NeuroTalk Support Groups - Is 5 months after my trauma too early for bone scan to make a rsd diagnosis?

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- - Is 5 months after my trauma too early for bone scan to make a rsd diagnosis? (https://www.neurotalk.org/reflex-sympathetic-dystrophy-rsd-and-crps-/92357-5-months-trauma-bone-scan-rsd-diagnosis.html)

Is 5 months after my trauma too early for bone scan to make a rsd diagnosis?

I had trauma on my leg and subsequent pain and now doc wants to rule rsd out. How too little time passed for the bone scan to be of any use in making a diagnosis? In other words, have I had the rsd long enough for it to have affected the bones and thus no shown in a scan and thus not be an effective tool in making an rsd diagnosis?

I don't know the answer to your question on the timing, but it might be good to have a starting /baseline scan anyway.

If something positive shows up then you'll know & have proof.
Or if it is clear for now, then you'll have something to compare with if it is needed in the future.

I don't know about bone scans, but the qiucker you can find out if you have this, the better chance you have of stopping it. My doctor usually uses a set of two nerve blocks to diagnose RSD, but if he finds that is the case, then he doesn't perform any more unlike some docs who will just keep doing them over and over. If you don't already have a pain management doctor, they know more about this disease than most orthos or family practice doctors. Might be a good idea to see one for diagnosis and hopefully quick treatment. Good luck!

Not sure what a good idea it is. I had a bone scan 6 months or so after getting CRPS and it was clear. So of course some people said, "no RSD." Disability carriers like that sort of stuff in particular.

Of course, two years later I had all of the requisite symptomatology that many alleged experts want to see up front before they make a diagnosis, but in the meantime they were sitting on their hands when I should have been getting appropriate care (heavy rounds of blocks, low dose ketamine infusions, etc.) when it could have made a difference: when I was still in the "acute stage" of CRPS. [I am advised that in Germany, the current "gold standard" is to pump local anesthetic right into the affected area for what may be a day or two. And guess what? It takes care of the problem.] If you have only had pain for the last five months, there are aggressive medical therapies out there that will do you no good if you don't jump on them now. Five months from now will, more likely than not, be too late.

But I digress. As to the predictive accuracy of the 3-phase bone scan, check out the following abstract, from a respected peer reviewed journal:

"Imaging in early posttraumatic complex regional pain syndrome: a comparison of diagnostic methods," Schürmann M, Zaspel J, Löhr P, Wizgall I, Tutic M, Manthey N, Steinborn M, Gradl G, Clin J Pain 2007 Jun;23(5):449-57.

Department of Trauma and Orthopedic Surgery, Sana Klinikum Hof, University of Erlangen-Nürnberg, Eppenreuther Strasse 9, 95035 Hof, Germany. matthias.schuermann@klinikumhof.de

OBJECTIVES: The complex regional pain syndrome type I (CRPS I) still is difficult to diagnose in posttraumatic patients. As CRPS I is a clinical diagnosis the characteristic symptoms have to be differentiated from normal posttraumatic states. Several diagnostic procedures are applied to facilitate an early diagnosis, although their value for diagnosing posttraumatic CRPS I is unclear. METHODS: One hundred fifty-eight consecutive patients with distal radial fracture were followed up for 16 weeks after trauma. To assess the diagnostic value of the commonly applied methods a detailed clinical examination was carried out 2, 8, and 16 weeks after trauma in conjunction with bilateral thermography, plain radiographs of the hand skeleton, three phase bone scans (TPBSs), and contrast-enhanced magnetic resonance imaging (MRI). All imaging procedures were assessed blinded. RESULTS: At the end of the observation period 18 patients (11%) were clinically identified as having CRPS I and 13 patients (8%) revealed an incomplete clinical picture which were defined as CRPS borderline cases. The sensitivity of all diagnostic procedures used was poor and decreased between the first and the last examinations (thermography: 45% to 29%; TPBS: 19% to 14%; MRI: 43% to 13%; bilateral radiographs: 36%). In contrast a high specificity was observed in the TPBS and MRI at the eighth and sixteenth-week examinations (TPBS: 96%, 100%; MRI: 78%, 98%) and for bilateral radiographs 8 weeks after trauma (94%). The thermography presented a fair specificity that improved from the second to the sixteenth week (50% to 89%). DISCUSSION: The poor sensitivity of all tested procedures combined with a reasonable specificity produced a low positive predictive value (17% to 60%) and a moderate negative predictive value (79% to 86%). These results suggest, that those procedures cannot be used as screening tests. Imaging methods are not able to reliably differentiate between normal posttraumatic changes and changes due to CRPS I. Clinical findings remain the gold standard for the diagnosis of CRPS I and the procedures described above may serve as additional tools to establish the diagnosis in doubtful cases. [Emphasis added.]

PMID: 17515744 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Mike

ps For an extended discussion of the value of early medical interventions, including links to articles that can be shared with your doctors, check out the "Are Nerve Blocks really worth it?" thread at http://neurotalk.psychcentral.com/thread90221.html

Good point Mike, I hadn't thought of that part of it.

Depending on your status related to medical ins, disability or work comp it may or may not be a good thing.

I did a quick search also and here is more info - [bone scan to make a rsd diagnosis]
http://www.google.com/search?q=bone+...ient=firefox-a

{Some are older and some newer so check dates to get the latest info.}

From a recent study printed in Medscape in 2008:

- A 3 phase bone scan may be helpful in revealing findings typical for the diagnosis of RSD. A false negative (misses RSD diagnosis in symptomatic people) is fairly common

- It is considered sensitive and specific particularly if done < 20 wks of onset. But a study by Werner reported sensitivity at 44%

- Sensitivity reported at 60% by Kozin, et al.

And a 2007 article from Orthopedics Today:

- The sensitivity of a 3 phase bone scan decreases with duration of the disease

- It has poor sensitivity, approximately 50%

So, not a great test for RSD, what is? It's a mixed bag. But do it sooner than later if you're going to do it at all and understand that this test will not be sensitive enough 50% of the time for RSD. In constrast, bone scanning is something like 97% sensitive when looking for bone tumors.

I have had full body RSD for 9 years. I have had two bone scans during that time and my RSD is not affecting my bones so the scan was clear both times.
Take care,
Sherrie

i had bone scan about 6mths into rsd and it was positive for already bone loss in my shoulders right wrist, and legs and spine. so i would say its a 50/50 chance of it coming back postive or neg.. that actually test that i had 11yrs ago to dx it was phentolmine challenge and thermography !! also vascular testing .. hope that this helps.

carrie

i was diagnosed like a month after my initial injury. nothing showed up on my bone scans or mri's or ct's or xrays tho... other than my original injury- hairline fracture to my radial. was pretty much process of eliminating everything else

Had my 1st scan at 5 months after onset and it only showed my broken kneecap which I didn't know I had. The 2nd scan was done exactly a year later and it came back negative for anything at all. I was glad to know my break had healed!

Hugs,

Karen