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.
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