technetium-tc-99m-medronate and Cumulative-Trauma-Disorders

We reviewed three-phase bone scans of the limbs of 7 patients suffering from limb pain suggestive of occupational repetitive strain injury (RSI) and compared them with 13 patients with limb pain due to various aetiologies. Doppler ultrasound measurement of blood flow had been performed in 13 of the 20 patients. The bone scan results showed increased blood flow and pooling (second phase) in the affected limbs of patients with RSI as compared to those with algodystrophy or non-specific limb pain (sensitivity 86%, specificity 85%). Doppler ultrasound also demonstrated increased blood flow to the affected limbs (sensitivity 83%) but failed to differentiate between the different aetiologies of pain (specificity 14%). We conclude that the blood-pool phase of three-phase bone scans can play a potential role in screening RSI patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Cumulative Trauma Disorders; Extremities; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Pain; Radiopharmaceuticals; Regional Blood Flow; Technetium Tc 99m Medronate; Ultrasonography

Topics: Adult; Cumulative Trauma Disorders; Fractures, Stress; Humans; Lower Extremity; Male; Military Personnel; Multiple Trauma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Upper Extremity

The diagnosis of repetitive strain injury (RSI) is subjective and solely based on clinical signs and physical examination. The aim of this paper was to assess the usefulness of three-phase bone scintigraphy (TPBS) in diagnosing RSI.. Prospective study at the Division of Nuclear Medicine, Department of Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP).. Seventy-three patients (mean age 31.2 years; 47 males) with clinical suspicion of RSI in the upper limbs were studied. A total of 127 joints with suspicion of RSI were studied. The shoulders, elbows and wrists were analyzed semi-quantitatively, using the shafts of the humeri and ulnae as references. The results were compared with a control group of 40 normal individuals. The patients signs and symptoms were used as the "gold standard" for calculating the probabilities.. From visual analysis, abnormalities were observed in the flow phase for four joints, in the blood pool phase for 11 joints and in the delayed images for 26 joints. Visual analysis of the joints of the control group did not show any abnormalities. Semi-quantitative analysis showed that most of the patients joint ratios were normal. The exceptions were the wrists of patients with left-sided RSI (p = 0.0216). However, the sensitivity (9%) and accuracy (41%) were very low.. TPBS with semi-quantitative analysis has very low sensitivity and accuracy in the detection of RSI abnormalities in the upper limbs.

Topics: Adult; Case-Control Studies; Cumulative Trauma Disorders; Female; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Statistics, Nonparametric; Technetium Tc 99m Medronate

Topics: Bicycling; Bone Neoplasms; Buttocks; Carcinoma, Hepatocellular; Cumulative Trauma Disorders; Humans; Incidental Findings; Liver Neoplasms; Male; Middle Aged; Occupational Diseases; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Injuries; Technetium Tc 99m Medronate

Topics: Athletic Injuries; Cumulative Trauma Disorders; Female; Humans; Middle Aged; Muscle, Skeletal; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thigh

The author reports three cases of longitudinal tibial fatigue fractures, reviews the literature, and discusses characteristic features that suggest the diagnosis may be made by bone scintigraphy.. Radiographs and two- or three-phase bone scintigraphs with Tc-99m MDP were obtained in three runners who had exercise-related leg pain and whose clinical symptoms suggested either stress fractures or shin splints. The literature was reviewed and previously reported scintigraphic findings were compared with those seen in these three cases.. In contrast to the focal, elliptical, cortex-based abnormal activity usually seen in the upper or middle tibia in patients with tibial stress fractures, all three patients had a long area of abnormal diffusely increased tibial activity that extended from the tibiotalar region proximally. This finding was seen on the 3-hour delayed static images of all three patients and was suggested on the blood-pool (tissue phase) images. The literature also contained reports of these same scan characteristics. Radiographs subsequently disclosed a longitudinal tibial stress fracture in one patient, computed tomography was positive in the second patient, and findings of clinical follow-up and radiographs were consistent with this diagnosis in the third patient.. In the appropriate clinical setting and with normal or nondiagnostic radiographs, the presence of a long area of diffusely increased activity in the distal tibia extending proximally from the tibiotalar junction is indicative of a longitudinal fatigue fracture.

Topics: Adult; Cumulative Trauma Disorders; Female; Fractures, Stress; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Running; Technetium Tc 99m Medronate; Tibial Fractures; Time Factors

Topics: Cumulative Trauma Disorders; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tenosynovitis; Tibia

Topics: Abdominal Muscles; Adolescent; Chronic Disease; Cumulative Trauma Disorders; Humans; Leg; Male; Martial Arts; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adult; Cumulative Trauma Disorders; Elbow; Elbow Injuries; Forearm Injuries; Humans; Male; Periostitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Ulna; Weight Lifting

The three-phase bone scan is finding increasing utility in acute and chronic pain syndromes in sports medicine settings. This useful technique may have significant clinical application in assessing the increasing numbers of patients with exercise induced lower leg or medial tibial pain. The authors present a case of exertional lower leg pain or medial tibial pain in which three-phase bone imaging exhibited a dramatic increase in early flow after a simple derived exercise stress. The three-phase bone scan should play a key role in the assessment of exercise pain, and may be enhanced by the addition of simple exercise intervention.

Topics: Adult; Anterior Compartment Syndrome; Bone and Bones; Cumulative Trauma Disorders; Exercise; Exercise Test; Humans; Male; Pain; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Medronate; Tibia

Topics: Adult; Carpal Bones; Cumulative Trauma Disorders; Female; Fractures, Stress; Fractures, Ununited; Humans; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Ulna Fractures; Wrist; Wrist Injuries; Wrist Joint

A case of clinically diagnosed repetitive strain injury was referred for investigation to rule out the possibility of an occult bone disease. The patient was a female keyboard operator who had pain and tenderness over the flexor muscles of the right hand and arm. The pain was severe and almost constant. The authors observed an increase in Tc-99m MDP delivery to the affected forearm during the dynamic sequence of a three-phase bone scintigram, indicating increased blood flow compared to the contralateral side. The same result was achieved using quantitative blood flow measurements with the Doppler technique and Tc-99m HMPAO perfusion imaging. These findings agree with recent studies that suggest increased total arm blood flow in repetitive strain injury and may provide an easy screening method.

Topics: Adult; Cumulative Trauma Disorders; Female; Forearm; Humans; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Medronate; Ultrasonography

Topics: Adult; Baseball; Cumulative Trauma Disorders; Humans; Humerus; Male; Periostitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tennis

Three cases of osteitis pubis detected by bone scanning with Tc-99m MDP in professional ice hockey players are presented. This entity is related to mechanical stress and aggravated by forceful contraction of the adductor and rectus abdominis muscles. The signs, symptoms, and laboratory data are relatively nonspecific, as are radiographic findings in the early stage (pubic symphysitis). The use of bone scanning in the appropriate clinical setting aids in diagnosis.

Topics: Abdominal Muscles; Adult; Cumulative Trauma Disorders; Hockey; Humans; Male; Muscle Contraction; Occupational Diseases; Osteitis; Pubic Symphysis; Radionuclide Imaging; Stress, Mechanical; Technetium Tc 99m Medronate

Topics: Cumulative Trauma Disorders; Fractures, Closed; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia; Tibial Fractures; Tomography, X-Ray Computed

Four young patients who developed a fatigue fracture of the femoral neck are presented. The clinical features of pain with movement are described. The role of nuclear medicine is discussed with emphasis on its importance in the early diagnosis of this entity. The radiologic stages based on the site and time of presentation are analyzed: 1) normal, 2) sclerotic bands perpendicular to the trabeculations, 3) incomplete fracture, 4) complete fracture.

Topics: Adult; Cumulative Trauma Disorders; Female; Femoral Neck Fractures; Humans; Male; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

A case of fracture of the right scapula in the superomedial portion with no history of direct trauma is presented. It is most likely due to jogging with weights in both hands. A brief review of scapular fractures is also reported.

Topics: Adult; Athletic Injuries; Cumulative Trauma Disorders; Fractures, Bone; Humans; Jogging; Male; Radionuclide Imaging; Running; Scapula; Technetium Tc 99m Medronate; Weight Lifting

Ballet dancers are athletes susceptible to ligamentous and bony injury. We reviewed retrospectively the bone scans (technetium-99m methylene diphosphonate) of 23 ballet dancers with pain in the back and/or lower extremities to determine the usefulness of scintigraphy in the detection of stress lesions of bone. The scintigraphic studies in 19 dancers identified multiple areas of stress injury in both symptomatic and asymptomatic locations. Thirteen dancers had 22 stress fractures (microfractures of trabeculae with associated bone repair) manifested by an intense focus of increased uptake of radiopharmaceutical, and 19 dancers had stress reactions (areas of accelerated remodeling and resorption of bone) demonstrated by diffusely increased uptake of radiotracer. Ten of the 13 dancers with stress fractures were symptomatic and six of the 19 dancers with stress reactions were symptomatic. The radiographs of 10 dancers with positive bone scans were normal or showed no distinction between acute and chronic injuries. Stress fractures were most prevalent in the feet, and stress reactions were most prevalent in the tibiae. The study confirmed that ballet dancers sustain significant bone stress in their legs and feet. Our results show that scintigraphy can be used to detect stress fractures and stress reactions at both symptomatic and asymptomatic sites in this population.

Topics: Adolescent; Adult; Ankle Injuries; Bone and Bones; Child; Cumulative Trauma Disorders; Dancing; Female; Fibula; Fractures, Bone; Humans; Leg Injuries; Male; Metatarsal Bones; Middle Aged; Pain; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Tibia

Review of 121 bone scintigrams obtained on racing Thoroughbred horses with clinical histories indicative of forelimb lameness revealed 3 scintigraphic patterns of stress-induced trauma to the dorsal cortex of the third metacarpal bone: (1) focal, intense uptake associated with recent stress fracture; (2) regional uptake of varying intensity or a mixed pattern of uptake associated with chronic stress fracture; and (3) diffuse, mild to moderate uptake associated with periostitis (bucked shins). The latter scintigraphic pattern appeared to be an exaggerated manifestation of the normal remodeling process evident in immature horses (2 to 3 years old). Scintigraphy was most helpful in identifying radiographically occult stress fractures, determining the extent of cortical involvement before surgical intervention in cases of chronic stress fractures, and monitoring the fracture healing process.

Topics: Animals; Cumulative Trauma Disorders; Fractures, Bone; Horse Diseases; Horses; Lameness, Animal; Metacarpus; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

Thirty-three patients attending the Nottingham Sports Injury Clinic in whom a clinical diagnosis of a stress fracture of the pars interarticularis was made were evaluated with both radiography and bone scintigraphy. This was done in an effort to distinguish a recent stress fracture which would produce a positive scintigram from an established 'incidental' spondylolysis giving a normal scintigram. Nine patients demonstrated abnormal radiography with a normal scintigram. A further nine patients had a positive scintigram. Six were associated with a spondylolysis indicating a recent stress fracture but two had normal radiography suggesting a stress fracture in the 'sub-radiological' phase. One patient had increased uptake in relation to degenerative changes of the lower lumbar facet joints. Oblique views of the scintigram helped in localisation of the abnormal uptake to the pars interarticularis.

Topics: Adolescent; Adult; Athletic Injuries; Cumulative Trauma Disorders; Football; Fractures, Bone; Humans; Lumbar Vertebrae; Radiography; Radionuclide Imaging; Skiing; Spondylolisthesis; Spondylolysis; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Athletic Injuries; Cumulative Trauma Disorders; Female; Fractures, Bone; Humans; Leg Injuries; Male; Radionuclide Imaging; Technetium Tc 99m Medronate