Three-phase bone scintigraphy is used often to diagnose reflex sympath
etic dystrophy of the hand. This study presents an analysis of the lit
erature relating three-phase bone scanning to reflex sympathetic dystr
ophy in the upper extremity. The data show a wide variability in scint
igraphic accuracy in patients with clinically obvious reflex sympathet
ic dystrophy. The results of bone scintigraphy correlate best with the
clinical diagnosis of reflex sympathetic dystrophy within the first 2
0-26 weeks of onset. Even then, the sensitivity in the most recent ser
ies approximates 50%. After 26 weeks, there is a poor correlation betw
een three-phase bone scanning and reflex sympathetic dystrophy. Conseq
uently, three-phase bone scintigraphy should not be used as a major cr
iterion in diagnosing reflex sympathetic dystrophy. The diagnosis of r
eflex sympathetic dystrophy remains a clinical diagnosis made by an ex
perienced hand surgeon.