Abstract
Introduction: Epicondylitis humeri is a serious problem as a professional disease, where working conditions are a recognized cause of illness. The diagnosis is based on subjective patient data, orthopedic examinations and imaging methods.
The quantitative three-phase elbow scintigraphy allows for the objective diagnosis of metabolic changes in bone tissue at the subcellular level. Material and methods: 47 individuals with an average age of 55 years (26 women (31-60 years) 21 men (26-64 years)) with elbow pains.
Elbow elongated three-phase scintigraphy was performed sitting down with the upper extremities on the collimator in the supine parallel position, marked epicondyles of humerus of both limbs. 10 MBq/kg 99mTc-HDP (hydroxymethylene diphosphonate) was applied to the foot superficial vein. The evaluation was performed visually in terms of blood supply symmetry, phase 2 and 3 as well as quantitatively with index calculations (number of impulses/pixel from areas of interest of radial, ulnar epicondyle of both upper extremities to mean value of impulses/pixel of right and left forearms (reference region) and the aggregate index (multiple of phase 2 and 3 indices), referred to as the Local Metabolic Activity Index (ILMA).
The evaluation by the two evaluators took place independently. Results: Mean ILMA values in 19 subjects with negative scintigraphic findings were Dxrad 1.7 +- 0.4; Dxuln 1.8 +- 0.5; Sinrad1.4 +- 0.3; Sinuln 1.9 +- 0.4; in 28 subjects with positive findings Dxrad 4.5 +- 1.6; Dxuln 4.0 +- 1.1; Sinrad 4.4 +- 1.1; Sinuln 4.4 +- 1.5.
So far, 3 patients have been recognized occupational disease with ILMA values: 1. Sinrad 5.1; 2.
Sinrad 3.9; 3. Dxrad 4.7.
In the intraindividual investigation the difference between the indices of the re-examination was 0-0,9; interpersonal variability ranged from 0-1,2. Conclusion: The method of quantitative three-phase elbow scintigraphy enables to objectify metabolic changes in the area of epicondyles in the assessment of occupational disease.