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Quantitative three-phase bone scintigraphy in the evaluation of intravenous regional blockade treatment in patients with stage-i reflex sympathetic dystrophy of upper extremity

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Abstract

Objective: To investigate the role of quantitative three phase bone scintigraphy (QTPBS) in the evaluation of efficacy of intravenous regional blockade treatment in patients having reflex sympathetic dystrophy (RSD) of the upper extremity.Material and Methods: Twenty-six patients with stage-I RSD were focused on in this study. Patients were treated with physical therapy and intravenous (I.V.) regional blockade therapy consisting of dexamethasone and lidocaine. All patients were clinically evaluated before and 1 month after the completion of the therapy protocol. QTPBS was applied to patients before therapy and 1 month after the therapy. As a control group, 11 healthy subjects also underwent QTPBS. Perfusion, hyperemic and fixation indices were calculated from three-phase bone scintigraphy.Results: All patients showed statistically significant clinical improvement after the therapy (p < 0.01). Pre-treatment, perfusion (1.67 ± 0.63), hyperemic (1.44 ± 0.48) and fixation (1.69 ± 0.48) indices of patients were higher than those of healthy subjects (PI: 0.95 ± 0.05, HI: 0.94 ± 0.06, FI: 1.01 ± 0.2) (p < 0.01) and all indices significantly decreased after the treatment (PI: 1.33 ± 0.46, HI: 1.18 ± 0.23, FI: 1.42 ± 0.26) (p < 0.01).Conclusion: I.V. regional blockade therapy combined with corticosteroids is a simple, safe and effective method for the treatment of patients with stage-I RSD in the upper extremity. QTPBS is a valuable and objective method to evaluate the response to therapy and may be useful for staging of patients and predicting the response to therapy.

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References

  1. Veldman PHJM, Reynen HM, Arntz IE, Goris RJ. Signs and symptoms of reflex sympathetic dystrophy: Prospective study of 829 patients.Lancet 1993; 342: 1012–1016.

    Article  CAS  PubMed  Google Scholar 

  2. Boas RA. Complex regional pain syndromes: Symptoms, signs and differential diagnosis. In: Janig W, Stanton-Hicks M (eds).Reflex sympathetic dystrophy: A Reappraisal. Seattle, WA; IASP Press, 1996: 79–92.

    Google Scholar 

  3. Kozin F . Painful shoulder and the reflex symphatetic dystrophy syndrome. In: Koopmann WJ (ed).Arthritis and Allied Conditions. 13th edition. Philadelphia; 1997: 1908–1922.

  4. Derbekyan W, Novales-Dias J, Lisbona R. Pancoast tumor as a cause of reflex sympathetic dystrophy.J Nuc Med 1993; 34: 1992–1994.

    CAS  Google Scholar 

  5. Scwartman RJ, McLellan TL. Reflex sympathetic dystrophy: A review.Arch Neurol 1987; 44: 555.

    Google Scholar 

  6. Zyluk A. The reasons for poor response to treatment of posttraumatic reflex sympathetic dystrophy.Acta Orthop Belg 1998; 64: 309–313.

    CAS  PubMed  Google Scholar 

  7. Kozin F, Soin JS, Ryan LM, Carrera GF, Wortmann RL. Bone scintigraphy in reflex sympathetic dystrophy.Radiology 1981; 138: 437–443.

    CAS  PubMed  Google Scholar 

  8. Mackinnon S, Holder L. The use of three-phase radionuclide bone scanning in the diagnosis of reflex sympathetic dystrophy.J Hand Surg 1984; 9A: 556–563.

    Google Scholar 

  9. Demangeat JL, Constantinesco A, Brunot B, Foucher G, Farcot JM. Three-phase bone scanning in reflex sympathetic dystrophy of the hand.J Nucl Med 1988; 29: 26–32.

    CAS  PubMed  Google Scholar 

  10. Atkins RM, Tindale W, Bickerstaff D, Kanis JA. Quantitative bone scintigraphy in reflex sympathetic dystrophy.Br J Rheumatol 1993; 32: 41–45.

    Article  CAS  PubMed  Google Scholar 

  11. Zyluk A, Birkenfeld B. Quantitative evaluation of three- phase bone scintigraphy before and after the treatment of post-traumatic reflex sympathetic dystrophy.Nucl Med Commun 1999; 20: 327–333.

    Article  CAS  PubMed  Google Scholar 

  12. Bickerstaff DR, Kanis JA. The use of nasal calcitonin in the treatment of post-traumatic algodystrophy.Br J Rheumatol 1991; 30: 291–294.

    Article  CAS  PubMed  Google Scholar 

  13. Fialka V, Zifko I, Bochdansky T, Schneider B, Schimmert S. Late sequelae of reflex sympathetic dystrophy: Results of clinical, scintigraphic and dynamometric investigations.Eur J Phys Med Rehab 1991; 3: 59–64.

    Google Scholar 

  14. Rosenthal A, Wortmann R. Diagnosis, pathogenesis and management of reflex sympathetic dystrophy syndrome.Comprehensive Therapy 1991; 17: 46–50.

    CAS  PubMed  Google Scholar 

  15. Poplawski EJ, Wiley AM, Murray JF. Post-traumatic dystrophy of the extremities.J Bone Joint Surg 1983; 65A: 642–649.

    Google Scholar 

  16. Desai A, Intenzo C. Tourniquet effect.J Nucl Med 1984; 25: 697–699.

    Google Scholar 

  17. Leitha T, Staudenherz A, Korpan M, Fialka V. Pattern recognition in five-phase bone scintigraphy: diagnostic patterns of reflex sympathetic dystrophy in adults.Eur J Nucl Med 1996; 23: 256–262.

    Article  CAS  PubMed  Google Scholar 

  18. Mudun A, Bursali A, Oklu T, Araci A, Silahci H, Cantez S. Scintigraphic evaluation of the effectiveness of intranasal calcitonin therapy in Sudeck’s atrophy.Nucl Med Commun 1993; 14: 805–809.

    Article  CAS  PubMed  Google Scholar 

  19. Werner R, Davidoff G, Jackson D, Cremer S, Ventocilla C, Wolf L. Factors affecting the sensitivity and specificity of the three-phase bone scan in the diagnosis of reflex sympathetic dystrophy in the upper extremity.J Hand Surg 1989; 14A: 520–523.

    Google Scholar 

  20. Blocux P, Drussens M. The use of99mTc-HSA dynamic vascular examination in the staging and therapy of monitoring of reflex sympathetic dystrophy.Nucl Med Commun 1991; 12: 725–731.

    Google Scholar 

  21. Hoffman J, Phillips W, Blum M, Barohn R, Ramamurthy S. Effect of sympathetic block demonstrated by triple-phase bone scan.J Hand Surg 1993; 18: 860–864.

    Article  CAS  Google Scholar 

  22. Siegel BA, Donovan RL, Alderson PO, Mack GR. Skeletal uptake of Tc-99m Diphosphonate in relation to level bone blood flow.Radiology 1976; 120: 121–123.

    CAS  PubMed  Google Scholar 

  23. Genant HK, Bautovich GJ, Singh M, Lathrop KA, Harper PV. Bone seeking radionuclides: anin vivo study of factors affecting skeletal uptake.Radiology 1974; 113: 373–382.

    CAS  PubMed  Google Scholar 

  24. Tauntas AA, Noguchi A. Treatment of reflex sympathetic dystrophy syndrome (RSDS) with intravenous blocks of a mixture of corticosteroids and lidocaine: a retrospective review of 17 consecutive cases.J Orthop Trauma 1991; 5: 412–419.

    Article  Google Scholar 

  25. Zyluk A. Results of the treatment of posttraumatic reflex sympathetic dystrophy of the upper extremity with regional intravenous blocks of methylprednisolone and lidocaine.Acta Orthop Belg 1998; 64: 452–456.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Departments of Nuclear Medicine, Gülhane Military Medical Academy and Medical School, 06018 Etlik/Ankara, Ankara, Turkey

    Emel Öztürk, Nuri Arslan & Mehmet Ali Özgüven

  2. Physical Medicine and Rehabilitation, Gülhane Military Medical Academy and Medical School, Ankara, Turkey

    Haydar Möhür & Kenan Tan

  3. Department of Nuclear Medicine, Osmangazi University Medical School, Turkey

    Emre Entok

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  1. Emel Öztürk
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  2. Haydar Möhür
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  6. Mehmet Ali Özgüven
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Correspondence to Emel Öztürk.

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Öztürk, E., Möhür, H., Arslan, N. et al. Quantitative three-phase bone scintigraphy in the evaluation of intravenous regional blockade treatment in patients with stage-i reflex sympathetic dystrophy of upper extremity. Ann Nucl Med 18, 653–658 (2004). https://doi.org/10.1007/BF02985958

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  • DOI: https://doi.org/10.1007/BF02985958

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