Neck & Arm Neuropathies

Use of EMG in C Spine problem

I need some advice, last year I had my c6-c7 disc removed and fused with hip bone and metal plate. All was well for one year now I have a herniated c5-c6 disc. My doctor wants to do a c6 nerve root block, right now I’m doing traction treatment but that’s not working, I’m trying to get some advice on weather a EMG would be a good idea instead of the nerve root block. Don’t want to do surgery again only as last resort. They brought up the idea of steroid injections to get rid of pain in neck and shoulder so i can continue my career. Any advice please reply

Answer:

In situation like yours, I would want to know what is causing the recurrent symptoms before I treat and an EMG (you can’t have an MRI because of the metal plate) would be very helpful.

Nerve injury due to bulged disc; is it reversible?

If a disc has caused nerve damage in an arm, will it be permanent or can it be fixed?

Answer:

Nerve damage is reversible when the nerve is still connected (in continuity) and the cause of the damage has been removed. Disc bulges usually leave the nerve connected, so when the cause is eliminated (or gets better on its own) the nerve regenerates. Nerve Growth is slow though, about 1 mm/day.

Mixed median nerve neuropathy with demyelinating features

I was tested two years ago and just advised today that I have the above diagnosis. I would like more information as I was told there is nothing to do since the damage has been done, except pain control and seeing a neurologist. Where do I find out more about this?

Answer:

That does not sound like a very good EMG diagnosis because it doesn’t tell you much. Usually demyelinating lesions of the peripheral nerves heal very quickly, unlike axonal lesions, where the nerve fiber is cut, which take longer to heal. I would have that report looked at by a qualified EMGer, neurologist or physiatrist

Posterior Interosseous Nerve Syndrome (PIN)

I just had an EMG a few weeks after a nerve conduction test revealed concerns in my elbow to wrist area. The EMG Doctor diagnosed me with PIN Syndrome on the spot. I have not heard from my primary care physician yet with the complete analysis; however, I don’t know what caused this or what to expect from here. Up till now there has been muscle loss around the wrist area and slight weakness in the hands. Is there a means to predict what I can expect in the future or what possibly causes PIN? Thanks.

Answer:

Posterior interosseous syndrome can be caused by elbow trauma, fibrous or tendinous compression of the Radial Nerve in the forearm, rheumatoid disease, cysts, etc. and usually consists of the symptoms you describe. Most causes are easily treatable, provided your doctor has determined the cause first. As for predicting what will happen in the future, first thing is to determine the cause and treat, and second thing is to think of nerve lesions in the following manner:

A nerve is like a wire (the axon) covered by a sheath (the myelin). When a lesion involves the myelin only, the nerve heals very quickly (few weeks). When it involves the axon or a combination of myelin and axons, then healing is slower, months, provided the offending lesion is removed.

So you need to know what is causing it and if it consists of myelin, axon or myelin and axon lesion.

Comment:

Thanks for the info. I have no recollection of any one event that could have caused this. I have participated in a lot of sports in the past but can never remember any injury or event, etc. It does seem that the outside of my elbow has slight discomfort when I rotate my hand and wrist inward while making a fist. The joints in my hip and ankle on the same side have been slightly bothering me from time to time, especially when I run (about 4 miles per day).
My question is how does one determine the cause you mentioned in your response? Are there additional tests or other means to determine the cause?
Thanks again for the information. It is really helpful.

Answer:

My concern in your case is that you haven’t heard from your primary care physician yet with the complete analysis. So wait until you find out and make sure you mention the wasting and weakness. The questions you want to ask are:

Is this truly PIN and what is causing it? Could it be something else? Is there anything else associated with it?

Then you will have a better idea as to where you’re heading.

Arm-shoulder-neck pain, with no gain from operation

At first they thought it was carpel tunnel but then said it disc C5&6. Oct 97 disc was removed and C5&6 fused and removed 3 sets of bone spurs, however they were unable to remove all sets of bone spurs. Perhaps this is why I am unchanged with my pain? My pain is from my right arm/hand all the way to my neck/head where I have mayofacial pain. I have burning spots here& there up my arm and a major knot in shoulder and occasional pain in left arm/hand from overcompensating. I stepped down from my desk job in ’96 (unable to type/write) to a light duty job, which only temporarily gave relief. I had the neck fusion operation in hopes to get my (a) job back. Symptoms started / progressed since ’88. Any insight? Thank you.

Answer 1:

Please don’t feel alone. Though I had carpal tunnel in my left hand. Due to severe pain and numbness in fingers, arm and now shoulder. They gave me an EMG and found my left arm/wrist to be fine and my right hand to have moderate TC. That’s the hand that is good. Then the EMG showed nerve damage/problems in the neck. My spinal x-ray showed c5, 6 &7 to be degenerative and numerous bone spurs. Also, they said it looked like the area the nerve was in was narrowing?? This came on to me like over night after I worked real hard shoveling a long road area. I also had fallen the day before and maybe that jolted the spine. I know there is help out there. We just need to find it.. I am searching all the sights. I can’t handle night time.. I cry myself to sleep. It hurts so badly. During the day I can handle it. Take care.

Answer 2:

I am not quite sure where to begin. I guess the first thing is to make sure that you do not have a carpal tunnel and the second is to see if your nerve roots (C5-6 and/or others) are not still compressed. An EMG would help answer both. Of course an MRI of the neck would also help to see how the fusion is doing.

Comment:

Dear doctor, Thank you for your reply. I have an EMG scheduled now 4/20. My C5-6 fusion (Oct97) is healed per my postoperative x-rays every 4 weeks for 6 months and 1 MRI. I had another MRI from a different doc 8/98, which said other disc is starting to go. My doctor told me he removed 3 sets of spurs. Six months later I found out, when he referred to spurs still in my x-rays, that there were still spurs there. He said that the ones still there had been too dangerous to remove during the operation. If the operation was unsuccessful in stopping my pain he said there was, unfortunately, nothing more he could do. Did the EMG & NCS procedures exist in 1996’97? If so, I wonder why my doctors never thought of my having them before operating? What is the difference between CERVICAL RADICULOPOTHY and DEGENERATIVE DISC and CERVICAL STENOSIS. Also is a slipped disc the same thing as a bulging disc? Thank you again in advance.

EMG for CTS & Spinal Stenosis vs. Hip Replacement

My mother broke her hip and her wrist in 1993. She has since been diagnosed with CTS and Spinal Stenosis. She is in quite a bit of pain and has just been referred for an EMG for the arm and the leg. Is there any reason that both could not be done on the same day? Also, will the EMG help to resolve the question of whether the stenosis or the hip is causing her pain?

Answer:

Usually the EMG of the arm and leg are done in a single session. Also the EMG will be able to determine whether or not the spinal stenosis is causing nerve damage which in turn causes pain.

Cervical spondylosis, bone spurs & traction

I need your help, please tell me is there a site on help for degenerative c5-c6 c6-c7 discs. I am 42 and I was told that my discs have degenerated with bone spurs, which are taking up the room where my nerve is and that is why I am having the severe pain/tingle/numbness down my entire left side. They wrote on my diagnose treatment for PT – cervical radiculopathy -traction machine program. I wish they wrote neater. Please explain this to me. I’m afraid that traction might be the wrong thing?? This sounds like something for a slipped disc. Not degenerative one?? Also thank you for all your prior help. You gave me the courage to go through having these tests. They stated that my x-ray showed great narrowing. Is there any thing I can do? Such as an exercise or a special diet to dissolve the bone spur matter or prevent more? Thanks again

Answer:

There is a wonderful patient education site, which talks about bone spurs etc. I think you’ll find it useful. As for traction it is usually prescribed for discs not bone spurs. If you don’t find it is helping you, you can stop it. There are no diet exercise / programs that get rid of spurs, these form over years and can only (if need be) removed surgically.

EMG with C disc “Shoulder, arm and neck pain”

I am scheduled for an EMG upper extremity. An MRI shows bulges at 5-6 and 6-7. At this time the pain is excessive. It feels like someone has shoved a white-hot branding iron under my scapula. What exactly will the EMG show? And, how painful is the test? I am a surgical assistant; will I be able to return to work the day of the test?

Answer:

The EMG should tell you if the disc bulges are causing any nerve damage which is causing your symptoms. The test is uncomfortable (there are a couple of posts above which go into this) and lasts about 30-45 minutes. Normally, you should be able to go to work afterwards because nothing is injected or drawn during the test, but if you are in a good deal of pain to begin with, you may be uncomfortable after the test and my advice to you is to take the day off

Cervical disc with severe UL pain

I have nerve damage in arm from a cervical disc. Later, both arms been killing me and feeling dead and cramping up. What’s going on?

Answer:

Your problem could be related to the cervical disc, perhaps unusual to be both sides. You should consult neurologist to diagnose and help your pain. EMG should be valuable in your case to point further to the nerve damage.

Tunnel Syndromes

I am a 51-year-old male and since the age of 35 I’ve had several surgeries for nerve problems. First I had two surgeries for Carpal Tunnel of the right wrist, then Radial Tunnel Surgery of the right arm, and this month I will be going in for Tarsal Tunnel surgery. My health is good out side of this I have no major health problems. I did notice within the past few years I’ve suffered with sever sweating (hot Flashes). My question is, all these nerve problems seem to be occurring on the right side of my body. Included in these problems I’ve had sever spasms in my right ribs and sever pain on the right side of my neck and shoulder. Why does this seem to be happening to me and have there been any other cases similar to this? This is almost like a chain reaction of nerves, one problem after another. Can you help?

Answer:

I am not quite sure why you’ve had all these surgeries. While Carpal Tunnel is a common one to have, I must admit that I haven’t heard of too many patients having Radial Tunnel surgery. Tarsal Tunnel is another uncommon one. Sweating on the right side of your body can be caused by a problem in what we call the autonomic nervous system and would be something you need to look into. My advice to you is to seek a good neurologist and try to let him/her sort these things out for you.

Comment:

Thank you for responding. The sweats I’m having are through out by body not just on the right side and have been sever. It keeps me up all night. The Tarsal Tunnel surgery I’m having this month is because I lost the feeling in my heel, big toe and little toe and the ankle is painful. I’m glad that there may be an association between these nerve problems and these sweats this could narrow the search down. I would have never thought of this. And thank you again

Puncture to nerve in inner elbow area

I was in for a routine physicial on March 29th. And upon a blood draw I experienced intense pain shooting to my left hand. I thought right away it was my nerve. The lady that took the blood said she had never experienced that either. I have been seeing an intern and he had his dad who semi-retired and is a neurologist do a nerve conduction test last Wednesday. The test came out negative. I have numbness in my hand and fingers I have had what my therapist call a lot of trigger points in all areas of my lower and upper arm all the way to my underarm. I have been going to therapy for three weeks being treated with heat and electro therapy. Should I be as concerned as I’m on Vioxx for the inflammation if I don’t take it by the end of the day my arm is clinched so close to my side because my whole arm hurts. Is there another test I should have done? Should I continue the therapy and give it time? Would an MRI tell me what is going on in there, could she have got a tendon also? I thought I should give you all of my symptoms. It started with tingling in my hand and fingers shortly after it happened. The tingling started spreading up my arm and I started getting increased discomfort in my elbow area. Within 5 day’s the muscles in my arm started hurting. Today my fingers are numb and are very sore and stiff. My muscles in my underarm hurt a great deal as well as my forearm and bicep. The discomfort in my arm changes spots. The pain in my fingers is consistent I’m sorry to post twice before a response but I just found this forum and I have been searching for answers to insure I am getting the right treatment. I have never had something like this. It’s been a month. I have been told it takes a long time for nerves to heal. I guess I just want to know how long, and is it my nerve. Will an MRI show what it is or would you recommend an EMG? Thanks so much, I’m scared! Thank you for any advises you can give me.

Answer:

According to your symptoms, it seems like a nerve lesion by injury or pressure, probably the median nerve was injured during needle puncture. I wonder did you have an EMG needle examination of the muscles or just nerve conduction studies. If it is so, then I think you need to see your neurologist again to do (or repeat) EMG needle examination of the muscles, which should be helpful to exclude nerve lesion and its degree. I think the EMG is more helpful in your case than MRI

Comment:

I went to a Neurologist yesterday and was diagnosed with a median nerve lesion. I have been treated for 6 weeks for ulnar neuropathy. Lots of therapy and taking Vioxx but I still had a lot of pain. You suggested I see a neurologist and get an EMG. I found a sharp Dr. and the Dr. agrees, he will be doing the test on the 22 of May.
My question is He gave me a prescription for Neurontin, I was wondering if it will interfere with the test in any way.
I am very thankful for this forum and for all your help. I will keep you posted. I still have a great deal of pain in my whole arm and I hope the Neurontin will help.

Answer:

I hope all the best for you and to get well soon. About the Neurontin, it does not interfere with EMG test at all.

Comment:

Hello Dr., I have appreciated all of your advise in the past.
I went to the Neurologist Wednesday he does believe I have a Median Nerve lesion. He did a nerve conduction test and told me it did not show any concerns of permanent nerve damage or motor skill damage. He has me on Neurontin, I am up to 4x/300mg per day. I was told He does believe I have pain and that the nerve will take time to heal. I was very relieved to hear that and left his office feeling good, then when I got home I started thinking why did nothing show up when I have so much pain.
The pain is mostly in my finger index, middle, and ring finger. If I wait to long before I take the medicine I have a lot of discomfort in my elbow and lower arm.
The Doctor said, “be patient”. Those nerves heal an inch a Month.
I called the office back today and asked if he would send me for an MRI and he had the nurse tell me he would not OK it.
I was hoping I would have someone tell me exactly what is happening in there.
Should I just give it time he wants me back in 2 Months.
Thank you in advance,

Answer:

Thank you. I am pleased that you feel better. All the best

Treatment for pinched nerve

My husband has been diagnosed by a general practitioner as having a pinched nerve. The pain starts in the neck and runs down the shoulder, elbow, arm and some of his fingers are numb and tingly. This all came on very suddenly. He has been in extreme pain. They did x-ray his neck to check for disc problems and said that everything was fine in that area. At this point he is on Percocet and several muscle relaxers. Should he see a neurologist? I already made an appointment with my neurologist to see him next week, but was not sure if he should continue with the general practitioner first. Thanks for your advice.

Answer:

I would agree with you to see a neurologist. He may have more to offer. However, regarding the pain, it is usually ease away with the time.

EMG/NCS & MRI positive for cervical radiculopathy but normal myelogram
I had EMG and NCS done in november99 positive for c6-7 radiculopathy also an MRI showing c 6-7 bulging disc. Just had a myelogram recently and the doc said it looked “real good”, and I don’t have a disc or nerve problem. Now I’m confused

Answer:

Diagnosis of radiculopathy or disc herniation (root lesion) depends on clinical examination, EMG and radiology including MRI and Myelogram. The myelogram is most accurate way to detect disc herniation. Now an abnormal EMG can result from herniated disc in your case but the herniated disc may be too small to be significantly “appreciated” by myelogram, so considered insignificant by myelogram, although it is causing nerve root pressure symptoms and abnormal EMG. Furthermore, an abnormal EMG can be explained by other causes distal to roots, which could give similar EMG findings such as Brachial plexus or peripheral nerve lesions.

Needle EMG and Radiculopathy and who is authorized to perform EMG?

Is a needle EMG always required to suspect that a patient has radiculopathy or can a Dermatomal Evoked Potential Test and/or a Somatosensory Evoked Potential test raise suspicion that a patient has radiculopathy? Can a chiropractor or a podiatrist perform a needle EMG?

Answer:

Evoked potentials test the sensory roots (they go from the periphery to the spinal cord) but don’t test the motor roots, those which, through the muscle, control movement. Therefore Evoked potentials can only tell you if you have a sensory radiculopathy. Only Needle muscle examination can tell you if the motor root is involved. You should also know that some studies indicate that EMGs may be (falsely) negative in up to 30% or 40% of root lesions.

30-40% false negative in detecting root lesion

In your answer to a previous post you stated that some studies have indicated that needle EMG can give false negatives 30-40% of the time in detecting a root lesion. Why is this? Also does this apply strictly to testing for radiculopathies or other disease processes as well?

Answer:

That does not sound like a very good EMG diagnosis because it doesn’t tell you much. Usually demyelinating lesions of the peripheral nerves heal very quickly, unlike axonal lesions, where the nerve fiber is cut, which take longer to heal. I would have that report looked at by a qualified EMGer, neurologist or physiatrist

Posterior Interosseous Nerve Syndrome (PIN)

I just had an EMG a few weeks after a nerve conduction test revealed concerns in my elbow to wrist area. The EMG Doctor diagnosed me with PIN Syndrome on the spot. I have not heard from my primary care physician yet with the complete analysis; however, I don’t know what caused this or what to expect from here. Up till now there has been muscle loss around the wrist area and slight weakness in the hands. Is there a means to predict what I can expect in the future or what possibly causes PIN? Thanks.

Answer:

Yes, thanks for the clarification; the 30-40% false negatives in the studies I quoted applies only to radiculopathies.

This is due to many factors, including the fact that while radiculopathies may be painful, they may actually not cause any nerve damage (which is what is picked up by the needle exam of the muscle), sampling or interpretation errors, detection error due to poor relaxation, timing of the exam etc..

Comment:

Thanks for the clarification. Are there any general statistics in regard to false negatives or diagnostic accuracy in general for EMG? Or are there statistics for individual disease processes such as neuropathies, myopathies etc?

Answer 1:

Well, generally speaking, in compression or entrapment neuropathies (such as Carpal Tunnel, Ulnar, Radial or Peroneal Neuropathies, or Bell’s Palsy), the yield is pretty high (I do not have numbers) even though there are still false negatives. In root lesions, as I mentioned before, the yield drops, as it does in neuropathies and myopathies, probably again in the 30-40% area. EMG is considered to have the highest yield in entrapment/compression neuropathies.

Answer 2:

I would like to tackle this point by talking about how the electrodiagnosis contribute to diagnosis of myopathies in form of false positive or false negative. First of all, it is important to keep in mind, unfortunately, that none of the abnormalities in EMG is pathognomonic or specific for any single myopathic disease. Second, EMG is important but general guide to diagnosis, but we should keep in mind again that exceptions do occur. Now, the question, could EMG be false positive in myopathies? The answer is yes, due to technical reasons (MUP measurement, over-reading), also it can be false negative, due to again technical reasons (MUP measurement, simply missing mild changes) or mistaken the changes to be due other cause. Regarding neuropathy, again, false positive can occur due to technical reasons, temperature and age. While the false negative can also be due to some technical reasons in the recording.

Cold blue hands with severe pain

I am a 31-year-old female and have been diagnosed by 4 different doctors with abnormal nerve conduction. They are now checking chromosome 17 and a couple of them say my arms will only get worse. I am in extreme pain most of the time, I have muscle spasms in both my forearms, At times I cannot move my hands at all and the veins or nerves get so swollen they look like they are going to come out of my skin. My hands are constantly cold and my fingernails turn blue to the point where people have thought I was wearing nail polish. It pains me just to type this. The pain goes no higher than the elbow. Are there any answers you can give to me? Thank you for your time.

Answer:

I am not quite sure what the abnormality is on your nerve conductions but symptoms you describe involve more than just your nerves and at least involve collagen tissue and your blood vessels (the coldness you describe and the change of color sounds like Raynaud’s phenomenon). Usually Rheumatologists are specialists in this area. Any nerve or nerve conduction abnormality is a secondary phenomenon and can be diagnosed/treated by a Neurologist.

Comment from another patient:

A friend’s daughter has those symptoms and she was diagnosed with Raynaud’s. Have you been checked for that? Good luck

MRI & EMG positive while myelography negative in cervical radiculopathy

I had EMG and NCS done in november99 positive for c6-7 radiculopathy also an MRI showing c 6-7 bulging disc. Just had a myelogram recently and the doc said it looked “real good”, and I don’t have a disc or nerve problem. Now I’m confused

Answer:

Diagnosis of radiculopathy or disc herniation (root lesion) depends on clinical examination, EMG and radiology including MRI and Myelogram. The myelogram is most accurate way to detect disc herniation. Now an abnormal EMG can result from herniated disc in your case but the herniated disc may be too small to be significantly “appreciated” by myelogram, so considered insignificant by myelogram, although it is causing nerve root pressure symptoms and abnormal EMG. Furthermore, an abnormal EMG can be explained by other causes distal to roots, which could give similar EMG findings such as Brachial plexus or peripheral nerve lesions.

Conservative Vs. surgical management for c. radiculopathy & myelopathy

I had an MRI with the following impression: Narrowed right C5-6 neural foramina from osteophytes. Slight flattening of the central and left Paracentral thecal sac at C5-6 from disc bulge. I saw a neurosurgeon who recommended surgery after evaluating the history since onset (3 months ago) of arm numbness/tingling stabbing spasms, reflexes and MRI. Neck pain in almost not present now. Arm numbness/tingling pain spasms continue but are less frequent and intense. Do you think I am a candidate for surgery?

Comment:

I forgot to add that the end of my thumb, the last knuckle, is “always” “constantly” a little numb now, since mid June. Which the neurosurgeon said I would never get back because the nerve root was damaged not just irritated & inflamed. Sometimes I feel as if it’s creeping up my arm and my wrist is ever so “a tiny bit” numb all the time now too (as it feels just a little off). Would this information increase your opinion that surgery would be helpful to prevent and improve my situation? Thank you by the way for your thoughts on the subject.

Answer:

Nerve damage, with no prospects of it getting better on its own, is usually an indication for surgery. Again, if you are at all unsure, it is best to seek a second opinion. It would be useful to get an EMG before the surgery however to determine the amount and location of nerve damage. Best of luck.

Comment:

Thank you again for your advice. I saw an orthopedic spine surgeon and he prescribed VIOXX and 3X’s a week (for six weeks) of PT (physical therapy); heat, massage, traction and so on before re-evaluating surgery need in six weeks. My right arm reflexes are still there— but way off, the numb/tingling stabbing pains are less intense and they now only come with certain head/neck/arm positions. I’m hopeful the PT will do the trick. Thanks again!

I have another question. What is the significance of a diagnosis of cervical spondylosis with myelopathy? What is Myelopathy and how does a neurosurgeon diagnose it. Another words what are the symptoms of cervical myelopathy (at the C5-6 level for example)?

Answer:

Cervical Spondylosis with myelopathy means that you have a tight spinal canal in the neck area. The spinal cord is inside that canal of course and it comes under pressure because of the lack of space. This is what is referred to as a myelopathy (myelo refers to the spinal cord and pathy is used to indicate disease). The diagnosis is made by CT or MRI and or myelogram. The symptoms may involve root symptoms (the ones you described above) and also some weakness and increased reflexes in the legs if the canal is too tight.

Comment:

Thanks for all your input. Seeing another doctor helped. After 6wks of PT I saw the Orthopedic doctor yesterday again, for re-eval after PT. He said I have beaten the odds.. Considering how large my disc bulge was, the swelling has gone done enough so that I no longer have myelopathy nor is there permanent damage. He did say that I had about a 30% change of needing the surgery sometime in the future, due to the nature of cervical spondylosis.

In your experience would you agree or disagree with the likelihood of future surgery need in such cases?

And what would be the best course of action to optimize my continued recovery, non-recurrence (including myelopathy) and therefore the need of surgery (ACDF)? Thank you!

Answer:

I cannot say what the chances exactly are but I think 30% is about right. I also understand your concern about doing the right thing to avoid recurrence. In such cases however it is difficult to predict what may cause such recurrence. Needless to say staying fit and getting right away in treatment (PT, anti-inflammatory etc.) when symptoms develop would help. Other than that, in all practicality, there is little you can do to prevent events outside of your control.

Comment:

Thanks again; gee I’ve said that a lot. My doctor advised me also about staying fit. I am slowing entering back to my workout routines. He also gave me an “ER” prescription (fill only if symptoms come back) for anti-inflammatory and advised me to ‘save up’ PT visits encase of reoccurrence; as insurance cuts one off after X amount of visits per contract year. Should symptoms reoccur would you advise getting a myelography before surgery this time? And why?

Answer:

If you mean a myelogram, that’s a purely surgical decision, in most instances an MRI will suffice to see if there are any significant changes since your last visit.

Husband EMG who has shoulder neck and elbow pain with negative MRI

AI’m concerned over my husband. He had a negative MRI and had following EMG findings. He has gone through Facet block with no relief and has bad L Shoulder, neck, and L elbow pain going down two small fingers with positive Tinel sign. Other options we could look for it has been a year now. Test was 4 month after accident. Muscle Ins Act Fibs PSW FASC CRD AMPL Duration Poly REC The reading for his lumbar area was L Tib anterio I 0 0 0 0 n n I rr R ” ” I 0 0 0 n n I rr L Medial Gas I 0 0 0 n n n rr R ” ” I 0 0 0 n n n rr L Vastus Med n 0 0 0 0 n n n rr L Bicep Fem I 0 0 0 0 n n n rr L Paraspinal I 0 0 0 0 R ” ” I 0 0 0 The upper area showed L deltoid I for insertion and rr for recruitment, rest normal L Infraspinatus all normal L tricep I for insertion and rr for recruitment, rest normal L flexor carpi ulnaris I for insertion, PSW, RR recruitment, rest normal R flexor carpi ulnaris I for insertion, rr for recruitment L & R first dorsal interosseous I for insertion, PSW, rr for recruitment, rest normal L & R extensor digitorum communis I for insertion, rr recruitment, rest normal L paraspinals I for insertion, rr recruitment, rest normal. My husband had no readings for any fibs or fasc just 0. Any help appreciated thank you

Answer:

It is very difficult to interpret an EMG study over the web. Naturally the EMGer who performed the test is best qualified to give you the definitive answer.

From the limited information I have, these findings (PSW, polyphasic units.) can be seen when there are pinched nerves in the back and the neck. In the example you give me, the muscles involved point to the L5-S1 nerve roots in the low back and to the C8-T1 nerve roots in the neck.

Radiculopathy with negative EMG for nerve damage

I have constant numbness/tingling in my R LE (bi lateral at times), increased with activity. Can you explain how I can have the diagnosis of radiculopathy with a negative EMG? What exactly does it mean, and will epidural steroid injections help? Does it mean it’s permanent? Also, how could a sensory root lesion be detected, by NCS?

Answer:

To explain further why the EMG is negative in some cases with radiculopathy. The medical reasons were pointed out in previous posting. But I would like to say, if you have a car with maximum speed limit of, say 120, then it cannot go faster than that. Similarly, in EMG it has its own limitations we cannot exceed. We cannot do more than what it could give; otherwise, we do not need any other tests. The EMG is complementary or extension to medical examination and it does not replace or substitute a good medical examination by all standards. To go back to your question of epidural steroid injection, it may help, and it is up to your treating doctor to decide. A negative EMG in your case does not mean that your symptoms are permanent. On the contrary, a negative EMG can be reassuring. Finally, I am sorry, I do not know how to help you with the last point.

Puncture to nerve in inner elbow area

I was in for a routine physical on March 29th. And upon a blood draw I experienced intense pain shooting to my left hand. I thought right away it was my nerve. The lady that took the blood said she had never experienced that either. I have been seeing an intern and he had his dad who semi-retired and is a neurologist do a nerve conduction test last Wednesday. The test came out negative. I have numbness in my hand and fingers I have had what my therapist call a lot of trigger points in all areas of my lower and upper arm all the way to my underarm. I have been going to therapy for three weeks being treated with heat and electro therapy. Should I be as concerned as I’m on Vioxx for the inflammation if I don’t take it by the end of the day my arm is clinched so close to my side because my whole arm hurts. Is there another test I should have done? Should I continue the therapy and give it time? Would an MRI tell me what is going on in there, could she have got a tendon also? I thought I should give you all of my symptoms. It started with tingling in my hand and fingers shortly after it happened. The tingling started spreading up my arm and I started getting increased discomfort in my elbow area. Within 5 day’s the muscles in my arm started hurting. Today my fingers are numb and are very sore and stiff. My muscles in my underarm hurt a great deal as well as my forearm and bicep. The discomfort in my arm changes spots. The pain in my fingers is consistent I’m sorry to post twice before a response but I just found this forum and I have been searching for answers to insure I am getting the right treatment. I have never had something like this. It’s been a month. I have been told it takes a long time for nerves to heal. I guess I just want to know how long, and is it my nerve. Will an MRI show what it is or would you recommend an EMG? Thanks so much, I’m scared! Thank you for any advises you can give me.

Answer:

According to your symptoms, it seems like a nerve lesion by injury or pressure, probably the median nerve was injured during needle puncture. I wonder did you have an EMG needle examination of the muscles or just nerve conduction studies. If it is so, then I think you need to see your neurologist again to do (or repeat) EMG needle examination of the muscles, which should be helpful to exclude nerve lesion and its degree. I think the EMG is more helpful in your case than MRI.

Comment:

I went to a Neurologist yesterday and was diagnosed with a median nerve lesion. I have been treated for 6 weeks for ulnar neuropathy. Lots of therapy and taking Vioxx but I still had a lot of pain. You suggested I see a neurologist and get an EMG. I found a sharp Dr. and the Dr. agreed he will be doing the test on the 22 of May.
My question is He gave me a prescription for Neurontin, I was wondering if it will interfere with the test in any way.
I am very thankful for this forum and for all your help. I will keep you posted. I still have a great deal of pain in my whole arm and I hope the Neurontin will help.

Answer:

I hope all the best for you and to get well soon. About the Neurontin, it does not interfere with EMG test at all.

Comment:

Hello Dr., I have appreciated all of your advise in the past.
I went to the Neurologist Wednesday he does believe I have a Median Nerve lesion. He did a nerve conduction test and told me it did not show any concerns of permanent nerve damage or motor skill damage. He has me on Neurontin, I am up to 4x/300mg per day. I was told He does believe I have pain and that the nerve will take time to heal. I was very relieved to hear that and left his office feeling good, then when I got home I started thinking why did nothing show up when I have so much pain.
The pain is mostly in my finger index, middle, and ring finger. If I wait to long before I take the medicine I have a lot of discomfort in my elbow and lower arm.
The Doctor said, “be patient”. Those nerves heal an inch a Month.
I called the office back today and asked if he would send me for an MRI and he had the nurse tell me he would not OK it. I was hoping I would have someone tell me exactly what is happening in there.
Should I just give it time he wants me back in 2 Months.
Thank you in advance,

Answer:

Thank you. I am pleased that you feel better. All the best

Comment posted later by the same patient:

I have post several times in the past and you have been very helpful. I currently am healing I hope from a puncture during a blood draw. I am concerned and have asked my Doctor about a tingling in my cheek that started shortly after the injury. It is not always there and changes to different areas of my left cheek. The elbow that was injured is my left elbow. It has been 5 months.

Is this something that can happen when you have an injury of this kind?

I have the physical therapist tell me everything is connected and as long as I take the Neurontin I am on regularly it is not as noticeable.

Answer:

I cannot see a relationship between the problem at the elbow and the tingling in your cheek. I am not sure why do you have cheek tingling. It seems coincidental.

Comment:

I got my injury to my nerve back at the end of March (blood draw, elbow). I have had a lot of different stages of healing, and strange feelings at different times. I get jabs and pains in my fingers but I also get jabs and pains in my toes. Do you think this is all a normal part of healing? I had an EMG in May and I was told it did not show any sign of Permanente damage.

Should I have another test done? I am on Neurontin 600 mgs three times a day. I get these pains if I go to long between doses.

Should I get another EMG?

Is this normal?

Should I see another Doctor?

Answer:

I can understand the pain in the fingers but not the pains in the toes. Therefore, it would be good idea to consult another doctor before you proceed to another EMG.

Comment:

I have posted before and you have given me good advice. I the best advise you gave me was to see another Doctor. I did and was given diagnoses of Venipuncture RSD, are you at all familiar with this? I am hoping I have not waited to long to get the right Doctor. I have had two visits with Dr. who is in Florida and he has treated RSD in patients for 30 years. I feel I am getting the proper treatment although he has said that my type of RSD is the most vicious type to have. He has me on 4 medications and I am in Physical therapy and I am using a heat pad and feel somewhat better. I have stopped taking the Neurontin that was making me very tired all the time and that caused me to gain 20 lbs. in 8 months. I have a very scary health problem that might be with me for life.

I had told you and you asked me to keep you posted so I am doing that. I hope that if there are other patients out there that don’t feel the Doctor understands their pain that they get other help and with someone that knows about RSD.

Neck/Arm Nerve damage from Anesthesia Needle

Hello, I have a friend that was to undergo surgery about 5 weeks ago. In the course of having the anesthesia put into his neck, the anesthesiologist hit a nerve. My friend’s arm became uncontrollable and through some very scary moments, the anesthesiologist succeeded in applying the full anesthesia — but the surgery was canceled due to the immediately obvious consequences: right arm in severe pain, limp and no motor control. After 5 weeks, the pain is at a constant level – no change. He still has virtually no motor ability in his right arm. He describes what he feels this way: “It is like my arm is going to explode from pressure.” He has the sensation of his arm being completely “inflated”, though there is no inflation apparent on the outside. Multiple physicians have been consulted. Everyone has a “wait and see” conclusion, as this is such a rare thing, and none consulted have had any experience with this kind of incident. At this point in time, my friend lives with pain every second. He is looking for ideas — directly or anonymously — as to how he can 1) perhaps stimulate nerve regeneration, 2) expedite nerve regeneration, 3) any experiments.

Answer:

It is difficult to imagine exactly what happened, but in such instances, it is not uncommon that the nerve can get damaged as a result of the puncture or the injection. Nerve damage resulting from puncture or injection can take a long time to recover. In such cases I recommend seeing a neurologist to get an EMG and assess the amount of nerve(s) damage and then a Neurosurgeon who specializes in peripheral nerve surgery in particular. This will be useful to determine if any surgical intervention may be necessary, now, or after a certain period of time has elapsed to give the nerve enough time to heal on its own.

Cervical Myelopathy
It has been a while since I have left a message. They think that I have cervical myelopathy. Six months later, and 4 doc’s. The most recent doc I visited talked with me for 10 mins. Watched me walk and said this is what he thinks I have. 98% sure! Anyone out there ever heard of it??? Am taking Baclofen 10mgs at night for the first 15 days then twice a day after that. Any comments?

Answer:

Cervical myelopathy is due to pressure on the spinal cord at the level of the neck. Baclofen should help to ease the spasticity. All the best.

Brachial plexus injury

If damage occurred to a nerve during shoulder surgery, will nerve conduction studies show the damage to that nerve? Symptoms include decreased range of motion, atrophy of muscles in arm and severe pain. Also have history of some carpal tunnel syndrome. Will the test shoe which injury is causing the problems listed above? Also, is the needle test really necessary if you have already had the other part of the test and it showed nerve damage?

Answer:

Yes, nerve conduction studies are very helpful in your case. It should help to tell where is the lesion and is it one or more than one nerve involved. Also, I would think that needle examination in important in your case.

Best treatment for C3/4 disc protrusion

With C 3/4 disc protrusions and radiculopathies what’s the best course of treatment?

Answer:

You’re asking a very general question which is impossible to answer without a great deal more info on the subject, age, lab findings, symptoms etc.. There may be a variety of approaches which are suitable for some cases but not for others.

EMG/neurological tests in multiple level disc and upper and lower limb complains

I suffer from extreme low back pain and neck pain and weakness in my arms pains in my shoulders…and more. I had surgery on my back 10 years ago. I had an MRI and it shows multiple levels of bulging. I have numbness in hands and feet, sciatica, etc…My question is why do I have to go to a neurosurgeon or get EMG test?? I am going tomorrow for the neurology tests. However I already met with a neck surgeon who said he would be happy to operate on my neck…He didn’t need Nero tests???? It seems to me I should see a orthopedic surgeon not a neurosurgeon…I heard that neck surgery may stabilize a back…Is that true??? The multiple levels of bulging are in my neck…

Answer:

Various doctors rely on different tests to establish a diagnosis and it may well be that in cases like yours, there are too many doctors involved in the care who might not know what the others are thinking. It is always best to narrow down the number of doctors you’re dealing with to avoid such situations.

Just Wondering about cervical myelopathy

Has anyone ever heard of cervical myelopathy? Prognosis? Treatment? etc. After all I have been through I am very skeptical. Any feedback would be great!

Answer:

Cervical myelopathy means that you have a tight spinal canal in the neck area. The spinal cord is inside that canal of course and it comes under pressure because of the lack of space. This is what is referred to as a myelopathy (myelo refers to the spinal cord and pathy is used to indicate disease). Diagnosis is made by CT or MRI and or myelogram. The symptoms may involve root symptoms and also some weakness and increased reflexes in the legs if the canal is too tight. Treatment, when the disease is advanced, involves surgery to relieve pressure on the spinal cord.

Comment:

Thank you! You have told me more than anyone else I have asked. When searching the internet for cervical myelopathy, there isn’t much. I have started Baclofen 10 mgs twice daily, been taking for about 2 1/2 weeks, have noticed some increased weakness, but less cramping, a little more pain. No talk of surgery. Today I go for my first PT, hopefully something helps, and this has been the most frustrating 8 months of my life. Without your web site I would still be out in the dark!

Answer:

Would like to hear of your symptoms and history. I have been thru a very frustrating time also. I have weakness in my legs and ankles and increased reflexes. I also have tripped and fallen several times and suffered one broken bone already. I have a small spur in the cervical area (arthritic) PT has helped somewhat but certainly has not eliminated the problem. I do not have a lot of pain, just leg muscle cramping and stiffness and what I mentioned above. Baclofen has not been working for me. Doctors do not seem to be too anxious for surgical intervention. Would like to hear from you.

Myelogram results for cervical disc

I just got my myelogram back reads: Extradural defects located at the C 5/6 level of disc. What does this mean?

Answer:

The result of the myelogram would indicate that there is a sort of pinched nerve at that level (C5/6), which is the upper cervical level. This result should be taken into consideration in your further management after your doctor has looked at the myelogram films.

Having neck and UL pain. What specialty might be of help?!

Hello. I have been fighting headaches, neck, shoulder, arm, and back pain for about five years, and I’m wondering if someone can help me decide where to go next. I have been doctoring in a small town–have seen doctor, chiropractor, physical therapist, and anesthesiologist. So far physical therapy has helped the most. Right before Christmas, the last two fingers on my right hand went numb. I couldn’t start my car, had trouble opening doors, holding anything with a handle. The pain was worst right between (and under the right) my shoulder blades, but I’m also having pain across the top of my right shoulder and behind my right arm pit. In the past, I’ve had extreme tension-type headaches, stiff neck, cold and hot sensations down my right arm (usually feeling like water pouring down, heaviness in my upper arm, stiffness and pain under my shoulder blade, and a quivering across my upper back. My arm seems weak, but I can do things if I concentrate. The symptoms started while I was pregnant with my second child, but I can’t think of any injury that could have started them. I saw an orthopedic surgeon in a larger city last week and had an MRI that showed a bulging disc (C6-C7), but he feels that the disc isn’t significant enough to cause all this trouble. Wednesday I am having local anesthetic injected into the nerve root there as a “diagnostic procedure.” My question is this–am I seeing the right kind of doctor? I am completely frustrated by the pain and the amount of time I’ve wasted so far. Can anyone give me any idea of what I might be dealing with?

Answer 1:

I gathered that you have 2 problems that could explain your symptoms. The first one is the neck, this has been investigated by MRI and was not significant, and you are undergoing some further evaluation for that. But the second problem is the symptoms in the hands, that could be the cause of good deal of your symptoms, I believe a pressure or entrapment of nerve at wrist (carpal tunnel syndrome) should be excluded by doing (EMG). Seeing a neurologist would help you evaluate all your symptoms, including the headaches.

Answer 2:

I saw your post and also the reply by another doctor telling you to go see another doctor of course. I deal with clients everyday with your types of symptoms and it could very well be a situation involving your nerves somewhere between your head and your fingers. Since you have tried just about every type of doctor, I would suggest that you find a massage therapist to work with and start working with the muscles in your neck, upper back, rhomboids, pectoralis major and minor and all the way down your arm. Of course, don’t neglect the rest of your body either. Tight muscles can impinge nerves and cut off circulation to any part of your body. Releasing the tension in these muscles and getting the blood flow circulating properly again can do wonders. I know I had a serious injury, which involved symptoms that you are describing and studied to become a massage therapist while healing from my injuries. I believe massage therapy sped up my healing process and gave me lasting relief. And I still have doctors running around trying to figure it all out with all their tests. Massage therapists get right to the source and take care of it. Let me know if it helped or if you have any more questions.

Answer 3:

OR, you could burn incense and chant…..for God’s sake see a competent neurologist.

Need For EMG due to multiple sensory & motor complains

I was referred to a neurologist who has ordered an EMG but I am reluctant to schedule it. Briefly, symptoms for several years have included episodes of numbness in face, arms, and or legs (uni- and bi-lateral), extreme fatigue/weakness in primarily legs, arms secondary (episodes where extremely difficult to get up stairs), “heaviness” in legs, hand tremors, constantly dropping things, loss of balance and coordination. An MRI brain scan showed 1 lesion in deep right frontal lobe with differential of demyelination (no trauma history). I have an ongoing history of recurrent positive EBV. MS has been mentioned by my PCP. The Neurologist mentioned peripheral nerve disease but I don’t see how it fits with some of the symptoms. I haven’t seen EMGs noted as a primary diagnostic tool for MS. Would an EMG really be of any benefit? Any input would be greatly appreciated – Thanks!

Answer:

The EMG is not helpful in the evaluation of chronic fatigue syndromes (unless it is due to a neuromuscular transmission disorder such as myasthenia gravis). It would be useful however in detecting any nerve disease causing the numbness you describe and or the presence of muscle disease, which is causing the weakness and heaviness in the legs.

MS cannot be evaluated by EMG because MS is caused by a demeyelination at the Central Nervous System level which is not investigated by EMG.

Comment from another patient:

I just read your post as I was looking up info on having an EMG test done. We seem to have identical back problems, and I was wondering how everything has turned out for you. If you should get this post, I would love to hear from you.

Comment:

Thank you SO MUCH for your quick and thorough response! You provide a great service to the public and are a rare person in the field of medicine. In spite of my experience as a medical research writer, determining how to handle your personal health care can be quite challenging! Based on your response, I guess I should probably go ahead with the EMG. You mentioned CFS, and because of my background, I was able to locate one of the leading specialists at National Jewish after researching CFS and noting similarities to my problems. Of course, I’ve been on the merry-go-round of tests in order to rule out any other cause. If you think the test is worth a shot, I’ll go ahead! But, if you think otherwise, let me know. I’m quite tired of diagnostic tests!

Answer:

You’re welcome. At the bottom least, a negative EMG will rule out any “peripheral” cause of your symptoms. A positive one may help in addressing those, which can be treated.

Tingling and numbness in both hands, is EMG important?

I have recently had tingling and numbness in both of my hands. It gets extremely painful at night. I woke up one morning and my left hand was totally numb and it took over an hour for feeling to return. Blood tests that I have had in the past (unrelated to this) have had some form of indication of possible lupus or other disease as the doctors ask to do another test that will rule out these things. When the tests are run, the results are OK. I am being scheduled for an EMG for the hands and the information in your forum has been very helpful in knowing what that is all about. I’m just wondering if these blood tests are telling us something and we’re just missing what it is? There is also extreme cramping in the hands and feet. Thanking you in advance for any reply.

Answer:

I believe that your doctor is working in the right direction to reach a diagnosis. The EMG study, however, should be very valuable to rule out any nerve entrapment at the wrist (carpal tunnel syndrome), as your symptoms do really suggest that.

Persistent neck and back pain despite normal radiography

I was in a car accident about 2 years ago and have been in a lot of pain since then. I’ve had e-rays and a MRI done but they seem to be normal and I can’t understand if I’m normal why am I still hurting? Is there another test that would show more than what I’ve already had done? Symptoms are lower back pain, neck pain, and pains that go throughout my right side. Can you give me any advice?????

Answer:

You need to see neurologist or orthopedic doctor to have good evaluation, then he would decide if further tests are needed or not, including EMG.

Comment:

Thanks for replying to me. I seen I think an orthopedic Dr but he was I guess you can say a insurance Dr and made me bend over and looked at my MRI results and said “nothing” was wrong with me. I made a mistake in seeing this Dr and now insurance company is giving me a hard time. But if nothing is wrong with me I shouldn’t be hurting. Can you have nothing wrong and still hurt?? Thank you

Answer:

It seems to me that “nothing” i.e. no weakness and no other abnormalities were found on clinical examination and MRI. This is reassuring. Symptoms of pain may persist after car accidents. However, physiotherapy frequently helps.

Can biceps injury be due to CTS or disc bulge? Time of wearing splint in CTS?

Hello, I had an EMG done yesterday and have bilateral carpal tunnel. My question is this: the Doctor said that I have muscle damage in my bicep muscle, would this be a possible result of the CTS or maybe the result of a disc bulge in my neck? Also should I wear the splints during the day, if possible or only at night? Thanks

Answer:

The muscle damage in the biceps muscle is not a result of CTS, but may be a result of disc bulge in the neck. CTS does not cause damage of any muscle except the thenar muscle in severe cases. Regarding the wrist splint, you should wear it at night and day times.

CTS and Thoracic outlet syndrome?
I am concerned that my CTS might indeed be TSO, I have heard they can be confused, would an EMG be a tool to arrive at a definitive distinction? If not in your opinion what would be a useful diagnostic tool?

Answer:

Thank you. Careful history, symptoms and signs can often differentiate between them. Also, the electromyographer can quite easily tell between CTS or thoracic outlet syndrome (TOS) by nerve conduction tests and EMG. It is the best diagnostic tool to diagnose either. However, you may need other investigations (radiology) to see if there is extra rib (cervical rib) that could be the cause of TOS. Practically, CTS is very very common while TOS is very rare.

Bilateral elbow pain and swelling
For about 4 years now I have had pain on the inside of my elbow–you know where they usually draw blood? It wakes me up at night and it swells. Sometimes there is a hard knot there. I have it in both arms but my right is the most painful. I have tried to find out exactly what is there that could hurt but haven’t found anything. Any help would be appreciated.

Answer 1:

It sounds like a pain and swelling in both elbows, which does not go with a nerve problem. This is outside my specialty, however, I would suggest a consultation with Rheumatologist.

Answer 2:

I agree, this doesn’t sound like nerve in nature. In cases like this, it might be tendinitis (the Biceps tendon is in that area) or joint disease.

Comment:

Thank you both so much–at least I have an idea now what to look for. I forgot to mention that sometimes the pain radiates down the inside of my arm to the palm of my hand–it feels like someone has ripped my arm open with a knife. Thank goodness it doesn’t last more than about 30 minutes. Ascriptin AD helps a lot.
Thank you both very much.

Cold hands and feet with tingling in arms and back

I’m writing this because I’m at my last end. My symptoms have been…nerve pain in my thighs and tingling, cold feet and cold hands. I recently have been feeling tingling in arms and back. The doctor has run ten and ten of test and I even went to a nerve doctor and he ran electric test and the results were all normal but I still have the pain in my thighs. This is really starting to be annoying. HELP!

Answer:

These symptoms, in cases like yours, could be caused by a peripheral neuropathy, a condition that can have many causes, such as diabetes, alcoholism, toxic exposure, metabolic and other nutritional conditions.

For symptoms such as yours, it is best to start with a good internist and then have them refer you to a good neurologist. Many things could be at the origin of these symptoms.

Elbow brace wearing in ulnar entrapment

I just had an EMG and the Doctor told me that I had a severe pinching of the ulnar nerve. I have had numbness in two fingers since Christmas. Having difficulty picking things up and typing. He suggested I wear an elbow brace for one month and see him again. My question is what are the chances that a brace will work? Has it worked for anyone? Won’t I be able to tell if it is working by the feeling in my fingers? If the brace does not work and surgery is required, how long is recuperation? We are going to Scotland to golf in April and I sure would like to be healed by then. Thanks for any information.

Answer:

EMG result should be taken into consideration, among other factors, before we could say anything about recovery time or surgery. However, in general if the ulnar nerve compression is mild then you would feel that brace works perhaps in a week or two by having less or disappearance of numbness. But if the lesion is severe, it takes longer time, months (variable according to severity), or it might not work then it is the decision of the surgeon.

Partial hand sensory loss after fractured 5th metacarpal

My son was in an MVA fracturing the base of his fifth metacarpal on his dominant hand. Sensory deprivation in ulnar nerve distribution of right dominant hand below the wrist. Protective sensation absent, although NCV and EMG findings report nerve is healed. He is now having difficulty with 4th and 5th digital adduction and MP flexion with IP extension. If the EMGs and NCVs are normal what would be an explanation for his sensory loss and progressive motor loss? an aneurysm?

Answer:

I am not too sure whether the problem is in the ulnar nerve or digit bones. I am inclined from your description to say that it is NOT the ulnar nerve, as its study is normal. But to explain the sensory loss, it may be due to very distal lesion of digital sensory nerves that could be missed by standard studies.

Comment:

Thanks for your prompt reply; What test other than standard EMG/NCV would be appropriate?

Answer:

I would not have other tests or to suggest any. Just a careful neurological examination of the power and sensation should be very helpful to rule in/out any sensory loss or motor weakness.

Neck pain with upper limb radiation

I was hit by another driver 2 years ago and have suffered with neck pain, left arm pain from forearm to fingers, numbness in left hand and shoulder pain. I’ve been seeing and orthopedic doctor until recently when he ordered another MRI and it was normal. I was told to live with the pain or see one of the Partners. He didn’t know where the pain was coming from. The first MRI showed three bulging disc in my neck. Before the recent MRI I was told I had a nerve impingement of neck. I’m frustrated and confused as to why a doctor would drop a patient that is in pain. I told him I would go through any tests is he would just find the cause of the pain. I had to go back to my medical doctor and she has referred me to another orthopedic doctor in the same group but she has ordered a nerve conduction test due to left arm numbness and shoulder pain. What can I expect? To left arm numbness and shoulder pain. What can I expect? Also, both MRI where open, is there a difference in the open MRI and closed MRI and closed MRI, as far as result?

Answer:

EMG and nerve conductions are helpful. They may show pinched nerve in your case. However, I would recommend consulting a neurologist as second opinion either before or after doing the EMG and nerve conduction studies. Regarding the open or closed MRI, I do not know.

Shoulder/arm/hand/finger pain and numbness

I woke one Morning with painful R arm, (Mar 98) like if I had pulled a muscle. By the time I got to TX, my R arm was numb and painful, also like if it was paralyzed. I was over the road truck driver at the time but only for 6 months. I went to the Drs and after several tests I was told I had C5-C6 Slight herniated disk. So had the surgery in September of 98; the pain in my shoulder never did go away nor did the numbness in the hand. After several more tests I was told that I have impingement, so again after several physical therapy Sessions and no result. Surgery was done and about a half inch on bone was taken off of the shoulder. That was almost a year ago and still pain in shoulder and numbness in hand. Now it is in the left hand (numbness) involving the pinky, ring and middle finger, which go up to the elbow area. Although this numbness is more like a sleeping feeling, but is constant and so far no matter what has not gone away. So again more tests EMGs X-Rays and possibility of MRI and CT scans. I have had bone scans and arthritis has been ruled out. What is a DMG as that has been mentioned? I’m 45/female and normally very active.

Answer:

I do not know what DMG, but probably you meant EMG (Electromyography), which is a test for nerve and muscle. You will find details in the previous emails, particularly the last one. Anyhow, from your symptoms (left side), it is likely that you have pinched nerve, hence EMG is requested as well as other radiological studies. All the best.

Really painful muscle fasciculation in my thumb pad involuntary twisting & CTS

I had a EMG/NCS (Needle) (Nerve Conduction Study) in Jan, and I did go see a surgeon, and they want me to have surgery again, but I am hesitant. I went through a lot back in 1994, and had to give up a good job because of all this. I had bilateral Carpal Tunnel Syndrome surgery, and a right DeQuervains syndrome surgery with a ganglion cyst removed at the right carpal tunnel region back in April 1994. My right hand has not been the same since. My Left hand recovered fine. For the past few years, it has been getting progressively worse. I worked in a factory as a machine packer, packing 300 sweet-tarts per minute, and picking up / gripping (using my index finger and thumb) each box putting them on the conveyer belt. I developed DeQuervains syndrome, CTS, and a massive ganglion cyst due to this repetitive work. My doctor diagnosed me with repetition motion syndrome. I stayed off work for 6 years due to this injury. I figured I would try and find a job this past year, and work part time. I wanted to gradually get back to work, and get use to using my hands again. The job I took was just part time 4 hours a day doing light data entry. That is when I started noticing my right thumb having really painful muscle fasciculations in my thumb pad. At times, my right hand and fingers started having really painful charlie horse symptoms – thumb cramps – sudden tightening of the thumb muscle involuntary twisting movements, and uncontrollable thumb motions. I find it challenging to drive a car, open doors, pick up my grand daughter and a lot other daily activities are almost impossible. I recently talked to my doctor about the problem, and she sent me to have another EMG. Conclusions were 1. Mild to moderate delay of right median motor and sensory latency consistent with right Carpal Tunnel Syndrome. 2. Chronic denervation and giant fasciculation suggestive of injury or continued irritation of right distal median at the wrist of the branch to thenar muscles. The problem I’m having is in my thumb pad and my ability to grip, hold and open things. I am having really painful muscle fasciculation in my thumb pad. At times, my right thumb pad starts having really painful charlie horse symptoms -thumb cramps – sudden tightening of the thumb pad muscle involuntary twisting movements, and uncontrollable motions of my thumb. Any reason I may be having this? I did have another Carpal Tunnel Syndrome surgery, on Feb 13, 2001. I know I should not expect too much this soon, but I called my doctor because my thumb pad is still twitching and jumping around and having thumb cramps. He is telling me I have a rare condition and he is not sure how to diagnose my condition. He wants to send me to another Neurologist. I do feel my Carpal Tunnel Syndrome will be better with the surgery I had. He said I had a lot of scar tissue, and that was probably my problem, but my thumb pad is still painfully twitching and jumping around. I just wish I could find out what is wrong with the twitching and cramps in my thumb.

Answer:

It seems like you need to wait for possibly few more weeks to see some improvement because your condition is chronic. Now, if your surgeon is also suggesting a neurologist, then go ahead and see him.

Thoracic Outlet Syndrome

I just wish I could find out what is wrong with the twitching and cramps in my thumb, and was hoping may be someone could let me know if they have ever heard or seen this condition before. Today I went to see another doctor to get my stitches out, and my fingers were ice cold and were blue and purple and had no feeling in them. The new doctor said he talked to my other doctor and a few other doctors and they all think I have Thoracic Outlet Syndrome. He noted that’s what he was thinking I had. He said after reading my report, and seeing me today he is almost positive I have Thoracic Outlet Syndrome, and trying to locate just how far up my arm it goes. Right now he wants to give me some time to heal, and wait a little longer before he goes any further. I just had high hopes in this surgery, and guess I just need to give it more time. Just Looking for answers.

Answer:

The combination of CTS, which is a distal lesion, may rarely be associated with a Thoracic Outlet Syndrome (TOS), which is a proximal lesion of brachial plexus. The finger skin changes supports that. EMG can also occasionally help to confirm that. Whether to advocate for TOS surgery or not and when, this is a surgical decision. The surgeon should make sure how much benefit the patient would get out of the surgery.

Role of cortisone injection for intense neck and head pain accompanied by arm numbness

I have been reading your forum messages on arm, neck and shoulder pain. I had C5-6 fused in ’98 and continued to have severe neck and head pain to this day with numbness in my arm. My physician (neurologist) is treating the situation as the effects of surgery in the area with pain killers that are not very effective. Physical therapy only seemed to be limited help for a short while. I sought another opinion. The second neurologist has suggested a cortisone injection to the nerve in my neck to stop the pain which was viewed as a possible pinched nerve. I have also been experiencing “dropping” of things from my left hand. I have not seen this injection listed in any of the forums as a possible answer to the pain. I am scheduled to have this done in about a week and a half. Is this recommended?

Answer:

Cortisone injections reduce the swelling which may be causing the pain symptoms but do not treat the cause of the swelling. It is also useful to have an EMG in instances such as yours to find out if there is still any nerve damage and the extent and location of it. Carpal Tunnel is to known to cause the dropping of objects from the hand.

Is surgery sufficient for treatment of DeQuervain’s syndrome

I was recently diagnosed with DeQuervains’ Syndrome on my right hand. I previously have had carpel tunnel release surgery on both hands. My doctor gutter splitted my wrist and I can’t use my right arm for 3 weeks. I guess my question is this, After the 3 weeks is over, Is there usually more treatment and therapy involved, or does the split take care of the problem??

Answer 1:

DeQuervains’ Syndrome surgery should take care of your problem. However, physiotherapy is usually done afterwards. Orthopedic surgeon decides this.

Answer 2:

You can learn more about DeQuervain’s Syndrome by going to our main page, and clicking on the Patient Education Material link, which will take you a list with the DeQuervain’s Tenosynovitis link.

Long thoracic nerve vs. dorsal scapular in asymmetric scapulae

I have an asymmetric scapula that is low and prominent at the inferior medial edge and looks farther away from the spine than my other scapula and causes me lots of pain and problems. My EMG showed a single repetitive discharge from the LTN at the end of the test. The tester thought that clinically it didn’t seem to account for the way my scapula looked. I also showed moderate to severe weakness in all muscles tested on the right side of my back-scapular region. My rhomboids and levator were also tested. This has been ongoing for 2 years and I am quite impaired by the problem. I really need help to figure this out. I am not improving and although my scapula is not a typical textbook example of winging I have pain and weakness down the arm, and pain and looseness around the scapula. Could I have some dorsal scapular nerve injury too that is simply hard to find. My trapezius also looks a little sunken in on that side. Thanks

Answer:

Sorry for delay in replying. Now, winging of scapula can be due to long thoracic nerve or dorsal scapular injury. It depends on findings clinically and EMG. However, in your case you mentioned that trapezius is sunken a little, this muscle is not supplied by either nerves. This is against those possibilities. I think good neurological examination should help, but we should keep in mind that injury of nerves not the only cause of winging scapula. All the best.

Axonal Peripheral neuropathy

Need help understanding EMG report – please. Ending comment states abnormal EMG exam & nerve conduction studies. Two problems noted – 1) Mixed motor-sensory – but principally sensory neuropathy. With decreased amplitude & normal latencies – axonal in form. Changes shown by low-amplitude conductions and on motor side by marked increase in irritability distally bordering on denervation. Patient also has bilateral carpal tunnel syndrome with prolonged median sensory & palmar latencies. Can anyone put this in non-medical – simple English terms? Having problems understanding what is meant by “decreased amplitude & normal latencies” and also irritability distally bordering on denervation. Is this bad? Also, does anyone know where you can obtain standard nerve msec readings – for instance I have 4.1 msec for sensory distal latency – how bad is that? I really appreciate any and all help on how to understand what is going on.

Answer:

You are not alone in your confusion in interpreting this report. You definitely need to post more of the data (amplitudes, latencies and conduction velocities, as well as needle EMG results) to be more definitive. To answer partially…
1. Your nerves are built somewhat like a piece of wire, an insulating outer layer (myelin) and a bunch of small wires on the inside (axons). In general, if the myelin is being affected by some process, the conduction velocity will be slow and latencies will be prolonged. If the inner wires (axons) are being affected, the amplitudes of the response recorded are decreased. The description would indicate that you have some widespread process affecting the axons of the sensory nerves, although without the data I hesitate to say this.
2. The sentence about “marked increase in irritability …” makes no sense. Sounds like a reference to the EMG study (the needle part) but I can’t tell.
3. Normal values are dependent on many factors (technique, temperature etc), so again this is hard to comment on. Generally, 4.1 ms across a 14 cm distance (a typical distance for a distal sensory latency) would be mildly prolonged (but some reports would call this normal).
Confused yet? Again, need more data to be more definitive. Hope this helps.

Comment:

Thank you very much for your initial response. I didn’t know how much info to give as I am new to all of this but in a nut shell here is the report:
Results: Upper extremities-Irritability was normal, without fibrillations or positive sharp waves.
Lower extremities – Irritability was markedly increased in the intrinsic muscles of the feet with runs of positive sharp waves on needle insertion, but none were sustained with the needle at rest. Irritability elsewhere was normal.
Nerve Conductions: Right Median Nerve – Motor distal latency at 8cm was 4.1 msec; Sensory distal latency at 13cm was 4.1 msec; Palmar sensory latency at 8cmm was 2.6 msec
Left Median Nerve – Motor distal latency at 8cm was 3.0 msec; Sensory distal latency at 13cm was 4.2 msec; Palmar sensory latency at 8cmm was 2.8 msec
Right Ulnar Nerve – Motor distal latency at 8cm was 3.1 msec; Sensory distal latency at 13cm was 2.9 msec
Left Ulnar Nerve – Sensory distal latency at 13cmm was 3.1 msec
Sensory responses for the ulnar nerve were moderately reduced in amplitude and median responses were markedly reduced in amplitude.
Right Sural Nerve – Sensory distal latency at 14cm was 4.0 msec
Left Sural Nerve – Sensory distal latency at 14cm was 3.7 msec
These values were obtained only by the use of averaging techniques and were markedly reduced in amplitude.
The balance were the comments mentioned initially. The patient is my husband and he has been exposed to chemicals at work which we believe is the cause of the peripheral neuropathy as he is not diabetic and has never been a heavy drinker. He is 49 and has been very healthy his entire life – until now. He works construction so has worked hard and while thin is very muscular. He does have allergies (dust, grass, etc) but has also been found to have a 35% loss to his lungs. This was a 2nd opinion doctor required by the workers compensation carrier for a case that has gone on since July 1999. In seeing the various docs we are told that he has nerve damage and not much treatment other than for pain is available. His doc has told him that he is 100% disabled due to the constant pain in hands, arms, legs & feet and nothing to rehab him into. Obviously the W/C carrier wants to fight that diagnosis. The part of this 2nd opinion report that worried me the most was the denervation comment. From the tests in Oct 1999 & Feb 2000 it looks like the condition is getting worse as the numbness/loss of feeling is going higher up the arms and legs. Any insight you can give me is appreciated. (Sorry for the length of this note.) God Bless you!

Possible double crush to ulnar nerve
Two years ago this May 17th 2001. I was rear ended by a drunk driver to make a long story short I have had a long recovery and am still going threw treatment, My question: After the accident and to date I’ve had neck pain and numbness in my little and ring fingers. I had very severe pain in my neck so bad that just riding in a car was like having no shocks, feeling jolts to my neck even gravel seamed like boulders, and I would get pains in my collar bone as if it was broken. I went in and had Ulnar nerve surgery to help the numbness in my arm and fingers and in this area has helped, the perplexing thing is as I awoke in the recovery room I noticed a great improvement in my neck pain? and the pain in my collar bone has not returned, this is all on my left side. I have been told that the Ulnar nerve should not effect the neck in this way, but, I know the relief I have gotten to the neck area since! I still have damage at the C6,7, and T1 nerve areas. that I am going threw injections for at present but since the operation have been able to drive fairly well though turning of my neck becomes more painful the longer I do. A friend of mine who has some knowledge in this area has suggested a “double pinch” of the ulnar nerve that she had heard of? But I’ve been unable to find any information in this area of question. Are there any answers? There must be? Is there any information I can be directed to? I thank you sincerely for any help in this area.

Answer:

The Double-Crush syndrome is well known and has been described by Upton and McComas in their landmark paper in 1973

TITLE: The double crush in nerve entrapment syndromes.
AUTHORS: Upton AR, McComas AJ
SOURCE: Lancet. 1973 Aug 18;2(7825):359-62

The basic premise is that when a nerve is injured proximally (or in this case close to the neck), it makes it more susceptible to injury distally (away from the neck).

What exactly happens to give pins and needles sensation?

When you experience the sensation of “pins and needles” what exactly is taking place? Is it a result of the healing process of the nerve or is it a result of damage to the nerve. I know when your foot is “asleep”, the pins and needles come after the numbness but before normalcy, as your foot recovers……so I am wondering if the sensation might indicate a reactivation of proper nerve impulses? I’m experiencing pins and needles in association with lyme disease and am wondering if this could be the reawakening of my damaged nerves and thus a good thing…..or does it result as my nerves are damaged, and thus a bad thing? Thanks. Ruth

Answer:

This is quite interesting question. Any or all of the sensory symptoms (pins and needles) and signs are considered diagnostic for a dysfunctional sensory nervous system or point that some thing going on with sensory nervous system. It could either occur at start or later in the process of nerve affection. Although pins and needles may get less with recovery. But does not basically or necessarily be a bad sign.

I have Left elbow pain. Is it necessary to have EMG?

Do I really need this test? I have been treating what the doc thought was tennis elbow. But the cortisone shot I had didn’t help that much. So he wants an EMG. I don’t want it if it is not necessary! I have always had left neck and upper arm pain (I have Fibromyalgia and injuries from years ago) The main pain is in the elbow area and runs down the arm…It is different form my usual pain. Hurts to use the arm and hand…gripping and pulling mainly! Any advice out there? Sometimes the hand gets cold and tingles and turns bluish too. I still think it is a joint problem.

Answer:

You are right. It sounds like a joint problem. However, only tingling suggests nerve problem. Therefore, EMG may be of help.

Comment:

Thanks for the quick response. I am concerned that with the Fibro pain I already have that the test will make my pain worse so if I don’t need it I don’t want it. The arm is also sensitive to touch. Like skin surface pain…all this seems to lesson when I don’t use it. That tells me it is a joint problem but the doc said since the marcaine took the pain away for 3 hours it could be nerve pain??????????? Any input here? It is set up for next Tuesday in the doctor’s office. (A neurologist) Wouldn’t the marcaine take any pain away????????

Answer:

Marcaine should work as local or regional anesthesia and analgesia for pain of any kind, as you said. However, The EMG study should not worsen your pain, although it does cause little pain by itself, which is quite tolerable. EMG is a diagnostic test only.

Brachial plexus injury & EMG

My fiancée was involved a snow mobile accident in January of this year. He sustained 9 fractured ribs, a fractured scapula, a bruised lung, weakness in one leg and brachial plexus injury – all to his right side. It has been 3 months since his accident and he has not gained any movement or sensation of touch in the right arm. He continues to experience severe nerve pain despite taking 50mg nortriptyline and 3000mg neurontin daily (pain management consult). His first EMG is scheduled for next week and subsequent consult with the neurosurgeon. His initial MRI indicated that root avulsion was not “suspected”. Is the EMG test definitive for his type of injury? Will this test tell us if he is likely to gain the use of his arm or not? If there is no sign of peripheral nerve activity – what is the next step? Is there any advantage to repeating the EMG at a future date – the first test being a baseline? At what point is an operative option contemplated and what would they be? Thank you in advance for your time,

Answer:

The answers your questions are as follows: EMG/NCS is very useful in suspected cases of root avulsion. But clinical electrophysiological correlation is needed. I mean the examiner cannot interpret its findings alone but should utilize the clinical findings with EMG results. EMG would also help to determine its severity as well as the prognosis. Also, follow up EMG is useful to see signs of recovery after nerve injury. Another test; somatosensory evoked potential is also useful in such cases. Regarding the surgery, it is up to the neurosurgeon. The neurosurgeon would assess the case and decide accordingly.

Ulnar nerve entrapment

One month ago I had an EMG on my left arm. The results indicated an ulnar nerve entrapment, and recommended elbow surgery. I had continual pain in my arm and hand before the EMG. The pain greatly increased immediately after the test, and has persisted continuously to date. I understand this is not normal. What could be the cause? Has anyone had a similar experience?

Answer:

The nerve stimulation itself does not cause any lasting damage and usually the pain and discomfort resolve within 24 hours. In some instances however, nerve irritation during the test can cause an inflammation around it, especially if the nerve is already irritated because of the damage to it. In those instances, anti-inflammatory such as Aspirin or Motrin might help by reducing the inflammation. If they don’t something else is going in and it is best to seek a consultation for that.

Comment from another patient:

I would suggest caution on this one. I had numbness/tingling symptoms and a specialist (with good recommendations) diagnosed Ulnar Nerve problems. I had a release & transposition on one elbow and a year or so later on the second. It turns out that more than likely the source of the problem was c4-5-6 problems, not the nerve. I did have an EMG to rule out the neck but my guess is the results were inconclusive or false. This syndrome (from my research) is not that common. Feel free to mail me for more specifics

EMG in CTS and double crush syndrome

Hi, I have had an EMG results show carpal tunnel. I also have cervical radiculopathy from disc bulge and spurs impinging on nerve at C5-6 and C6-7.My neurologist does not believe in the “double crush” theory and states that even if he did, I did not have impingement of the C7 nerve. He obviously did not even look at my MRI report, which clearly states this. He also said that because he tested my median nerve at the wrist and it showed compression this proved only Ct. This is not my understanding of the process. My question is; if it were indeed double crush would the testing of the wrist median nerve still show entrapment? Thank you very much

Answer 1:

I would say that neurologists are evenly split on the existence (or lack thereof) of the double-crush syndrome. Let me quickly explain it. The double-crush theory says that if your nerve is compromised proximally (up high near the neck) it is more likely than not to be also damaged distally (below near the hand), meaning that the existence of a proximal lesion makes the nerve more susceptible to damage distally. So in answer to your question, if you are a double-crush believer, the testing of the median nerve at the wrist will show entrapment.

Answer 2:

The concept of double crush syndrome is known for many years. I think from seventies. It means, there are 2 lesions along one nerve course, i.e. patients with one peripheral nerve lesion did in fact have a second lesion elsewhere and they implied that both lesions were contributing to the symptoms or on another way, somewhat include symptoms which result from a combination of two separate, local lesions at different anatomical sites in the same nerve, whether or not one actually contributes to the causation of the other. Practically, a patient may have carpal tunnel syndrome (distal) and another lesion (proximal) of plexus/root in addition. So, yes, EMG could show a carpal tunnel syndrome (to answer your question), which is fairly easy to diagnose by such method.

Reflex Sympathetic Dystrophy (RSD) and EMG

My husband has RSD (Reflex Sympathetic Dystrophy) and just started seeing a new Doctor. This Doctor is ordering EMG and We’re not sure if he should get this test, as you are never supposed to inject anything into the injured area. This year we didn’t even get his Flu Shot, as no one really knows if it will hurt him or make the RSD Spread. When someone has RSD you need to watch what you put into you body. Please get back to me soon as he goes for this test tomorrow.

Answer:

In general EMG is not contraindicated in RSD. Although it does not test sympathetic nerves, but it is used to exclude nerve injury. Actually, it is one of the tests in work up in patients with RSD.

Pinched Nerve @ C6 when to operate

After FINALLY getting confirmation that I do have a pinched nerve at C6 (EMG) I’v had steroid injection directly into C6. I’ve experience some relief, but it continues to flare up. My question: is the next step surgery? And what could that surgery be for this specific location?

Answer:

It has to be clear that operation or no operation is a surgical decision. However, the surgeons usually try conservative therapy with medications, if no help and pain is severe with abnormal rediology and usually EMG, then the approach is called anterior approach; anterior cervical microdiskectomy.

Can EMG localize if injury level if it is in the spinal cord or not?

Can EMG show if a nerve injury is from the spinal cord? I took a fall at home in January. Hurt my neck up high. Slowly, I got weakness in arms with uncoordination, then in the legs, with fasciculations, weakness and heaviness. I was told after EMG that I had nerve damage in arms and legs, particularly in left hand? Can EMG tell exactly where the nerve damage comes from? Since MRI showed bulging at c34, c45, c56 – and hernia at L4-5, it is assumed that my symptoms are related to the disks. However, I just need to know how sensitive the EMG is and what can it actually rule out?

Answer:

There are 2 kinds of nervous system; central nervous system (CNS) and peripheral nervous system (PNS). The CNS consists of brain and spinal cord. EMG has no role in diseases or lesions of CNS. But EMG has important role in diseases of PNS, starting from motor neuron at spinal cord down to roots, spinal nerves, plexuses, peripheral nerves, neuromuscular junction and muscles. In spinal cord lesion, if there is associated root (nerve) lesion or damage, then EMG is useful to localize the involved nerve or “level”. However, only at C5 and below. Higher level, EMG does not help.

Comment:

What symptoms would c34 and c45 bulging cause if these are two areas that could not be detectable on EMG?

Answer:

Level C3-4 (C3 root is intact): muscles are flaccid then spastic (after spinal shock). Breathing is affected (patient cannot breathe on his own). Loss of sensation below the neck. Reflexes are brisk (absent initially with spinal shock).
Level C4-5 (C4 root is still intact): Muscles are paralyzed as above. But patient can breathe on his own but low reserve. Sensations are preserved to upper chest but still not in upper limbs. Reflexes changes as above.

I think I need to explain how the C3 root intact at Level C3-4. This can be explained because of anatomy of the roots to vertebral column. At the cervical level, the root exit ABOVE its corresponding vertebra. That is, C3 root pass above the C3 vertebra. Therefore, in C3-4 level, the C3 root is intact and likewise the C4 root is intact at C4-5 level. This rule is only applied for cervical spine but not for thoracic or lumbosacral spine, as the root passes BELOW its corresponding vertebra.

Weird Symptoms

I have been having some strange symptoms for the past 4 years. In 1998, I was tested for possible MS and passed the MRI and nerve reflex tests. My symptoms are intermittent tingling in hands and feet, pain on left arm like a sunburn, weakness in legs, sometimes twist sentences around, vision looks pixeled when looking at solid colors (white and blue the worst), easily go into a stare (daze). Memory really poor. Repeating patterns such as mini-blinds, striped shirts, louvers cause me to see shimmering/dancing patterns. Intermittent shake to the hands, some days there’s none at all. At night, the tingling seems to go away. Some days are much worse than others. I also suffer from Migraine headaches about once a week since 1990. Just want your thoughts what I should do, if anything? Possibilities what it could be? Thanks.

Answer:

Migraine can explain some of your visual symptoms, but it may not explain all of them. I think you need another good neurological examination. EMG may also help to rule out peripheral neuropathy, as you have some symptoms suggesting it (tingling and weakness in legs). Some blood tests would also be useful such as B12 level. All the best.

Doctors say I have spinal cord sprain and I cannot understand that term

I had an EMG, which showed radiculopathy in c spine and Lumbar spine. I have been getting weakness in arms and legs, tingling and small muscle jumps. Doctors did MRI of neck and found bulges. After symptoms progressed, Doctor said I might have spinal cord sprain. I’m trying to look it up and I can’t find any such thing on the internet. He said his physical exam indicated this. IE: hyper tendon reflex. Ever hear of this. Is this a cervical spine sprain? or something different?

Answer:

Well I suspect he may have said spinal stenosis (? or spondylosis) causing the increase in your tendon reflexes and the radiculopathies.

Comment:

No, he did not specify stenosis, and it didn’t appear on the MRI as a stenosis. And it seemed that the only leg that had hyper tendon reflex was my left leg. (Because I remember him noting that.) What do you make of this? Also, he seemed to get a lack of reflex at my left wrist. Is that a positive or negative sign?

Answer:

Spinal cord sprain is not a diagnosis or a clinical condition. Probably a description of something different that your doctor tried to put in layman’s term.

Do not know what to make of your “hypereflexia” on one side, this would be certainly the case when you have a stroke, but in problems originating from the back or the neck and involving roots, the case is hyporeflexia on the other side. The same is true for your left wrist.

EMG for Elbow and failed Carpal Tunnel

Please explain which areas of the limb are tested for these problems, I need to be prepared.

Answer:

Presumably by failed Carpal Tunnel, you mean a failed Carpal Tunnel release (surgery). The carpal tunnel is located at the wrist, so if your doctor is planning an EMG for the elbow area, he must be looking into other causes for your pain/numbness. Typically an EMG for any arm/neck problems would involve shocks (nerve conduction studies) in the lower half of your arm, and needle examination (no shocks, but a “microphone” type needle to “listen” to electrical activity present in muscles) of the arm and possibly neck muscles. Discomfort felt during an EMG is quite dependant on the individual. Each exam is different for each patient. Skill of the technician or physician administering the test can also have a great deal to do with the degree of discomfort.

When to operate for radial nerve damage?

Hello, I’m wondering if you can give me any insight to the EMG results I got today. I fractured my mid humerus 7 weeks ago. It was a closed fracture, but at high velocity. Radial nerve damage was apparent with severe wrist drop and some sensory loss in my hand and forearm. Sensory seems to be recovering slowly but no sign of motor recovery yet. The EMG showed fibrillations at rest and no MUPs. I know that there are differing opinions on when surgical intervention is necessary, but in your opinion, are these results a good indication for surgical exploration?

Answer:

This is surgical decision. The surgeon takes the EMG results into consideration. He may wait for sometime, perhaps several months, to see whether the patient would recover spontaneously or not. But it’s his decision at the end of the day.

Arm pain due to pinched nerve in C6-C7

I have a pinched nerve in the C-6, C-7 area with pain radiating down my right arm. My doctor recommended Ibubuprofen 600 mg. every 8 hours. Why is the pain so much more severe at night when I’m relaxed and trying to sleep, and is there anything else I can do for relief (and sleep)? I’ve tried Flexaril 10 mg. and Benadryl 50 mg., which made me groggy, but did not affect the extreme night pain. I’ve also tried heat and ice, which didn’t help much either.

Answer:

This is usual that pain is worse at night as the brain is not busy or occupied with anything else except by one “activity”; the pain. Now, if the pain is still bad, you need to consult your doctor again. Pain clinic is also of help. However, the pain is usually self-limiting, but for variable period between individuals.

Comment:

Thanks so much for your response. I’m finally getting some sleep thanks to Vicodin and Trazodone, and the sleep is making a big difference in reducing the intensity of the pain. During the weeks that I was experiencing the worst pain, for the first time in my life, my blood pressure shot up, 150’s-160/90-100. It seems to be coming down as the pain recedes. Could the hypertension be related to the pinched nerve?
MRI report: broad based protrusions at C3-4 and C4-5 and prominent C5-6 and C6-7 bilateral ulcinate spurring, most marked at C6-7 within region of exiting spinal nerve. I’ve never had any accidents, and have a very healthy lifestyle. Could my work as a dental hygienist (33 years) be a significant contributing factor in creating this condition, and would you recommend changing to a less physically demanding careers?

Answer:

I am glad that you feel better. Regarding the high blood pressure, it could well be related to pain and stress. Although, it seems not bad. It is age related. However, you may consult an internist if needed. The other point whether your condition is work related, it does add strain to the neck. But, I cannot be certain.

Lost distal UL sensations with normal electrodiagnostic studies

My husband had an injury which left his right hand from the elbow down with no feelings and cannot use it. The Drs. have no idea what it is, all tests came back negative. It has been 6 months now and we are very frustrated. We just got back an EMG report which states all is normal except for a decreased interference pattern in the first dorsal int. muscle and a motor unit interference pattern with a normal firing rate in the right abductor pol. brevis muscle. Does this mean anything?

Answer:

EMG result would rule out “significant” nerve or muscle lesion that explain absence of sensation of the right arm. However, the reduced interference pattern is not specific and may be explained by weakness, pain or poor cooperation by patient. The weakness can be due to peripheral (nerve or muscle diseases) or a central lesion. The peripheral lesion seems to be out, supported by normal EMG (apart from reduced interference pattern). But it is not clear if the central lesion is excluded or not. This of course would need careful neurological consultation and appropriate radiological tests.

Comment:

Thank you so much for your reply, could you possibly recommend what tests he should have so far he had an cervical MRI, MRI of the upper and right arm (they originally thought a brachial plexus injury) a cat scan without contrast of the brain and will be having a MRI of the brain soon. He had a neurological exam, which was unremarkable except for loss of sensation in his arm, decreased sensation in his left leg and serve back pain. The neurosurgeon released him since there was nothing for him to fix. We are very frustrated with trying to find out what this is. Thanks for your time and reply.

Answer:

The sympathetic nervous system may have an abnormal function after an injury or trauma for unclear reasons. All investigations are normal. I must emphasize that is difficult for me to say that it is reflex sympathetic dystrophy, but because no clear diagnosis was made and some features may suggest it. Therefore, your treating physician must see, assess and document both history and, if present, clinical findings, in order to support the diagnosis, as he is looking at the patient himself in better position.

Answer:

Thank you, we will look into that.

EMG rules out Ulnar Groove entrapment?

I recently had a EMG, ordered by my PCP, to rule out causes of a peculiar ‘cold’ feeling on the pinky side of my right hand. No pain, no tingling, no weakness, no apparent loss of sensation. The neuro did what I thought was a pretty exhaustive study of sensory and motor conductions all up and down both arms. She did needle exams in several places: deltoid, biceps, pronater teres, triceps, opponens pollicis, dorsal interosseous, flexor carpi ulnaris and cervical paraspinals. The EMG came back ‘fairly’ clean. There was minimal slowing of ulnar sensory conductions across the right wrist, no motor slowing. The needle test was clean with two exceptions…. 1) The Neuro stuck my right dorsal interosseous once and got some insertion activity, 1+ on both pos waves and fibs. She stuck it several more times and was not able to reproduce the effect. On each of the several re-tries, it was clean. She theorized she may have hit a nerve end plate the first time, causing the insertion activity. 2) Left side cervical paraspinals/posterior rami showed +/- insertion activity +/- pos waves and +/- fibs. Right side was clean. She attributed this to a possible old nerve irritations, or possible mild lower cervical radiculopathy w/o any affect on the upper extremity muscles. My PCP seemed pretty unconcerned about this EMG/NCV result. In large part, I guess so am I? I have had clean needle exams on lower extremities in the past, except for mild irritation in the bottoms of feet, which I understand is quit common. However the insertion activity on the left paraspinal does bother me. I have been diagnosed with Benign Fasciculation Syndrome in the past. A few questions; 1) What is cervical radiculopathy? 2) What, if anything, would you recommend I do to follow up on that finding? 3) Is it common to find minor abnormalities in otherwise healthy 48 yr old males?

Answer:

1. Cervical radiculopathy is pinching of nerve close to spinal cord, after its exit from spinal cord. It is called nerve root. It is commonly caused by spondylosis or protruding disc.
2. Regular physio/exercises.
3. This is hard question, but in careful way, “yes” possible in the feet, as in your case (in selected muscles), and “no” for the changes in your arm. However, the management depends on how much symptoms and signs are there. Thank you.

Regarding title question. Yes EMG is used to exclude ulnar nerve entrapment at elbow.

Comment:

Very interesting….

I wonder if those paraspinal insertion noises could be a result of my recent training for a 300-mile Appalachian Trail Backpacking trip. I’ve been carrying a backpack weighing around 50 lbs. I have no other symptoms of a spinal problem. I am quite active, physically…. swimming, running, hiking, setups, pushups, etc…. I also carry my golf clubs over my back around 12 miles/week.

Oh well, as long as it’s not indicative or some serious MND and I feel fine, I’m inclined to ignore it.

still trying to get a clearer indication on what I should do regarding the ‘old nerve irritations’ or ‘mild cervical radiculopathy’ on my left side paraspinals. As I’ve noted, I have no symptoms of any spinal problem, with the possible exception of occasional lower back pain, for which I already do a ‘set’ of exercises.

You indicate a set of ‘physio/exercise’. I’m very active anyways.

– Can you be more specific re: exercise?
– What other possible causes, if not radiculopathy, spring to mind?

Thanks for your reply and this wonderful web site

Answer:

Well, I cannot be more specific, sorry, the exercise, its quality usually recommended by physiotherapist. The other causes, such as trauma, fractures, tumors. Of course radiological investigation would show that

Regarding hand and shoulder numbness with imbalance
My life mate seems to have trouble, numbness in hands, and shoulder, and recently I witnessed the results from this problem. He told me this morning when he woke he felt as though his leg was going to break. I watched as my husband walked toward a small female goat and he both lost his balance and could not hold on to this female goat that did not put up a fight he fell sideways and barely could hold on. I could not believe my eyes and realized. He must be looked at immediately. What is the first step to helping him? He is one of the finest saxophone players I have ever heard and he fears that he will not be able to play, because he has lost feeling playing as well. Its always there now but at different evels of numbness. Please any advice would be helpful.

Answer 1:

From your email, I gathered that he has balance problem in addition to numbness hand and shoulder. It is not clear how long the symptoms are going on. He needs to see neurologist soon to sort out this from peripheral to central nervous system disease. He could need urgent management.

Answer 2:

From your email, I gathered that he has balance problem in addition to numbness hand and shoulder. It is not clear how long the symptoms are going on. He needs to see neurologist soon to sort out this from peripheral to central nervous system disease. He could need urgent management.

Ulnar nerve entrapment operated

I have been experiencing numb, cold, muscle loss and pain in my right hand for years. I have had 4 EMG, XRAYS, MRI SCAN BLOOD TESTS, seen numerous Specialists. It has been over a year ago since I had an operation on my ulnar nerve to release it??? Since then the pain has progressively increased and on my last two EMG they have found that I have it in my left arm. Please can anybody offer any advice, I am only 22 and trying to study photography which is proving impossible. I would really like to talk with someone who has or is going through a similar situation as I am finding dealing with my life very hard.

Answer:

Ulnar nerve entrapment at elbow can cause weakness and muscle loss in the hand. Try to avoid leaning on your elbows. Keep them straightened particularly during sleep. Finally, I would recommend consulting a neurologist to make sure nothing else is wrong, if you have not seen one yet.

Comment:

Thank you very much for such a quick response; I have received an appointment to see a neurologist next week. If I have the problem in both my arms could it occur in my legs? I have not that I can remember, knocked or damaged both my elbows to cause the entrapment of the nerves. If there is anybody who has or is going through a similar situation please leave a message. Thank you

Answer:

Not necessarily so, I mean you may not get anything in the legs. However, it depends whether there is underlying disease. As a matter of fact, that is why I advised a neurological consultation. Please keep us updated after seeing the neurologist. All the best.

Comment from another patient:

Hi: I had both elbows done (ulnar nerve release, decompression & transposition) and a couple of years later the problems got worse. Both hands and feet. Part of the problem turned out to be cervical disc problems. I had 3 level fusion and most of the problems seemed to go away but there still seemed to be nerve problems. The nerves may never regenerate I am told and to add to all this, they say I have a polyneuropathy, probably attributed to diabetes. I guess the point of this note is that it can be a very complex problem with symptoms & findings masking other underlying causes. Good luck, feel free to email and ask any questions

Lost arm sensory function after C. fusion with normal EMG

About 9 Months ago I went thru Cervical Fusion on C-6, C-7 after a job injury. I am still dealing with headaches, shoulder pain and motion restriction and numbness in my left forearm, which after an MRI shows a mild rotator cuff tear. I was sent for an EMG, which took all of 30 minutes for both tests on my left shoulder and arm, which by the way went numb during the test, which came up negative. My question is, is it normal for the tester not to get a reading and if it is how do they base the results? The Ortho say my symptoms are related to nerve root compression. The neurologist says all nerves are intact but I drop things with my left hand and have lost sensory function down the arm. When the Neurologist said the nerves are fine, my wife asked if that was an arm-to-arm comparison, which was not but a comparison to what he termed “standards”. What does that mean?

Answer:

The “EMG” studies are divided into 2 parts; the nerve conduction studies part need taking readings and calculations, thus obtaining the results based on those numbers and calculations. Second part is the Needle Electrode Examination. By this the examiner would also take certain “readings” and make an impression, although it may not appear to patient as clear readings as in the first part. This may explain your first query. Regarding the last point; the standards mean that we follow the results in comparison to previously done studies on normal persons matching the age and sex. However, your wife point is quite valid and important because we frequently use the “healthy” or non-symptomatic arm as a control (or standard) to compare with the “sick” or symptomatic arm. The doctor should be able to decide on this matter.

Tingling hand and feet with weak legs

I am a 44-year-old male, 140 lbs, 5’6″. For the past few years, I have experienced weird symptoms. My hands and feet intermittently tingle and hurt, my arms feel like they are sunburned, I get random pin-prick sensations about anywhere on my body. My legs are weak as I find myself standing with my knees locked. My vision is almost foggy, for lack a a description and images with repeating patterns “shimmer”. My memory has been real poor and I tend to flip words around in sentences. Sometimes when I wake in the morning, I can’t tell where my arms are. I have seen a Neurologist in 1998 and had an MRI and some reflex tests. Came back fine. He said, “not to worry”. I am very worried.

Answer:

According to your description (not all symptoms though), peripheral neuropathy should be ruled out. You had MRI and have seen neurologist in 98, MS was out, I guess. Anyway, EMG is needed in your case and I would recommend seeing a neurologist again. Please keep us updated.

Comment:

I’m not a physician but have similar symptoms.
Have them evaluate you for a small fiber sensory neuropathy.
(Some helpful diagnosis tests for this are the quantitative sensory testing and the small fiber skin punch biopsy) EMG and Nerve conduction studies and routine Neuro exams will not diagnose this. Also when you mentioned shimmering in the eyes thought this site would be useful. www.geocities.com/quinolones/
Many on this site have experienced long term (as in years) visual problems, paresthesias, and sensory disturbances, memory and brainfog muscle weakness etc.
I assume your Neuro has done differential diagnosis ruling out things like: Lyme Disease, MS, Lupus, Hepatitis, Autoimmune diseases, B12 deficiency, vasculitis, diabetis, viral and infectious etiologies like Histoplasmosis, Toxoplasmosis, paraneoplastic syndrome, Cytomeglovirus, ME, etc.
Often times Physicians assume someone just has a post viral syndrome and labels the cases idiopathic and does no further testing. However treatable things should be ruled out first.
Some useful sites may be
Massachusetts General Hospital Neurology Forums
Cleveland Clinic Neurology Forums
Neuropathy Trust website
Neuropathy Association website
and www.geocities.com/quinolones/

EMG Results with ulnar neuropathy in Guyon’s canal

I was involved in a motor vehicle accident in Dec. of 2000, and have had pain at the right wrist and hand ever since. Surgery was suggested after a EMG was done. I decided to wait to see if it would get any better without surgery. The results of the EMG were mild to moderate, acute and chronic, ulnar neuropathy at the wrist on the right. The lesions are most likely a Guyon’s type 1 at the proximal wrist on the right. I am still having some pain in that area, and wonder after six months if I should expect to see any more improvement without surgery. Will this be a chronic problem or will it continue to improve over time?

Answer:

What usually happens after a traumatic nerve lesion is that the surgeon would wait for several months before embarking or deciding for surgery. I am not expecting further improvement following this kind of lesion after 6 months. However, see your doctor to discuss this further.

Peripheral neuropathy and EMG

My wife had an EMG performed and was told she had a PN. She is experiencing numbness/tingling in her feet and hands along with some in her face. Her sugar level was tested (negative) and spinal fluids were tested (High protein). She has a hard time walking, etc……She has swam in a pool a couple of times, and each time, has felt better for a while afterwards…. Can anyone help?? She has also had an MRI and CT scans which were negative……She also has very cold feet and legs

Answer:

The neurologist would try to find a cause for the peripheral neuropathy. However, it is not always easy task. I think she should continue the swimming exercises and attend the neurologist for close follow up.

Numb hand – please help!

I have one numb left hand. I guess I should start at the beginning… I am 52, and in relatively good health. I am a budget analyst, where I do moderate computer work, and bartend about 8 hours per week. About four years ago, I experienced numbness in both my feet and hands. Within a few weeks, the numbness in all extremities except the left hand disappeared. However, the left hand numbness bothered me a lot, especially because I’m left-handed. I saw a neurologist who could not diagnose it specifically. He did nerve conduction tests over the next few weeks. Many of them. He never did narrow down the cause, except to say that he suspected the ulnar nerve. He determined that I have no loss of strength. I just can’t feel my hand. But that was it. No treatment was suggested. He pretty much said to learn to live with it. The numbness subsided (but never disappeared) over the years, and I therefore got used to it. (There is no pain associated with it.) Suddenly, however, the numbness came back with a vengeance about three days ago. My hand is almost completely numb. I can’t feel anything in my hand, and drop things a lot. Typing this is difficult, because I can’t feel the keys–I have to be very conscious of things in my hand. I therefore grip things too tightly sometimes, and smash them, and my handwriting is at best jerky. The numbness radiates upward along the outside of my arm to the elbow. I’ve just today noticed that I am also numb one the underside of my upper arm and a little down the back. All this only on the left. I also should say that the neurologist ruled out carpal tunnel syndrome because at the time the numbness radiated to the wrong fingers. Now the entire hand is numb. It’s as if I’ve slept on it and just waken up, but the hand won’t–feels sort of thick and clumsy. I hope I haven’t been too wordy here. Just want to be very specific. I will admit that today I’ve gone into the panic mode. Don’t know where to turn. Will acupuncture help? What shall I do about this? I see no point in going back to the doctor because I feel as though he’ll just write it off as peripheral neuropathy again. I think that diagnosis is used sometimes as a garbage diagnosis when they can’t figure out what’s happening. Someone please help me out here. Any suggestions? I’m afraid this condition will soon affect my work

Answer:

First of all, seeing a neurologist is not that all bad, they do help. Not all neurologists similar to each other. So, you need to see, perhaps, another neurologist. The aim not only to diagnose your case (possibly the exact cause) but also to assess the severity. Then to find the best treatment modality. I must say that some nerve lesions are severe enough to need surgery. So, please seek another neurologist advice. Best of luck and keep us updated.

Comment:

Thank you, Dr. I didn’t mean to imply that visiting a neurologist is bad–only that I learned very little from my last experience. I do plan to make an appointment once again, and this time perhaps I’ll be a little more demanding of answers. In the meantime, will you even hazard a guess as to what’s going on?
Also, I’ve been thinking about the idea of acupuncture. What is your opinion of that providing relief?

Answer:

I know that acupuncture does help, but in certain problems. I am not too sure about your case whether acupuncture would help or not.

Abnormal NCV in different situations

Can an NCV be abnormal and an EMG abnormal?
What does an abnormal NCV (peroneal) mean?
Can repetitive ankle sprains cause abnormal NCV?

Answer:

1. Yes they can.
2. It would mean the nerve is affected or diseased. In case of peroneal nerve usually means affection at the level of the knee joint (at head of fibula). Sometimes, atrophy of the small muscle on the dorsum of the foot (Extensor digitorum brevis) would cause abnormal peroneal nerve study, although the nerve is fine “proximally”.
3. Yes, I have seen it. Although, the changes are “mild” involve the EMG (needle electrode examination) rather than the NCV (nerve conduction studies).

EMG for Elbow and failed Carpal Tunnel

Please explain which areas of the limb are tested for these problems, I need to be prepared.

Answer:

Presumably by failed Carpal Tunnel, you mean a failed Carpal Tunnel release (surgery). The carpal tunnel is located at the wrist, so if your doctor is planning an EMG for the elbow area, he must be looking into other causes for your pain/numbness. Typically an EMG for any arm/neck problems would involve shocks (nerve conduction studies) in the lower half of your arm, and needle examination (no shocks, but a “microphone” type needle to “listen” to electrical activity present in muscles) of the arm and possibly neck muscles. Discomfort felt during an EMG is quite dependant on the individual. Each exam is different for each patient. Skill of the technician or physician administering the test can also have a great deal to do with the degree of discomfort.

Numbness is getting worse and spread to whole Lt. Side; now I’m scared

Since my last post from just last night, the numbness has spread. I’m now numb all the way down my left side, though not as severely as in my hand. From the shoulder down, down the left rib cage, all the way to my ankle (but only on the outside of both the arm and the leg.) I tried today to get an appointment with several area neurologists, and can’t get one until mid-August! My family doctor will see me day after tomorrow, but I’m not sure what he can do, other than sympathize. At this point, I think I’d rather know what it is not, than to get rid of the symptoms. I’ll deal with the symptoms later. But my imagination is going nuts, with thoughts of everything from MS to diabetes to stroke to heart attack. Again, I have no pain and no loss of strength (thank God.) But my fear alone is weakening me. Please help me drag myself out of this panic.

Answer:

Seek help, use the fear to find the advice about your problem, but do not let the fear control your mind please. It would be better to go to an emergency department in hospital or as you said see the family doctor, to be reassured, until your appointment with the neurologist.

Comment from another patient:

Thanks. Even typing this is such a consummate pain (not literally) in my rear. Just wanted to say that I saw the doc today, and he has ordered blood tests, nerve conductions/EMGs Monday at the neurologist, and a carotid study at the hospital in two weeks. (Can’t get a consult with the neurologist, but he’ll do the tests, read them, and send their findings to my family doctor–go figure.) I hope mine disappears as well, but for now it’s just getting more severe. He did rule out heart involvement and diabetes and says he suspects peripheral rather than central nervous system problems. This thing is screwing around with my mind now, and I’m fighting very hard to fight the fear of the unknown. I’ll let you know…

How accurate are the test results for spreading numbness in hand and feet?

I had Nerve conduction and EMG tests done last fall as a result of spreading numbness in my hands and feet. The results showed that I had “mild, symmetric, axonal, predominately motor polyneuropathy with loss of fast conduction fibers.” The condition began to improve on its own, so the doctor said not to worry about it. (They do not know what could have caused it.) Because I still have intermittent, mild numbness I went for a second opinion (using the same test results). The second doctor said that the test is very subjective and that I may not, in fact, have nerve damage. How subjective are the test results? Should I be concerned if the tests reflect that I have mild nerve damage? .

Answer:

This is quite interesting question. Although, nerve conductions and EMG are “objective” tests. But certain factors must be well controlled such as temperature and distance measurement. As well as stimulus setup. Those are in a way “subjective”. Anyway, the examiner is usually fully aware of those factors and they are standardized. If the abnormalities are really mild, they may be considered as insignificant. What matters is that you are clinically feeling better.