Thesis

105 SPECT/CT in post-operative hand and wrist pain Figure 4 Forty-eight-year-old male patient with pain in the left wrist. Twenty-three years before he had a distal radius fracture followed by partial radioscapholunar arthrodesis 1 year later and panarthrodesis 3 years later. X-ray (A) shows fusion of the arthrodesis (arrow) on the radial site. Planar bone scintigraphy image (B) and fused SPECT/CT (D, E) and CT (C) show a focal increased uptake in the carpometacarpal II/III joint (arrows) with corresponding degenerative changes. Consequently, arthrodesis (arrow) of the carpo-metacarpal II/III joint was performed (intraoperative X-ray, F). Survival of the DRUJ arthroplasties was reported to be 64-99%, while synovitis of the extensor carpi ulnaris tendon, nerve irritation, sigmoid notch erosion and DRUJ instability are the most often encountered complications. There is no literature regarding the performance of SPECT/CT in wrist and finger arthroplasties. Since the wrist and the fingers are – in contrast to hip, knee and ankle – no weight bearing joints, it might be difficult to adopt SPECT/CT patterns from these larger joint verbatim to the wrist. In case of loosening of the arthroplasty – taking into account a “safety” time interval from implantation of the device to SPECT/CT imaging – one can expect increased uptake around the implant with lucencies on CT as diagnostic features. 4

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