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RSD: Role of Bone Scans

- Bone scan:
    - generally considered sensitive but not specific;
    - bone scans may help to r/o associated conditions such as a stress frx;
    - Triphasic Bone Scan:
          - may add higher degree of specificity;
          - first stage is the radionucleotide arteriogram:
                 - increased uptake is suggestive of RSD;
          - second stage is the blood pool stage:
                 - this is suggestive of RSD if there is diffuse increase in activity in the MCP and juxta articular regions of the digits;
          - third stage is the delayed stage (typically 3-4 hours)
                 - is suggestive if there is diffuse assymetric uptake in radiocarpal, intercarpal, MCP and IP joint in the affected limb;
                 - third phase is the most important phase

Reflex Sympathetic Dystrophy Imaging

Sensitivity and Specificity of 3-phase Bone Scintigraphy in the Diagnosis of Complex Regional Pain Syndrome of the Upper Extremity

Predictive value of the three-phase technetium bone scan in diagnosis of reflex sympathetic dystrophy syndrome.