Bone scan

Bone scans can help identify hidden fractures that cannot be seen in regular x-rays, they can also help detect bone cancer, arthritis, reason for mysterious bone pain and bone infections. In a normal x-ray, the radiation passes through the body and creates an image on the x-ray placed on the other side of the body, whereas in a bone scan the radiation travels to the surface of the body that is in turn detected by a camera. All metal items in contact with the body have to be removed before a bone scan. There are no restrictions on eating and drinking. Bone scans are not performed on pregnant women. You have to arrive 4 hours before the scan and let the tracer settle well into your body.Bone scan procedure involves:

• An injection with tracers is injected into the vein in your arm.
  
• After this you have to wait for 2-4 hours to allow the tracers to circulate and become absorbed by your bones. In organs and tissues such as the bones, this radio nuclide gets accumulated.
  
• You will be asked to drink lots of water to pass out the unabsorbed radioactive material through the urine. The absorbed radioactive material will flush out through the urine by 24 hours.
  
• During the bone scan, you will be made to lie motionless on the table, as a device with an arm-like gadget holding the gamma camera passes above the body. When the tracers enter the body, they emit gamma waves of radiation that can be detected by a special camera.
  
• The camera in turn generates images that can be inferred by radiologists or nuclear medicine specialists.
  
• The scan takes about 30-60 minutes for the entire skeletal and even less if only for specified areas.

When no abnormal area is seen with high or low accumulation of the tracers, the radioactive material is evenly distributed. This indicates that the bone area that is scanned is normal. In abnormal cases, radioactive material accumulates in a particular area of the bone. This is known as a hot spot. Hot spots can indicate a healing fracture, bone cancer, bone infection, arthritis or a disease of an abnormal bone metabolism. Certain spots may indicate less absorption of the radioactive material, they are called cold spots. This could indicate cancer or lack of blood supply to the bone.

Osteomyelitis

Osteomyelitis is a medical condition that results from bone infection. The bacteria Staphylococcus aureus is usually the cause of Osteomyelitis. Other possible causes for Osteomyelitis are streptococcus and E. coli. Infection is caused either through the bloodstream or direct bone infection through open wounds or fractures. Surgery, fungal infection, injury or boils can be the source for contamination and infection. Typically the infection results in the formation of pus and abscess in the bone. The blood supply to the bone is affected and Osteomyelitis sets in. Osteomyelitis can affect adults and children. While the long bones of the limbs are usually affected in children, the pelvic or back bone of adults is affected. Chronic Osteomyelitis sets in when there is prolonged loss of blood supply to the affected bone tissue. This can happen in diabetics, dialysis patients and those who abuse drugs intravenously. Persons whose spleen has been removed may be at higher risk for Osteomyelitis.

Osteomyelitis can attack more than one bone at a time. Symptoms of Osteomyelitis are localized swelling and redness in the affected bone area. The patient feels ill and nauseous. There might be fever and pain too. In some cases, Osteomyelitis also results in swelling of feet and ankles or lower back pain. The nagging joint pain fails to respond to pain medications and there is intense pain on touching. There is weight loss and severe fatigue. Tests to diagnose this condition include bone scans and MRI of infected bones. Blood tests and cultures can help identify the type of bacterial infection so that the right course of treatment can be adopted. Blood tests will reveal higher ESR and elevated WBC count in those affected by Osteomyelitis. X-rays can reveal the extent of infection in the affected bone. A biopsy of affected bone tissue can also help identify the bacterial infection.

With early diagnosis, this infection can be treated with antibiotics. Often the antibiotics are given intravenously. Treatment for Osteomyelitis involved hospitalization and bed rest. But newer forms of oral antibiotic therapy have been successful in penetrating bone tissue. This has drastically reduced the need for prolonged hospitalization. In chronic cases of Osteomyelitis, surgical removal of dead bone tissue is required. Bone grafting is done to promote growth of new bone tissue. In rare cases, Osteomyelitis can lead to blood poisoning (septicemia) and destruction of the bone.

Haglund's Deformity

Haglund's deformity is a bony growth along the posterior lateral border of the calcaneus or the heel bone surrounded by a tender tissue. Haglund's deformity primarily springs from bone enlargement at the back of the heel bone in the area where Achilles tendon attaches to the bone. Hence it is also called pump bump. It is also called as 'retro ocular bursitis and 'calcaneal exotosis'. Bursitis is an inflammation of the sacs (bursae) that contain small amounts of lubricating fluid to help the joints move smoothly. The syndrome is usually found to occur in females in their teens who often use high heels causing irritation of the rigid heel counter of the shoe rubbing up and down on the back of the heel bone. However, the deformity can also occur among runners and athletes. Common symptoms include red painful area in the back of the heel and swollen area at the back of the heel bone. There is irritation in the Achilles tendon. Repeated blistering on the back of the heel leads to callous formation.

Haglund's deformity is identified by physical examination and x rays. The doctor correlates the physical symptoms of redness and pain in the area with findings in x-ray studies, bone scans and MRI. Haglund's deformity can be present at birth or may be acquired by injury over the patient's lifetime. Shoe gear is the primary reason for Haglund deformity. Haglund's deformity can be caused by bursitis or pressure against the shoe.

The treatment for Haglund's deformity depends upon the severity and cause of the disease. During the initial stages when the disease is mild, applying ice followed by moist heat and compression will help ease discomfort from pump dump. Changing the type of shoes can stop the injury and consequent redness and swelling from developing. The pain can also be alleviated to some extent by placing a heel lift inside the shoe so as to lift the Haglund bump above the part of the heel counter of the shoe that rubs it. A doctor may also prescribe anti-inflammatory drugs to reduce pain. Soaking the foot may also soothe the area. In mild cases, a doctor may also recommend padding of the area. Normally corticosteroid injections are given to relieve the pain but for long term complication this injection cannot be recommended as it can weaken and cause rupture to the Achilles tendon. In severe cases of deformity, surgery may be necessary to remove or reduce the bony growth.