Three-Phase Bone Scintigraphy in Chronic Epicondylitis

Objective: To assess the utility of 3-phase bone scintigraphy as a complementary diagnostic method in chronic epicondylitis. Design: A cross-sectional study. Setting: Hospital outpatient clinic admitting patients with musculoskeletal disorders. Participants: Patients (N=59; 68% women) with unilateral chronic epicondylitis. Interventions: Not applicable. Main Outcome Measures: Three-phase bone scintigraphy was performed after an intravenous injection of 550MBq (99m)technetium-labeled hydroxymethyline diphosphonate (Tc-99m-HDP) in the patients. Blood flow and blood pool phases were graded visually as normative or abnormal. In the bone metabolic phase, the scintigraphic radiograph images were evaluated using a transmission densitometer. The ratio between maximal bone uptake of Tc-99m-HDP in each epicondyle and the mean of that in the adjacent humerus was used as a bone uptake measure, which was compared with clinical data (pain questionnaire, pain drawing, cubital pain thresholds, muscle strength) and with work ability and lifestyle factors. Results: The bone uptake of Tc-99m-HDP of the affected epicondyle was 33% and 17% higher in men and women, respectively, compared with the corresponding healthy epicondyle (P <.001 and P=.007). High bone uptake of Tc-99m-HDP was associated with better work ability, grip strength, and muscle performance in both sexes but was not correlated with the pain measures. Blood flow phases had a positive correlation with the duration of symptoms and a negative correlation with the bone uptake of 99'Te-HDP, grip strength, and work ability. Conclusions: High bone uptake of Tc-99m-HDP among patients with chronic epicondylitis was associated with better muscle strength, work ability, and arm function. In chronic cases, a higher degree of bone uptake of Tc-99m-HDP may thus indicate a healing response in the bone tissue.