RSD and Bone Scans

byrd45 Mon Jan 05, 2009 7:38 pm

Reply
Recommend Delete Message 1 of 1 in Discussion

From: byrd45 (Original Message) Sent: 12/21/2005 4:31 PM
HI Everyone,

This weeks discussion is going to focus on RSD and bone scans. I know in our posts the subject had been brought up as to how accurate bone scans really are. I had a bone scan within a few weeks of being injured. It was too soon to show anything even if it could, so it isn't real reliable in my case. Of course it showed nothing back then but it isn't invasive either which to me is always a plus. What I don't think is fair or right is how some doctor's rely so heavily on the results of these tests. I included a puzzle form Dr. Hooshmand which explains his opinion of the procedure. Here it is:

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

Fifty- Five percent accurate!!!!! They have to be nuts to count so heavily on this! Well to anyone who has been through this test and treated unfairly afterwards I think it is just horrible. I would love to hear your opinions and experiences on RSD and bone scans. You can just add them to this post and have a great week everyone!

Love,

Robyn

First Previous 2-5 of 5 Next Last Delete Replies 

Reply
Recommend Delete Message 2 of 5 in Discussion

From: GalenaFaolan Sent: 11/30/2005 7:25 PM
My first bone scan was done just shy of 6 months after I injured my knee. The only thing it showed was a "possible" healing hairline fracture in the kneecap. When I took the film to the Ortho who had ordered the test done, he told me himself that just because it didn't show RSD doesn't mean I don't have it. This was end of July 2003.

My second bone scan was done end of June, start of July 2004, ordered by the Neuro I was seeing by then. It came back all clear with no hint of anything according to the results. He also knew bone scans weren't much either so made it a point to tell me that it didn't matter that it didn't show up.

I feel lucky that these two doctors, idiots though they were, didn't rely on a bone scan. They both dx me with RSD despite the results of it.

I would say a better indicator of an RSD test would be the Thermogram. You can't get around the fact that a limb(s) are glowing blue on the screen! Smile

Love and Hugs,
Karen J

Reply
Recommend Delete Message 3 of 5 in Discussion

From: byrd45 Sent: 12/3/2005 8:42 AM
Hi Karen,
I am glad they didn't rely on the bone scan for me either because mine also showed nothing. I would think a Thermagram would be a better choice also. I know that some people with RSD can develop Osteoporosis. Maybe they use it for that reason too? Hope you are having a good day!
Love,
Robyn

Reply
Recommend Delete Message 4 of 5 in Discussion

From: GalenaFaolan Sent: 12/3/2005 1:16 PM
Yeah, bone scans show the Osteo, but I keep seeing that docs rely on it to dx RSD which is so wrong. It should just be one of all tests to check but not determine, ya know?

A much cheaper solution to Osteo is an x-ray. Bone loss shows up on them quite well and I think that a bone scan should be done after an x-ray if it needs determining as to how much bone loss is going on.

It could be a much better day for sure. I finally found a doc and I'm hoping he'll be good. I haven't had any pain meds for a few months now. Only 2 weeks and 2 days now till the appointment and hopefully pain meds and some relief.

Love and Hugs,
Karen J

Reply
Recommend Delete Message 5 of 5 in Discussion

From: byrd45 Sent: 12/6/2005 7:02 AM

Hi Karen,
I hope your pain levels are down today. I feel so bad for you that you are in pain and don't have any kind of relief right now. I will keep my fingers crossed that your new doctor helps you out.
Love,
Robyn