The Bone Scintigraphy as a Complementary Exam in the Diagnosis of the Avascular Necrosis of the Sesamoid

Abstract

Objective: This study aimed to present seven cases of avascular necrosis of the sesamoid and report the role of bone scintigraphy in the diagnosis of these patients. Methods: Seven patients with clinical suspicion of avascular necrosis of the sesamoid underwent three-phase bone scintigraphy with 30 mCi of 99mTc-MDP. Results: Most of the patients were young female adults with complaints of limiting pain in the forefoot, who were making use of inappropriate footwear and/or had a history of injury with or without fracture. There was no predominance of either of the feet or between the femoral or tibial sesamoid. Two patients (28.57%) had a bipartite tibial sesamoid and one (14.29%) had splitting of the tibial and fibular sesamoids. In 100% of the patients, three-phase bone scintigraphy, combined with other propaedeutic methods, proved to be crucial for the diagnosis. The initial procedure in all cases was conservative. In four cases (57.14%), there was no remission of symptoms, and surgical excision of the necrotized sesamoid tissue was performed. In all the patients, the therapy used was effective, with complete remission of symptoms, without complications or deformities of the forefoot. Conclusions: Three-phase bone scintigraphy becomes a cornerstone of the propaedeutics when avascular necrosis of the sesamoid is suspected, through contributing towards early and accurate diagnosis and enabling allowing appropriate specialized treatment.

Sesamoid osteonecrosis treated with radial extracorporeal shock wave therapy

“…The sesamoid bones have a tenuous circulation and it is thought that chronic microtrauma over time may cause disruption of blood flow 1. The resulting oxygen depletion results in ischaemia and cell death ultimately leading to osteonecrosis 2. This theory would in part explain why the condition is more common in females who have a higher incidence of single vessel supply to the hallucal sesamoids, compared with men.…”

“…Physiotherapy (taping, manipulation, therapeutic ultrasound and acupuncture) and NSAIDs also play a role in reducing pain. Conservative treatment is typically trialled for a period of 6 months after which surgical extraction is often recommended in refractory cases 2. Excision involves partial or total sesamoidectomy with removal of the necrotic area.…”