Quantitative bone scintigraphy in reflex sympathetic dystrophy

Area of Science:

• Nuclear Medicine
• Orthopedics
• Radiology

Background:

• Reflex sympathetic dystrophy (RSD) is a painful condition following fractures.
• Previous studies suggested increased uptake in RSD bone scans was limited to periarticular areas.

Purpose of the Study:

• To investigate the distribution of technetium-99m labelled methylene diphosphonate bone scan uptake in post-fracture RSD of the hand.
• To assess the sensitivity of delayed bone scintigraphy for RSD diagnosis, even with concurrent wrist fractures.
• To correlate bone scan findings with clinical indicators of disease severity.

Main Methods:

• Analysis of 29 bone scans from 16 patients with post-fracture hand RSD.
• Comparison of uptake patterns in metacarpophalangeal joints and metacarpal bones.
• Evaluation of delayed scans at 3 months post-fracture in RSD patients versus controls.
• Correlation of bone scan uptake with dolorimetry-assessed tenderness.

Main Results:

• Increased technetium-99m uptake was observed throughout the affected hand, not just periarticular regions.
• Delayed bone scintigraphy demonstrated significant uptake in RSD patients, distinguishing them from controls, even with wrist fractures.
• Early increased uptake gradually normalized over time.
• A strong correlation was found between bone scan uptake and local tenderness.

Conclusions:

• Bone scintigraphy reveals widespread increased uptake in post-fracture hand RSD.
• Delayed bone scans are a sensitive diagnostic method for RSD, even in the presence of fractures.
• Bone scan findings offer a quantitative measure of RSD severity, aiding treatment planning and assessment.