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