Bone Scan Noting Tibial Injury

Bone Scan Post Off Weight Bearing Right Side

Bone Scan from Talus Injury

There are many reasons I will order a bone scan for a patient. A radioactive dye is utilized to glue itself to phosphorus molecules. Bone is made up of water, calcium, and phosphorus. If a bone scan is hot, there is active bone metabolism going on. This patient injured her talus bone wearing unsupportive shoes. If you look at the upper left and right images, the marker points to the talus as a bright spot that is not present on the other side. Bone scans are wonderful since you do get both sides as part of the normal exam for comparison. It is the comparison of the injured side to the noninjured side that makes bone scans unique and quite special. Comparing the two sides by location and intensity of dye uptake can give you a great idea of what bone activity is occurring. In this case, the dye uptake in the talus clearly shows that strong healing is occurring.

The image on the lower left further localizes the spot (and this is the exact location seen on the MRI). The image on the lower right shows me in Quimper, France, in 2007 in front of one of those famous French doors.

So, the bone scan was very positive. The patient was told that great healing is going on. We have to continue for the next 6 months in a great pain free environment to let the healing continue. It is impossible to know how fragile the system is. This particular patient will not be running soon, but walking has been fine, elliptical will be introduced soon, and she is using orthotics to stabilize her ankle, a bone stimulator from Exogen, and daily icing and contrast bathing.

Hip Pain Decision Making: Role of Bone Scan

Here is the one of the hip xrays from my patient Albert. Albert has degenerative changes (wear and tear) on both hips, right greater than left. This is a standing AP Pelvic Xray with shoes on showing a short right leg that I am using lifts to level. Albert has had 6 synthetic cartilage injections into both hips, with the left hip doing great and the right hip still in pain. What complicates matters and the decision making for hip replacement is that he also problems with his right sacro-iliac joint and his right lumbar spine. Both areas can produce pain that can mimic hip pain and vice versa.

Here is a magnified image of Albert's right hip. The degenerative changes are mild to moderate only. Should he have a hip replacement was the question he asked me? I have seen Albert's function diminish over the last year and now he always has a cane in his left hand. But the xrays didn't look that bad!! His orthopedist was conservative, and really good at telling Albert that he would know when he needed a hip replacement. But was it just referred pain from the SI joint or low back? I encouraged him to get a bone scan for more definitive answers. He approached his orthopedist on the subject and the test was ordered.

Here is the Tc 99 bone scan images of Albert's hip area. I apologize that the image is turned around, but the side of the intense dye uptake is in the right hip. Bone scans document bone metabolism. Where is Albert trying to mend at the bone layer? The Tc 99 dye glues itself to the phosphorus molecules in your body. Phosphorus, calcium and water make up bone. After 2 hours of letting the dye circulate, the images are collected.

Here is a higher image on the body showing the dye in the kidneys already. You urinate the dye out of your body over 12 hours and patients are encouraged to drink alot the day of the test. The lumbar spine looks normal, but there is a slight increase in the right SI joint. But the dye accummulation in the right hip is so intense, Albert will be scheduling a hip replacement soon. Hopefully, we can get his short right leg corrected at the same time.