title: Three-phase bone studies in hemiplegia with reflex sympathetic dystrophy and the effect of disuse.
abstract: Eighty-five patients with cerebral vascular accidents were assessed with three-phase bone scintigraphy of the hands and with whole-body delayed bone imaging. Nine patients (10%) had normal three-phase bone images. Fifty-five patients (65%) showed decreased blood flow and blood-pool images of the hands and wrists with normal delayed bone scintigrams, indicating the effect of paralysis or disuse. Twenty-one patients (25%) had diffuse increased uptake with periarticular accentuation, felt to be bone-scintigraphic evidence of reflex sympathetic dystrophy of the hands and wrists; in two patients this occurred before its clinical appearance. Thirteen of the 21 reflex sympathetic dystrophy syndromes (RDS)-involved limbs (62%) had increased blood flow, whereas 8 (38%) had decreased flow. Gross limb blood flow appears to be related to the degree of muscle activity, but flow may be altered by the presence of sympathetic changes. A possible dissociation between whole-limb flow and bone blood flow in paralyzed limbs involved with RDS is discussed. The elbow was involved in only one case, and a true "shoulder-hand" distribution was seen in only 11 of 21 cases (52%). Five patients (6%) had leg involvement on whole-body imaging. Traumatic synovitis of the wrist, and trauma to subluxed shoulders, could be recognized on the delayed study.
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000000981:diagnostic imaging; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006225:Hand / Q000098:blood supply / Q000000981:diagnostic imaging; D006429:Hemiplegia / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012019:Reflex Sympathetic Dystrophy / Q000000981:diagnostic imaging* / Q000209:etiology; D012039:Regional Blood Flow; D012782:Shoulder / Q000000981:diagnostic imaging; D013669:Technetium Tc 99m Medronate; D013997:Time Factors
chemical_list: D013669:Technetium Tc 99m Medronate