Abstract
Introduction: Epicondylitis humeri is a common disease in activities with insufficient adaptation of tissues to physical stress. Aim of this study is to help assess it as a professional disease, where working conditions must be a recognized cause of the disease.
The diagnosis is based on symptoms of the patient, orthopedic examinations and imaging methods. The quantitative three-phase bone scintigraphy of the elbows 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 three-phase bone scintigraphy was performed with patients sitting down with their 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.
Visual evaluation of the blood supply symmetry (phase 1.), blood pool (phase 2.) and bone accumulation (phase 3.), was performed. In addition quantification of the phase 2. and phase 3. was performed using 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), refer- red 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; Sinrad 1.4 +- 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.