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Erschienen in:

28.01.2020 | Image of the Month

Segmental complex regional pain syndrome of the thumb

verfasst von: Malik Juweid, Salem AlYasjeen, Qabas Al-Ruwaishedi, Abdullah Alhouri, Abeer Bani Hani, Aws Kanfar

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 10/2020

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Excerpt

Complex regional pain syndrome (CRPS) commonly involves an entire hand or foot and only, rarely portion of an extremity [1, 2]. We report here a case of CRPS restricted to the thumb identified on a 99mTc-MDP three-phase bone scan (TPBS). A 47-year-old male presented with severe pain and popping sensation with movement in his left thumb for 6 months caused by thickening of the A1 pulley. He underwent A1 release with some improvement but with continued mild-to-moderate pain and numbness restricted to his left thumb. TPBS performed 3.5 months post-surgery showed increased flow (a), hyperemia (b), and periarticular bone uptake at the 1st metacarpophalangeal and interphalangeal regions (c) consistent with segmental CRPS of the thumb. CRPS involving only three fingers has been first described by Dammann in 1972 [1]. More recently, Konzelmann et al. showed a 12% incidence of CRPS limited to one to three fingers [2]. However, this entity is not well-documented in the nuclear medicine literature. TPBS is commonly used in the workup of patients with CRPS with a sensitivity of ~ 80% and specificity of ~ 85% [3]. A positive TPBS in patients with CRPS typically shows increased uptake in all three phases of the scan, particularly when performed within 6 months of symptoms but is sometimes only positive in the delayed bone phase [4]. This case clearly shows that TPBS can be positive in segmental CRPS with expectedly similar performance characteristics between segmental and whole extremity CRPS and should, therefore, be utilized whenever segmental CRPS is suspected.
Literatur
1.
Zurück zum Zitat Dammann F. Isolated Sudeck’s syndrome in only three fingers. Mschr Unfallheilk. 1972;75:13–22. Dammann F. Isolated Sudeck’s syndrome in only three fingers. Mschr Unfallheilk. 1972;75:13–22.
Metadaten
Titel
Segmental complex regional pain syndrome of the thumb
verfasst von
Malik Juweid
Salem AlYasjeen
Qabas Al-Ruwaishedi
Abdullah Alhouri
Abeer Bani Hani
Aws Kanfar
Publikationsdatum
28.01.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 10/2020
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-020-04701-5