Table 1 Correlation of clinical and SPECT/CT findings with consecutive therapeutic change
From: Diagnostic and therapeutic impact of SPECT/CT in patients with unspecific pain of the hand and wrist
Patients | Clinical symptoms | Estimated diagnosis | SPECT/CT diagnosis and therapy |
|---|---|---|---|
1 | Persistent pain after arthroplasty CMC-1 and revision with partial resection of the trapezium bone | Possible persistent osseous reaction after arthroplasty | Significant uptake in MC-1 base and the trapezium bone Therapy: additional infiltration |
4 | Persistent posttraumatic wrist pain 6 months after undislocated radius fracture | Posttraumatic osseous lesion | Persistent posttraumatic reactive bone remodeling at fracture site, no significant osteoarthritis Therapy: additional occupational therapy |
9 | Unclear pain in CMC-1 with pain, swelling, and redness | Unclear, ganglion cyst (detected in MRI) not correlating with clinical symptoms | Mild uptake in the hamate bone and distal radius, no osteoarthritic changes Therapy: immobilization and additional occupational therapy |
10 | Unclear persistent wrist pain and pain in both Dig-I for several years | Osteoarthritis | No significant osteoarthritis, no signs of inflammatory arthritis Therapy: rheumatologic follow-up and supportive therapy |
11 | Unclear right-sided wrist pain (ulnocarpal) | Unclear, possible insertion tendinosis | No pathologic osseous findings, thus exclusion of possible diagnosis (clinically possible tendinosis) Therapy: immobilization, infiltration, and occupational therapy |
16 | Unclear pain in right CMC-1, no trauma | Unclear | Uptake in both STT joints, beginning (activated) osteoarthritis Therapy: occupational therapy |
19 | Arthritic right-sided wrist pain, no trauma | Triscaphoid osteoarthritis/possible irritation of the STT joint | Moderate bone remodeling of the right RC and SL joints without significant osteoarthritis, no STT osteoarthritis Therapy: occupational therapy, change of working place environment, and NSAID |
20 | Persisting left-sided wrist pain during flexion, no trauma | Unclear | Persisting bone growth, no bony lesion, exclusion of other differential diagnosis |
22 | Unclear right-sided radiocarpal wrist pain 1 year after trauma | Posttraumatic osseous/osteoarthritic lesion | Persistent bone remodeling at fracture site Therapy: occupational therapy |
24 | Radiocarpal right-sided pain for more than 1 year, no trauma | Unclear, MRI findings did not explain clinical symptoms | Elevated radiocarpal bone metabolism, together with clinical findings suggestive for tendovaginitis Therapy: immobilization, infiltration, and subsequent surgery |
25 | Carpal pain after scaphoid pseudoarthrosis, CT shows no persisting fracture | Triscaphoid osteoarthritis | Persistent bone remodeling in former fracture zone, no ST uptake but slight stress reaction radio-scaphoidal Therapy: surgery |
29 | Left-sided wrist pain while grabbing and lifting | Tendinitis | Osteomalacia of the lunate bone Therapy: surgery |
34 | Pain in the CMC-1 and MC-1 base, wrist trauma 20 years ago | Osteoarthritis STT joint | Posttraumatic intraosseous ganglion cyst in the right scaphoid Therapy: surgery recommended, yet not operated |
36 | Persistent pain after posttraumatic arthrodesis IP-I | CRPS | Persistent bone remodeling in arthrodesis, osteoarthritis CMC-2 joint, no CRPS Therapy: supportive and occupational therapy |
37 | Persitent pain in CMC-1 joints after trapezectomy and right arthroplasty >3 years ago | CMC-1 osteoarthritis | Severely activated CMC-1 osteoarthritis Therapy: revision surgery |
46 | Pain after scaphoid fracture and consolidated pseudoarthrosis | RC osteoarthritis | No RC osteoarthritis, vital scaphoid fragment with bone remodeling Therapy: revision surgery |
49 | Persistent pain in the distal ulna after distorsion >8 months ago | Ganglion cyst (diagnosed in MRI) was suspected to cause pain | Reactive elevation of bone metabolism at ulnar styloid (insertion of TFCC), ganglion cyst as the cause of clinical symptoms was excluded Therapy: immobilization, infiltration, and shaving during later course of disease |
50 | Carpal pain, known radiopalmar ganglion cyst | Possible additional STT osteoarthritis | Activated osteoarthritis in multiple IP and MCP joints, exclusion of STT osteoarthritis Therapy: ganglion resection |
51 | Left-sided carpal pain with painful bump | Carpal boss MCP III with reactive bony lesion and possible additional degenerative joint lesions | Carpal boss MCP-III with osseous reaction |
Therapy: surgical resection without additional arthrodesis (no additional joint degenerations) |