What is the diagnosis and recommended treatment for a patient with tibial endosteal hyperostosis on the right tibia and arthritic changes in the knees, as shown on a whole body bone scintigram (Three Phase)?

Interpretation of Bone Scan Findings

Your bone scan shows arthritis in both knees but no evidence of an active bone problem in your right shin where the thickening was seen on CT. This is reassuring because it means the tibial hyperostosis (bone thickening) is not currently inflamed or growing.

What the Scan Showed

Your Right Shin (Tibia)

• The scan found no abnormal uptake in your right tibia, which means the bone thickening seen on your CT scan is not actively forming new bone or showing signs of an aggressive process 1
• The absence of increased radiotracer uptake on the delayed phase effectively rules out active osteoblastic (bone-forming) lesions 1
• This pattern is consistent with a stable, non-progressive condition rather than an active bone disease 1

Your Knees

• Both knees showed increased uptake on the scan, indicating advanced arthritic changes 1
• This is a common finding in people with osteoarthritis and explains knee pain or stiffness you may be experiencing 1

What This Means - The Diagnosis

Tibial Endosteal Hyperostosis

• The bone thickening in your shin (tibial endosteal hyperostosis) appears to be a benign, stable condition based on the negative bone scan 2, 3
• This condition involves thickening of the inner lining of the bone (endosteum) and can extend along the shin bone 2, 3
• Since there's no increased uptake on the bone scan, this suggests the process is not active and is unlikely to be something serious like infection, tumor, or stress fracture 3

Knee Arthritis

• You have bilateral knee osteoarthritis (arthritis in both knees) 1

Recommended Treatment Approach

For the Tibial Hyperostosis (Shin Thickening)

• No specific treatment is needed for the tibial hyperostosis itself since it's not showing active inflammation or growth 2, 3
• Monitoring with periodic imaging may be recommended if you develop new symptoms like shin pain or swelling 2, 3
• If you experience pain in the shin area, symptomatic relief with over-the-counter pain medications may be appropriate 4

For the Knee Arthritis

• Lifestyle modifications: Weight management and low-impact exercises to reduce stress on the knees 4
• Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for pain and stiffness relief 4
• Physical therapy: Strengthening exercises targeting the muscles around the knee to improve stability and reduce pain 5
• Bracing: Consider knee braces if you experience joint instability, as these can help support knee function 5
• Address metabolic factors: Control of associated conditions like high blood pressure, high cholesterol, or diabetes may help prevent progression 4

Important Points to Remember

• The negative bone scan in your shin is good news - it means the bone thickening is not an active or aggressive process 1
• Your main symptomatic issue is likely the knee arthritis, which should be the focus of treatment 1
• If you develop new shin pain, swelling, or other symptoms, follow up with your doctor for reassessment 2, 3
• The bone scan cannot distinguish between different types of arthritis, so if your knee symptoms are severe or unusual, additional evaluation may be needed 1