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Assessment of the Clinical Significance of Asymptomatic Lower Extremity Uptake Abnormality in Young Athletes

Division of Nuclear Medicine, Department of Radiology, and Division of Sports Medicine, Department of Orthopedic Surgery, Children’s Hospital, Boston, Massachusetts

This study was undertaken to evaluate our hypothesis that most asymptomatic lower extremity uptake abnormalities are of no clinical consequence and to assess whether these findings should affect patient care. Methods: One hundred consecutive young athletes referred for bone scintigraphy by a sports medicine clinic because of low back pain were evaluated for the presence of asymptomatic bone scan abnormalities in the lower extremities. The patients were then reexamined by the referring sports medicine physician, who had full knowledge of the bone scan results. Scintigraphic findings were correlated with the clinical evaluation at the time of scintigraphy and on follow-up evaluations ranging from 8 to 14 mo later. Results: Asymptomatic lower extremity abnormalities were present in 34% of patients. There were abnormalities of the feet in 30 patients (focal uptake in 26 patients, diffuse uptake in 10 patients), the tibia in 13 patients (2 focal uptake, 11 diffuse uptake), and the femur in 2 patients (both with diffuse uptake). None of the regions of abnormal lower extremity uptake was symptomatic at the time of initial evaluation. There was no change in the clinical management of any patient because of the scan findings. None of the patients was advised to restrict the activity level because of the asymptomatic scan findings. None of the regions of scan abnormality became symptomatic on follow-up evaluation. Conclusion: This study shows that asymptomatic bone scintigraphic abnormalities of the feet, as well as diffuse abnormalities of the tibia, are common in young athletes. These findings are most likely of no clinical consequence and do not require a change in the activity level. Focal abnormalities of the femur or tibia are not commonly seen in asymptomatic young athletes.

Key Words: stress fracture • bone scan • sport injuries

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				L. P. Connolly, P. A. d'Hemecourt, S. A. Connolly, L. A. Drubach, L. J. Micheli, and S. T. Treves Skeletal Scintigraphy of Young Patients with Low-Back Pain and a Lumbosacral Transitional Vertebra J. Nucl. Med., June 1, 2003; 44(6): 909 - 914. [Abstract] [Full Text] [PDF]

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