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1
Role of Bone SPECT/CT: Hand surgeon’s Perspective
Bo PovlsenConsultant Orthopaedic
Hand SurgeonGuy’s Hospital
Introduction
Life for a hand surgeon is easy we only treat 3 conditions:
1) Loss of function2) Loss of sensation
3)To much pain.
2
How to diagnose the cause of Loss of function?
Use your eyes
SPECT Scan not needed to tell you what is wrong here
How to diagnose the cause of Loss of Sensation
Neuro-physiological studies can tell us:– if the peripheral nerves
are compressed
– &– where to operate
SPECT Scan not needed to tell you what is wrong here either
3
How to diagnose the cause of Pain?
The simple Answer: With great difficulty
Why is the cause of pain difficult to diagnose?
No objective confirmation–Blood test, Biopsy or Scan
4
What is the therapeutic dilemma with surgical pain treatment?
To anatomically pin point the invisible pain before treatment can be applied
How do I reach a diagnosis on the anatomical location of pain?
A distillation of information obtained from:
1. Taking a detailed “pain” history
2. Clinical inspection & palpation & examination
3. Relevant objective investigations (SPECT/CT ?)
5
Taking a detailed “pain” history
When did the pain start? Do you have any medical conditions? Have the pain varied since then if so how? Do the pain vary during a 24 hour circle? Do the pain vary with activity? Do the pain co-inside with sensory symptoms? Can you pin-point the location of the pain? What makes the pain better or worse? Etc.
Clinical investigation to diagnose the location of the cause of Pain Inspection
– Swelling– Redness
Palpation – Tender– Warmth– Texture of swelling
Examination– Movement
– Active/passive– Pain association
6
Relevant objective investigations the location of the cause of Pain
Non-invasive– X-ray
– Ultra sound scans
– CT-scans
– MRI scans
Invasive– Bone scans (wrist registration)
– SPECT /CT scan– LA test injection
– Biopsy
– Arthroscopy
Structures that I treat on a hand that can cause pain Skin Subcutaneous tissue Nerves Tendons Bone/fracture Ligaments Joint Capsule Articular surfaces/OA
What do I use SPEC/CT for?
–Fractures of bone– Articular surfaces/OA
7
When do I use SPECT/CT Scan
Patient complain of pain but.....Clinical
examination?Standard x-ray
is normal
Wrist registration scan (WRS) of scapho-lunate joint arthritis
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Suspicion of scaphoid fracture, but WRS demonstrated trapezoid bruising
Pain after STT fusion, scan suggest union but ongoing inflammation
9
Scaphoid fracture, delayed diagnosis but no suggestion of OA
Hook of hamate fracture but uptake in intact hamate – do not operate!!!!!
10
? Scaphoid fracture. SPECT/CT: Capitate fracture – No need for OP
Pain after FOOH: Increased uptake; pisiform / triquetrum and triquetrum pseudarthrosis fragment => Excise
11
Scaphoid / trapezium joint uptake, no fracture demonstrated => No OP
Ulnar sided wrist pain. SPECT/CT: Diagnosis DRU-J OA / abutment
12
Multiple joint pain: Increased tracer several small joints in both hands
PAIN AFTER RADIO CARPAL FUSION. Non-union? SPECT/CT: OA CMC-J 3
13
Wrist pain & Scaphoid bone cyst. SPECT/CT: No OA =>Excision+graft
Wrist pain & x-ray 1st row OA SPECT: 1st & 2nd row OA=>full fusion
14
Ulnar sided pain: Ulnar abutment syndrome => TFCC debridement
Confirmation of correct diagnosis of anatomical location
when
LA injection removes pain instantly
15
Treatment of pain from arthritic hand jointsInjection of steroidDebridementDenervationJoint fusionJoint replacements
Thank you for listening
Any questions?