The role of bone scintigraphy in diagnosing reflex sympathetic dystrophy*

https://doi.org/10.1016/S0363-5023(05)80107-8Get rights and content

Three-phase bone scintigraphy is used often to diagnose reflex sympathetic dystrophy of the hand. This study presents an analysis of the literature relating three-phase bone scanning to reflex sympathetic dystrophy in the upper extremity. The data show a wide variability in scintigraphic accuracy in patients with clinically obvious reflex sympathetic dystrophy. The results of bone scintigraphy correlate best with the clinical diagnosis of reflex sympathetic dystrophy within the first 20–26 weeks of onset. Even then, the sensitivity in the most recent series approximates 50%. After 26 weeks, there is a poor correlation between three-phase bone scanning and reflex sympathetic dystrophy. Consequently, three-phase bone scintigraphy should not be used as a major criterion in diagnosing reflex sympathetic dystrophy. The diagnosis of reflex sympathetic dystrophy remains a clinical diagnosis made by an experienced hand surgeon.

References (26)

  • EvansJA

    Reflex sympathetic dystrophy

    Surg Gynecol Obstet

    (1946)
  • LivingstonWK
  • AmadioPC et al.

    Reflex sympathetic dystrophy syndrome: consensus Report of an ad hoc committee of the American Association for Hand Surgery on the definition of reflex sympathetic dystrophy syndrome

    Plast Reconstr Surg

    (1991)
  • Cited by (80)

    • ACR Appropriateness Criteria <sup>®</sup> Shoulder Pain-Atraumatic

      2018, Journal of the American College of Radiology
      Citation Excerpt :

      Bone scintigraphic abnormalities may be seen in patients with complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy [95-97]. Meta-analyses have found only moderate concordance between bone scintigraphy and the presence or absence of CRPS [98], and low sensitivity for detection of CRPS when compared to clinical diagnostic criteria [99-101]. Bone scintigraphic does have high specificity, and can be used to rule out CRPS [101].

    • ACR Appropriateness Criteria <sup>®</sup> Shoulder Pain–Traumatic

      2018, Journal of the American College of Radiology
      Citation Excerpt :

      Bone scintigraphy may be helpful in assessing for CRPS in patients experiencing chronic post-traumatic pain without clear etiology. Meta-analyses have found only moderate concordance between bone scintigraphy and the presence or absence of CRPS [86] and low sensitivity for detection of CRPS when compared with clinical diagnostic criteria [87-89]. However, bone scintigraphy does have high specificity and can be used to rule out CRPS [89].

    • Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin

      2014, Pain
      Citation Excerpt :

      Also, our group of healthy subjects was similarly distributed regarding gender and handedness compared to the patient groups. It was previously demonstrated that the increased periarticular bone metabolism of the distal hand joints in the TPBS is a feature only of the early stage of CRPS and might not be detectable in patients with longer disease duration [20,22,41]. Because we only included patients with disease duration of less than 1 year, this study could not reveal whether the ROI scores still correlated with the PPT of the PIP and MCP in later stages of the disease and whether the determination of a decreased PPT of the distal hand joints stays specific and sensitive for CRPS.

    View all citing articles on Scopus
    *

    No benefits in any from have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

    1

    From the Division the Division of Plastic Surgery, Washington University, St. Louis, MO.

    View full text