Read the article by Love et al in the journal Radiographics the concept of radionuclear imaging is discussed. Describe one thing that you learned about radionuclear imaging from this article, and how it may relate to a patient you have seen during one of your clinicals!
http://pubs.rsna.org/doi/full/10.1148/rg.232025103
An interesting thing I learned about radionuclear imaging from this article is about lower extremity injuries, specifically stress fractures and shin splints. This is a good tool for differential diagnosis because of the hyperfusion and hyperemia shown with a stress fracture, while shin splits imaging would be unremarkable. This relates to a patient I had during an outpatient clinical rotation that had signs and symptoms consistent with shin splints. As the article states, this is significant because of the difference in most effective treatment for shin splints vs stress fractures.
ReplyDelete- Chris Truong
One thing I learned about radionuclear imaging is that a scintigraphy may be required 72 hours after fracture occurrence when dealing with an elderly patient with osteopenia and unremarkable findings at the initial scan. Waiting 72 hours can result in increased sensitivity. This relates to a lot of patients that I have in my SNF as a lot of them come to SNF due to falls with negative x-ray readings. I recently have a patient who fell and received a x-ray that was negative but is experiencing severe,sharp pain and instability weight bearing through the affected LE. She could benefit from receiving a scintigraphy for increased sensitivity if her symptoms persist.
ReplyDeleteAfter reading this article, I learned that radionuclear imaging is not limited to musculoskeletal injuries and can be used for a widespread of conditions/diagnoses. I found the most interesting to be reflex sympathetic dystrophy. Radionuclear imaging offers another option to help determine a diagnosis for some patients who may have not had answers from other imaging. I recently had a patient that would have benefited from radionuclear imaging. She was a 40 year old women who was very active in yoga, water aerobics, and recently started jogging. She reported foot pain, but x-rays showed no pathology. She finally got diagnosed with a stress fracture in her foot 4 weeks after we started treatment. If she were to have had radionuclear imaging, this diagnosis may have came about sooner.
ReplyDelete-Kailey Thach
One thing that I learned from this article was that they are able to tell the difference from benign abnormalities, metastatic diseases, etc. just based on the origin on the spine. It might give a better clue in to origin of pain and symptoms as well. I had radionuclear imaging in high school, and I currently have two patients (both young gymnasts) who are undergoing radionuclear imaging. While I have not seen their results, I hope it provides answers into their pain. These girls both have extreme pain with extension, but all other images have been negative. This was the case for me as well in high school, with the bone scan they were able to find a stress fracture in the body of L5. From there it changed how I was treated, therefore, I would like to see the bone scan results from the two girls we have been treating during this rotation.
ReplyDeleteI was excited to read this article because a patient early in this rotation had a series of imaging done and one was a triple-phase bone scintigraphy. What initially lead to the scintigraphy being ordered was she had severe pain in her right knee that limited her from putting weight through it. The scan showed increased perfusion within the right distal femoral metaphysis. What it also showed was intense uptake in the sternal body which may represent a sternal fracture or a neoplasm. In the article, it states 25-45% of patients that have malignancy or evidence of bone metastases may be asymptomatic, which she was for her chest. I’m not sure what the follow through was with this patient since she left the hospital soon after the scintigraphy. Being that she is ninety-nine, they may have steered towards conservative care and not pursued more tests/chemo.
ReplyDelete-Ryan Haverkamp
One thing I learned about radionuclear imaging is that about 75% of patients with malignancy and pain have abnormal bone scintigraphic findings. This suggests that this type of imaging plays a vital role in tumor staging and management. This information relates to patients I see nearly every day in the oncology unit at my current clinical (St. Francis). Every person on this floor has both pain and malignancy. However, when reviewing patient histories I have rarely looked at their imaging results. After reading this article, I will start reviewing those findings with my CI.
ReplyDeleteI found the most interesting part of the article to be the section on infection and three-phase bone scanning. I was unaware that this was the method of choice for diagnosing osteomyelitis and that it has an accuracy of 90%. I learned that focal hyperperfusion, focal hyperemia, and focally increased bone uptake indicate osteomyelitis. Currently, I am working with a patient who had a girdlestone procedure following osteomyelitis of the R hip. She was seeking conservative care for R hip pain at least one month prior to her diagnosis. She has other imaging performed to rule out fractures and those were negative. Now I wonder what her outcome would have been with a three-phase bone scan performed earlier, if it was performed at all.
ReplyDelete- Dustyna Roman
I found it interesting that bone scintigraphy is often used to evaluate painful joint replacements. If found to be negative it is strong evidence that the prosthesis is not the source of the patient’s discomfort. I currently have a pt that fractured her hip 3 years ago and ended up having a hip replacement. She has been having pain ever since and believes that it is the replacement that gives her pain. I think she would benefit from scintigraphy to show her that it may or may not be the prosthesis used in her hip replacement.
ReplyDeleteTrevor Kimball
I learned that scintigraphy can be useful for more than just identifying areas of fracture, as it is very sensitive for identifying areas of abnormal osseous activity. I thought it was interesting that people with malignancy, it can find areas of bony metastasis even though they are asymptomatic 25-45% of the time, which can be very useful once someone is diagnosed with cancer and throughout their care. I also didn't know it could pick up plantar fasciopathy at the insertion site on the calcaneus, which could be useful for differential diagnosis down the road if the patient hasn't responded to your initial POC. It would be interesting for one of my patients with a mysterious lateral foot pain to get this done to see if there is increased osseous activity going on. We have made progress with her function and pain, but we don't have a great working hypothesis as to what is going on with her besides possible cuboid dysfunction.
ReplyDeleteJeremy Milford
I was not previously aware what was used to distinguish between stress fractures and shin splints. I knew that stress fractures in the tibia could be tricky to diagnose since they don't usually show up early on with conventional radiographs.
ReplyDeleteI have a pt who was having hip pain after his a hip pinning to fix a intertrochanteric due to a fall. Plain radiographs 3 weeks after surgery showed no abnormal findings but 10 days after that it was evident that the pin had migrated superiomedially and was gouging his acetabulum. I don't know if radionuclide imaging would have been able to differentiate between what should have been the normal healing process in this case but in light of what I know happened he probably would have benefited from additional imaging/workup.
I learned that scintigraphy can be used to evaluate previous joint replacements. If a joint replacement becomes painful after implantation, periprosthetic uptake may be indicative of something with the prosthesis causing pain. I am currently seeing a patient who has had knee pain after undergoing a TKA. The patient reports having x-rays done after the replacement and reports that the surgeon said everything looked good despite the patient's complaints of pain. The patient has had ongoing knee pain for 5 years now after the implantation of the TKA. Upon my initial evaluation, the patient displayed increased movement in his knee with anterior drawer, posterior drawer, and varus/valgus testing. Obviously, the patient no longer has these structures for them to be lax, but I could feel the prosthesis "clunk" or shift with all these tests. I am unsure what would cause the prosthesis to seem loose, but the surgeon seemed unconcerned with the x-ray results. I think this patient may be a good candidate for scintigraphy, which may or may not show periprosthetic uptake, and may or may not be indicative of an issue with the prosthetic. I think scintigraphy may cause the surgeon to take a closer look at the prosthesis. However, the patient has been benefiting from lower extremity strengthening and reports decreased pain since onset of therapy.
ReplyDelete-Kambry Porter
I was interested to learn that RSD usually manifests as diffuse, uniformly increased uptake throughout the affected region with a bone scintigraphy, but may manifest as a focal abnormality. My 9 yo. patient that had CRPS throughout her entire L UE may have benefited from having this imaging performed along with an X-Ray to help diagnose her with CRPS much sooner. She saw a multitude of different medical professionals before we saw her and finally put the whole picture together with her ortho doctor that she had CRPS (her original diagnosis was adhesive capsulitis). I am curious to know if her findings would have been diffuse, focal (such as in her hand/shoulder) as well as if she would have had decreased radiotracer accumulation because she is a child. I don't know if these findings would have progressed the POC sooner or would have had no effect on the outcome at all. Either way, it may have helped her mentally to know that we believed how much pain she was in.
ReplyDelete-Marcas Ekart
I didn't realize that it was primarily used to diagnosis bone metastasis in cancer patients. It seems quite like a how a PET scan looks a intense metabolic activity to show the presence of a possible cancer site, this shows increased bone activity could indicate a cancerous bone tumor. I have had 2 pts in this rotation alone that have multiple myeloma a treatable, but not curable form of cancer. One pt was found early and has lived with it now for 17 yrs, the other pt was not found early and has a prognosis for less then a year. The cancer cells congregate in the bone marrow and in the solid parts of bones. I would imagine that would show up in scintigraphy.
ReplyDelete-Cheri Flanagan
I did not know that Reflex Sympathetic Dystrophy could be diagnosed through any type of imaging. I always thought it was a diagnosis purely based on subjective complaints and objective findings. This information I have learned from this article definitely relates to a patient I had during my clinicals last summer at Wesley Medical Center. We had a patient that presented with s/s consistent with RSD following a femur and tib-fib fracture (car accident). I remember reading in her chart that the doctors guessed she had RSD, but they were not sure and didn't run any tests to confirm it. Apparently bone scintigraphy would have been a good option for this patient. I am not sure if it would have changed their treatment of her, but sometimes it's nice to have a diagnosis or reason for something that is causing you so much pain.
ReplyDeleteI learned that the SPECT is useful in evaluation of complex structures such as the spine as sections of the vertebrae can be examined on transaxial, coronal, sagittal, and three dimensional images which facilitates both localization and characterization of an abnormality. This reminds me of a patient my CI evaluated 2 weeks before my rotation began and we have been treating since then. The patient is a high schooler who encountered a hard hit during a football game and has since then had significant debilitating back pain along with concerning signs/symptoms including change in B/B control, radiating pain, and weakness. During my CIs eval she had these findings which led her to refer him back to his PCP for further evaluation prior to her treatment. He underwent several types of imaging including MRI, CT, and Xrays - all of which came back negative for any significant findings. I think radionuclide bone imaging may be an option to further assess his spine because his significant pain and symptoms don't add up. He can barely perform simple stretches or strengthening exercises with no resistance without being in excruciating pain in his lumbar spine. We have been taking it super slow on the side of caution to prevent further damage, just in case there is something going on that has been missed. He wants so badly to return to his usual high school activities and sports such as football.
ReplyDeleteMelissa Daughty
From this article, I learned that radionuclear imaging can be used for detecting tumors along with musculoskeletal injuries and other conditions like Paget's disease, RSD etc. It also was interesting to read that it can help differentiate between shin splints and stress fracture and other LE injuries. Radionuclear imaging could be a better option for patients who have other forms of imaging done with negative results. This relates to a 40 yr old female patient, who is a runner and has pain in L hip. We have been treating it as hip impingement but she continues to have pain. She probably would benefit from radionuclear imaging. Her labral tests are positive as well but her MRI was clear. We have been working with her for the last 10 weeks with ups and downs but making minimal progress. I wonder if she were to have radionuclear imaging, we might be able to get to the root of the problem.
ReplyDeleteNeha Joshi
One thing that caught my eye in this article was distinguishing areas of the body affected by Paget's Disease. I saw a patient during my summer rotation that casually mentioned she suffered from Paget's, and was being seen for balance issues and general weakness. She suffered from frequent muscle spasms and general tightness overall. Looking back, it would have been interesting to see if she had bone scintigraphy imaging done and if it correlated to the places where she had frequent spasms.
ReplyDeleteI didn’t realize how valuable of a resource scintigraphy was in relation to fracture diagnosis, which would be especially useful for physical therapists when they have a patient who presents as having a fracture even though the radiographs were negative. I find it interesting that with suspected fracture in the elderly (who also suffers from osteopenia) may need a repeat scintigraphy at 72 hours to maximize sensitivity while others can be detected within 24 hours. This makes sense seeing as scintigraphy relies heavily on bone formation and a patient who is suffering from osteopenia will have a slower rate of new formation. In the grand scheme of things 24-72 hours really isn’t that much of a difference and is still a good turnaround. We had a patient recently who was coming in due to an inversion ankle sprain as well as having shin splints. With shin splits presenting as a recurrent trauma to the tibia he could have benefited from bone scintigraphy to confirm whether he indeed had a fracture.
ReplyDelete- Aaron Casner
I personally enjoy working with patients with back pain or other back pathologies. So something I found very interesting about scintigraphy was the different areas of abnormalities that led to different diagnoses. For example when the vertebral bodies are the only thing abnormal, it could be tumor, trauma or infection while abnormalities in the articular facets are almost always benign. Other areas that extend beyond vertebral body’s are usually due to osteophytes. Also, accumulation in the vertebral bodies and pedicles usually indicate metastatic diseases, where areas involving vertebral bodies and facets but spare the pedicles is often benign.
ReplyDelete-Courtney Simon
I found this article very interesting. What I found the most interesting is how sensitive this test can be and that it can be used for so many different diagnoses. I didn't realize how effective it is for cancer patients. I didn't know that this test can help with the staging and management for them. In the article it states that "25-45% of asymptomatic patients with malignancy have evidence seen of bone metastases." That sentence itself I believe shows how important this type of test can be for patients with cancer.
ReplyDeleteOne of my patient's during my home health clinical would have greatly benefited from this because of his hip pain. This test can not only look at cancer but fractures, infections and joint replacements. We were seeing him for a stroke however, he always stated he has severe hip pain. We had told the doctor and the doctor did an x-ray however, this article stated that x-rays can come out negative and a scintigraphy can show a fracture or infection that an x-ray did not pick up. I think he would have benefited from having one done in order to help pin point his diagnosis and ensure he got the proper treatment for it.
While reading the journal over the concept of radionuclear imaging, one specific patient came to mind. She is 8 years old and was diagnosed with osteosarcoma in her proximal tibia, which resulted in her having a rotationplasty. While reading the metastatic disease portion of the article I learned that about the flare phenomenon. The flare phenomenon is seen in patients who are responding to hormonal therapy or chemotherapy. An increase in intensity or the appearance of new abnormalities from one bone scan to the next does not necessarily indicate progression of disease; this pattern reflects healing of the bone lesions. This flare phenomenon is typically seen within 3 months after start of treatment and is often associated radiographically with the sclerotic changes of healing. However, continued increase in the number and intensity of lesions beyond 6 months is usually indicative of disease progression. It was interesting to learn about the different areas and many conditions bone scintigraphy can be used for as a sensitive screening procedure.
ReplyDelete- Chandler Stoughton
Going into this article, I assumed that radiocuclide bone imaging was primarily only used for metastatic disease. The list goes on and on for the multiple other uses. The couple that jumped out at me was for plantar fasciitis and spondylolysis. We have a pt with suspected plantar fasciitis, but her symptoms are very inconsistent and she is not a very good historian. We have been doing a lot of STM to the plantar fascia with stretches and strengthening of the surrounding structures, with varied results. She does continue to do some aggravating factors, such as wear heels, and her compliance at times is questionable, but I feel further imaging to determine if this is truly the cause of her pain, level of involvment, and further help pt buy in to her condition would have been helpful. Another pt could possibly have a spondylolysis. She had come in for neck pain and HAs, but has noted a very specific mid thoracic pain that has not gone away. Her neck pain has been improving well, but the thoracic pain persists. She has had xrays, which did not show anything, but this could show a more advanced image to rule in or out true injury to this area.
ReplyDeleteI learned from this article that bone scintigraphy has a wide range of applications beyond being highly accurate at detecting fractures. I found it interesting that metastatic disease can present on imaging as both increased AND decreased uptake, and that the radiation therapy used for treatment of metastatic disease can cause bone to increase or decrease the uptake of the radionuclide. It seems like that could make interpretation very difficult in certain situations!
ReplyDeleteOne patient I've worked with who would have been appropriate for radionuclide imaging is a 13 year old male with spondylolysis. Fortunately, his spondylolysis was identified on radiographs. He tried other forms of treatment before PT, including chiropractic, massage therapy, and acupuncture. He has now gone through 4 weeks of PT but his symptoms have actually worsened, possibly due to progression to spondylolistheis since his original radiographs. And so on Tuesday he had a consultation with a surgeon to discuss back surgery. If his initial radiographs had been negative, perhaps his LBP would have been as "non-specific" and he would have had to continue PT for a longer period of time before he had been able to get in to the surgeon.
-Ashton Reichmann
I learned bone scintigraphy is extremely sensitive, meaning the probability of someone with the disease testing positive, even more so than conventional radiography. It was mentioned about 75% of patients with malignancy and pain have abnormal findings, it is able to detect fractures within 24hours, and over 90% accuracy using a three phase bone scanning in diagnosing osteomyelitis. It continues to assist in diagnosis of many other pathologies. I currently have a patient admitted due to lateral malleolar fracture and is currently in a skilled setting in rehab. She had been progressing well and seemed to plateau. She had been fatiguing and reporting higher pain levels around the area of injury. It was eventually found in imaging but this modality could have presented an early DVT diagnosis she eventually received. I hope to hear more about its use in the future based on the benefits it presents.
ReplyDeleteI found the "flare up" interesting. You would initially assume that more abnormalities found in the newer bone scan would mean progression of the disease. This flare phenomenon can indicate healing as long as the increase is no longer seen after 6 months after initiation of treatments.
ReplyDeleteI think that a bone scintigraphy would have been appropriate for a patient that I evaluated early in this clinical rotation. He came in for hip pain/weakness and had unremarkable radiographs of his hip and lumbar spine. He had significant weakness with hip flexion and hip pain in all planes, actively and passively. We ended up referring him back to his physician for further evaluation. He ended up having an MRI of his lumbar spine and hip identifying metastatic disease in the acetabulum, pubic rami, and ilium. I believe that this patient could have benefited from the bone scans being performed. I think the physician wanted to assess the soft tissue structures as well as the bone and that is why he used an MRI.
I thought the imaging results for children were interesting - accumulation is seen where the long bones are still growing and also in the facial bones. Bone scintigraphy may be helpful in the pediatric population to detect abnormal growth (lack of accumulation) in certain areas of the body if the child has a condition where growth of skeletal system is inhibited or abnormal. The results may help to decide whether or not to use bracing and/or when the appropriate time is to initiate such treatment. I've seen a few kids this semester with facial/skull and long bone abnormalities and would be interested to see the results if they received bone scintigraphy.
ReplyDeleteLani Martin
One thing I learned through this article that I found interesting concerned the diagnosing of fractures. Although, historically, radiographs have been the primary method of detecting fractures, bone scintigraphy is extremely useful in detecting fractures in patients with a history of trauma but negative radiographs, even if that trauma is considered minor. This relates to a young patient of mine who was involved in a pretty severe ATV accident and suffered a significant tibia-fibula fracture on his LLE. His rehab was progressing really well and about 6 months after his accident he started to have a major setback with pain in his RLE. I think he would have benefited from radionuclear imaging to at least rule out a potential stress fracture in his RLE from relying so much on his uninvolved leg for his daily mobility for so long. I think had he gotten imaging earlier, it could have been addressed as soon as possible and potentially avoided a setback in his therapy and significant pain.
ReplyDeleteThroughout reading this article last night I thought I don't think I have any patients on my case load that would benefit from this. However, this morning I had an eval on a 70 yr old female who had a knee replacement last May (2017). She had been through therapy and succeeded with adequate ROM, strength and was no longer using an AD as of June 2017. She came in today with complaints of "joint" pain in her replacement knee that started around the holidays and has not decreased at all. It was be interesting to see what her results of a bone scintigraphy would show as she is having no other significant problems besides her complaints of pain and increase in swelling.
ReplyDelete- Trista Cline
One thing I learned is that bone scintigraphy is useful for detecting fractures didn't show up on radoigraphs or in pts that have a history of trauma. One pt that I believe would benefit from scintigraphy is a kid I have seen that has osteogenesis imperfecta. He spends more time with fractures than without. There have been a few visits where he shows up limping and mom states he went to the doctor's office for imaging, showing negative radiographs. I believe that if he had bone scintigraphy performed, they probably would have at least found microfractures and might have put him in a boot.
ReplyDeleteRyan Faflick
An interesting thing I learned is that elderly patients with osteopenia and an initial unremarkable bone scintigraphy would benefit from having another bone scintigraphy taken at 72 hours post trauma. This is applicable to my current clinical rotation in the skilled nursing setting because some people may not know that an injury can take time to show up with imagining, especially in the elderly population. My CI had told me about a previous patient who had a fall and the initial x-rays came back negative, but the patient continued to report pain in their shin especially with weight bearing. My CI said she recommended another x-ray about a week after the injury and a distal tibial fracture was determined through with the additional imaging. This past Friday I did an initial evaluation on an elderly woman who had a left femoral neck fracture with percutaneous pinning. This patient had a fall on her back over the weekend and came back from the hospital earlier this week and I performed another initial evaluation. Even though the imaging performed at the hospital came back negative for reinjury or trauma this patient is in worse pain and has decreased functional mobility. I’m wondering if additional imaging or more sensitive imaging would be an appropriate recommendation if this patient’s symptoms do not improve soon due to the possibility of re-injury or fracture that was not caught on initial imaging.
ReplyDeleteKassidy Simmons
One thing I learned about bone scintigraphy is that it can detect bone fractures within 24 hours, (fractures that could sometimes be missed in Xrays). I have a patient with osteogenesis imperfecta that could benefit from radionuclear imaging due to the amount of fractures that he has had, and will continue to have throughout his life. My patient has type 3 OI, which is one of the most severe types, he has had ribs, humerus, and femur fractures (that I know of). He is 3 years old, and the last fracture that he had (mom told us), was when he was trying to bear weight through his arm in a prone position and broke his humerus. I think with someone like him that has already experience a lot of pain in his life and may not react to having a fracture like some of us would, this type of imaging would be beneficial to detect fractures early, before they can cause some bigger problems (bone infection, bone cutting blood supply/nerves, etc).
ReplyDeleteElvia Barraza
One thing I learned was how it can detect a painful joint replacement. I have a patient who had a TKA, and has really struggled to gain her motion (flexion and extension.) She had an empty end feel when trying to push motion, so that indicated to me that she was mostly limiting herself due to the pain. She eventually got a manipulation, which has helped tremendously in gaining back her motion, but she is still struggling (especially with extension now.) She always had multiple questions about her knee replacement and may have benefited form bone scintigraphy to rule out (or potentially rule in) whether the actual joint replacement was causing her pain.
ReplyDelete-Alice Hartman
I learned that radionuclide bone sacnning can be used to diagnose plantar fasciitis and shin splints. This would have been extremely helpful in my rotation due to the large poplution of those patients in the military setting I was in and in which radiology is readily available. It have been useful for one of our patients referred for shin splints that presented as a a high ankle sprain.
ReplyDeleteI thought it was interesting to see that you can use this type of imaging to evaluate joint replacements. During my rotations I have seen a handful of people that continue to have severe amounts of pain after a successful joint replacement. We had a lady at my last rotation that was having 7-8/10 pain throughout her entire therapy post TKR. I always thought that perhaps her age and other medical conditions limited her rate of healing. She did have imaging performed to ensure her that nothing was permanently damages dud to the procedure. Aft r talking with her doctor all the parts fit well and nothing was seen as a complication causing her pain. After reading about this type of imaging and seeing that it can take a better look at joint replacement and see if she is having tiny fractures undetected by traditional imaging causing intense pain during weight bearing activities.
ReplyDelete-Miles Christensen
Due to the fact that this is a quick, inexpensive, and highly sensitive form of imaging, it seems that many patients would benefit from this type of imaging! I recently had a pt. that was sent to us with a script for "L trochanteric bursitis". She was in extreme pain and it didn't seem to follow the classical symptoms of hip bursitis. However, due to the outrageous costs of imaging, her insurance company was requiring therapy first. After a couple weeks of therapy she was finally allowed to get an MRI and it was found that she had bone spurs and possibly an acetabular fracture. I can't help but think she could have definitely of benefited from this form of imaging earlier on since it is inexpensive! She did not have avascular necrosis, but according to this article if she had this an MRI is more sensitive for this condition. I found it interesting that an MRI is more sensitive since it seems that the uptake of the nucleide would help make this very apparent.
ReplyDeleteOne thing I learned that I found interesting was about the "flare phenomenon." Hormonal therapy and chemotherapy can effect the scans and an increase in intensity or appearance of abnormal findings does not always indicate a progression of the disease. I learned this is usually found within the first 3 months after beginning treatment and is often found with sclerotic changes that indicate healing. A continued increase in the number and intensity of lesions beyond 6 months is usually indicative of disease progression. This type of imaging could have been very useful for our patient that we are presenting on for clinical conference. He had cancer with multiple metastasis that eventually ended up in the spine.
ReplyDeleteOne thing I learned and found very interesting from this article is that bone scintigraphy is that it is not only very accurate in detecting fractures in trauma but provides useful findings for a wide variety of medical conditions. It is very useful at 75% for detecting metastatic disease, malignancy, and pain. It can be used to detect infection and evaluate painful joint replacement. It can also be used for many other miscellaneous conditions including reflex sympathetic dystrophy, avascular necrosis, and spondylosis.
ReplyDeleteTo relate to patients I have seen, it can be used in trauma for detecting fractures in patients with a history of of trauma, and can even reveal plantar fasciitis, which I found very interesting due to the amount of patients with this condition and the regular occurrence of it post ankle/foot surgeries. The typical appearance of PF on radionuclide bone images is increased activity at the insertion side of the long plantar tendon.
Although PT treatment for plantar fasciitis is relatively simple and not high demand, many patients struggle to demonstrate improvements in pain levels throughout their plan of care. Some struggle with understanding the anatomy and what the plantar fascia is and it's function. I have had patients ask many times for explanation of the anatomy and pathology behind plantar fasciitis.
I learned that radionuclide bone imaging is quick, relatively inexpensive, widely available and exquisitely sensitive for findings. Due to these factors, I think some patients who struggle to see improve pain and function would benefit from having bone scintigraphy performed to help them better understand the condition and get over the mental block they have towards progression due to chronic pain.