronic epicondylitis
Tuomo T Pienimäki1, Reijo J Takalo, Aapo K Ahonen
1Finnish Institute of Occupational Health, Oulu, Finland. tuomo.pienimaki@ttl.fi
Objective:
To assess the utility of 3-phase bone scintigraphy as a complementary diagnostic method in chronic epicondylitis.
Design:
A cross-sectional study.
Setting:
Hospital outpatient clinic admitting patients with musculoskeletal disorders.
Participants:
Patients (N=59; 68% women) with unilateral chronic epicondylitis.
Interventions:
Not applicable.
Main Outcome Measures:
Three-phase bone scintigraphy was performed after an intravenous injection of 550MBq (99m)technetium-labeled hydroxymethyline diphosphonate ((99m)Tc-HDP) in the patients. Blood flow and blood pool phases were graded visually as normative or abnormal. In the bone metabolic phase, the scintigraphic radiograph images were evaluated using a transmission densitometer. The ratio between maximal bone uptake of (99m)Tc-HDP in each epicondyle and the mean of that in the adjacent humerus was used as a bone uptake measure, which was compared with clinical data (pain questionnaire, pain drawing, cubital pain thresholds, muscle strength) and with work ability and lifestyle factors.
Results:
The bone uptake of (99m)Tc-HDP of the affected epicondyle was 33% and 17% higher in men and women, respectively, compared with the corresponding healthy epicondyle (P<.001 and P=.007). High bone uptake of (99m)Tc-HDP was associated with better work ability, grip strength, and muscle performance in both sexes but was not correlated with the pain measures. Blood flow phases had a positive correlation with the duration of symptoms and a negative correlation with the bone uptake of (99m)Tc-HDP, grip strength, and work ability.
Conclusions:
High bone uptake of (99m)Tc-HDP among patients with chronic epicondylitis was associated with better muscle strength, work ability, and arm function. In chronic cases, a higher degree of bone uptake of (99m)Tc-HDP may thus indicate a healing response in the bone tissue.
