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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)
  1. CMC, carpometacarpal joint; CRPS, complex regional pain syndrome; IP, interphalangeal joint; MC, metacarpal joint; MCP, metacarpophalangeal joint; PIP, proximal interphalangeal joint; RC, radiocarpal joint; STT, scaphoid-trapezium-trapezoideum joint.