Neurological Associates

Pain Management Center

Vero Beach, Florida

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RSD PUZZLE #49
The Role Of Bone Scan In The Diagnosis And Management Of RSD

Dear Sandy:

You had asked about the role of bone scan in the diagnosis and management of RSD. The recent study published in the Journal of Hand Surgery 4 months ago reported the research work done by  Dr. Lee and Dr. Weeks of Lexington, Kentucky showed that bone scan is diagnostic or accurate in the diagnosis of RSD in only 55% of the patients[1]. This is an atrociously low percentage. If it was 50% it would be flip of a coin. It is ludicrous to resort to a test that has the accuracy of flipping a coin. Yet, a lot of patients that I see have been told "You don't have RSD because bone scan was normal". Bone scan has no place in the diagnosis or management of RSD. If I have a heart attack and they tell me that they are going to do a test that has 55% chance of diagnosing my heart attack, obviously I'm not going to consent to such a test. The reason for bone scan being so inaccurate are legendary. Symmetrical involvement of RSD, spread of the RSD to other parts of the body, changes of bone circulation during different stages of RSD, and conditions that mimic RSD such as arthritis, are some of the reasons the bone scan becomes useless in the diagnosis and management of RSD. There is no special test-be it thermography, bone scan, QSART, doppler flow studies, or surface temperature studies-that can diagnose RSD. RSD is a clinical diagnosis with four principles.

1. A burning, stabbing, pain that can be elicited even with simple touch.

2. Motor dysfunction in the form of muscle spasm, weakness, tremor, and constriction of blood vessels.

3. Disturbance of immune system in the form of inflammation, swelling, skin rash, etc.

4. Constant input of pain to the brain causing insomnia, agitation, depression, and poor judgment. Do not waste your money on any bone scan.


H. Hooshmand, M.D.

Reference:

1. Lee GW, Weeks PM: The role of bone scintigraphy in diagnosing reflex sympathetic dystrophy. J Hand Surg [Am] 1995;20:458-63

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Copyright © 1997-2006 H. Hooshmand, M.D. No part of this publication may be reproduced, transmitted, stored in a retrieval system other than this specific media, transcribed, or translated into any language without the expressed written permission from the author; H. Hooshmand, M.D. and Eric Phillips and CMNE. This material is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician.

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The material on the Neurological Associates Pain Management Center Homepage and all it's associated, linked or reference pages is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician. H. Hooshmand, M.D., Neurological Associates Pain Management Center and Associates will not be held liable for any damage or loss as a result of information provided on this page or associated documentation. Again, this WEB SITE is simply published as an information source and should not be used to treat or make judgments on RSD/CRPS. All associated material on this web site may not be copied, reproduced or quoted without expressed written permission from the owner; Copyright © 1999-2006 H. Hooshmand, M.D.

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This page was last updated on 3/11/2000.