Case Author(s): Brigid Gordon, MD and Henry Royal, MD , 08/04/96 . Rating: #D2, #Q4

Diagnosis: Reflex Sympathetic Dystrophy

Brief history:

56 year old female s/p right distal radius fracture two months ago, now with pain and burning in her right hand.


Anterior, palmar view of both hands

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Full history/Diagnosis is available below

Diagnosis: Reflex Sympathetic Dystrophy

Full history:

This patient sustained a fracture of the distal right radius approximately 2 months prior to this bone scan. Since the fracture, the patient describes persistent pain and burning in the right hand with associated swelling and redness.




Three-phase bone scintigraphy demonstrated a classic pattern for reflex sympathetic dystrophy syndrome. The dynamic perfusion phase of the radionuclide angiogram and the immediate static images (not included) demonstrated increased activity in the distal affected limb, particularly in the periarticular region. On the 3 hour delayed view, the most prominent activity is again identified in the periarticular regions of the affected limb when compared to the normal limb. Also noted is increased activity at the healing fracture site.


Adult reeflex sympathetic dystrophy syndrome has been described as having three phases: 0-20 weeks with increased tracer activity (particularly in the periarticular regions) on all three phases of the study; 20-60 weeks with normal tracer activity in the first and second phases of the study and increased tracer activity (particularly in the periarticular regions) in the third phase; and, 60-100 weeks with normal or reduced tracer activity in the first and second phases of the study and normal bone activity in the third phase. These bone scintigraphy findings in addition to physical findings and symptoms highly suggestive of reflex sympathetic dystrophy syndrome.

References: Diagnostic Nuclear Medicine. 1996, 3rd edition. ed., Sandler, et al.,

Major teaching point(s):

Post-traumatic bone and joint changes.

Differential Diagnosis List

Reflex sympathetic dystrophy vs. inflammatory arthropathy.

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Effect of Trauma)

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Case number: bs063

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