3-PHASE BONE STUDIES IN HEMIPLEGIA WITH REFLEX SYMPATHETIC DYSTROPHY AND THE EFFECT OF DISUSE

  • 1 January 1984
    • journal article
    • research article
    • Vol. 25  (4) , 423-429
Abstract
Patients (85) with cerebral vascular accidents were assessed with 3-phase bone scintigraphy of the hands and with whole-body delayed bone imaging. Nine patients (10%) had normal 3-phase bone images. Ppatients (55; 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. Patients (21; 25%) had diffuse increased uptake with periarticular accentuation, felt to be bone-scintigraphic evidence of reflex sympathetic dystrophy of the hands and wrists; in 2 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 1 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.