title: Three-phase bone scintigraphy in chronic epicondylitis.
abstract: OBJECTIVE
  To assess the utility of 3-phase bone scintigraphy as a complementary diagnostic method in chronic epicondylitis.
  
  
  METHODS
  A cross-sectional study.
  
  
  METHODS
  Hospital outpatient clinic admitting patients with musculoskeletal disorders.
  
  
  METHODS
  Patients (N=59; 68% women) with unilateral chronic epicondylitis.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Three-phase bone scintigraphy was performed after an intravenous injection of 550MBq (99m)technetium-labeled hydroxymethyline diphosphonate ((99m)Tc-HDP) in the patients. Blood flow and blood pool phases were graded visually as normative or abnormal. In the bone metabolic phase, the scintigraphic radiograph images were evaluated using a transmission densitometer. The ratio between maximal bone uptake of (99m)Tc-HDP in each epicondyle and the mean of that in the adjacent humerus was used as a bone uptake measure, which was compared with clinical data (pain questionnaire, pain drawing, cubital pain thresholds, muscle strength) and with work ability and lifestyle factors.
  
  
  RESULTS
  The bone uptake of (99m)Tc-HDP of the affected epicondyle was 33% and 17% higher in men and women, respectively, compared with the corresponding healthy epicondyle (P<.001 and P=.007). High bone uptake of (99m)Tc-HDP was associated with better work ability, grip strength, and muscle performance in both sexes but was not correlated with the pain measures. Blood flow phases had a positive correlation with the duration of symptoms and a negative correlation with the bone uptake of (99m)Tc-HDP, grip strength, and work ability.
  
  
  CONCLUSIONS
  High bone uptake of (99m)Tc-HDP among patients with chronic epicondylitis was associated with better muscle strength, work ability, and arm function. In chronic cases, a higher degree of bone uptake of (99m)Tc-HDP may thus indicate a healing response in the bone tissue.
authors.affiliation: Finnish Institute of Occupational Health, Oulu, Finland. tuomo.pienimaki@ttl.fi
authors.forename: Tuomo T
authors.initials: TT
authors.lastname: Pienimäki
authors.forename: Reijo J
authors.initials: RJ
authors.lastname: Takalo
authors.forename: Aapo K
authors.initials: AK
authors.lastname: Ahonen
authors.forename: Jaro I
authors.initials: JI
authors.lastname: Karppinen
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004551:Elbow Joint / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018709:Statistics, Nonparametric; D013669:Technetium Tc 99m Medronate / Q000031:analogs & derivatives; D013716:Tennis Elbow / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; C024226:technetium Tc 99m hydroxymethylene diphosphonate; D013669:Technetium Tc 99m Medronate