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EMG
/ NCV in lumbar disc |
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I
am scheduled for EMG/NC's next week. The latest MRI shows
herniated disc at L5S1 and bulging disc at L4, with no
significant changes from original one 2-1.2 years ago.
'Have had pain in back and legs for what seems like forever,
now weakness is developing in left leg. What do these
tests entail and do they hurt? Thanks for your help.
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Answer |
EMG
stands for electromyography, which loosely translates
into electrical testing of the muscles and nerves. The
test is a little uncomfortable. The doctor uses electrical
impulses applied to your skin to test nerve conductions
and then uses a needle probe (without electricity) to
study muscles in your leg and back. The whole test takes
30-45 minutes. The test is quite useful, although not
a 100% fool proof, in detecting pinched nerves and diseased
muscles.
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Nerve
damage healing process |
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Upon
your advice, I went to see a neurologist and had an EMG.
The doctor told me that I had nerve damage due to the
three surgeries I had in October. He said that the nerves
would eventually regenerate and gave me a prescription
for amitriptaline. He wants me to work up to 50mg daily.
Right now I am up to 40 mg. I notice a very slight improvement
in the pain, burning, numbness, etc. Can you tell me how
long the nerves could take to repair themselves? Am I
looking at possibly a year or even more? It is the nerve
that runs from the groin down both sides of the thigh
and across the knee. Thanks for your comments. |
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Answer |
Nerves
grow very slowly, about 1mm/day, you can almost compare
it to how fast a hair grows and you will have a ballpark
figure. So it takes usually anywhere from 6 to 18 months.
Amitryptilline and other drugs like it help relieve nerve
pain such as yours so this should help and you should
start noticing some improvements.
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Intense
thigh pain |
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About
3 weeks ago I woke up with a sore and stiff knee. 2 days
later it went to what seemed to be my hip. I went to the
doctor and was put on Vioxx and Ultram, X-rays were normal.
I then went to a rheumatologist who said she thought the
pain to be coming from my adductor muscle. I have intense
pain especially at night, a limp, and muscle weakness
upon lifting my leg, or walking. This came on suddenly
and without any injury. Please any comments or thought
on the cause would be greatly appreciated. This has been
going on now for three weeks. I am beginning to get so
down from this not to mention extremely fatigued from
the lack of sleep. Please help!!! |
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Answer |
I
am not quite sure from your description if you're having
joint or neurological symptoms. Certainly a pinched nerve
in your back could cause the thigh pain and weakness.
Also there is a nerve called the femoral nerve which could
be compressed in the groin in patients with diabetes (the
condition is called diabetic amyotrophy) and cause these
symptoms as well. If your pain and weakness are not improving,
you should see a Neurologist.
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Comment |
I
have now gone to see a physical therapist, who, it seems
has done more for me than any Dr. so far. She seems to
think, after a half an hour of counsel with me and working
on me, that my pelvis is of balance or out of line. This
in turn is affecting the capsule around the hip joint,
which is then affecting the muscles in the thigh and groin.
She also said that the muscles in both of my legs were
very tight. I must say, when I got of her table I thought
I was cured for about a half an hour. I was able to go
up stairs and walk without any pain. It was all back again
that night. What are your thoughts on diagnoses like this.
Is this very common? Have you ever heard of a case like
this? Or any symptoms like this? Thanks!
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Answer |
Again
my concern in your case is the weakness you mention. A
nerve lesion could cause the pain and the weakness whereas
a pelvis lesion would cause mostly the pain. So unless
you are sure that there is no nerve lesion or pinched
nerve, you can treat it with Physical Therapy. But if
the nerve is involved you'd have to do something about
it otherwise no amount of physical therapy is going to
cure your symptoms.
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EMG
for CTS & Spinal Stenosis vs. Hip Replacement |
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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? |
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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.
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Leg
Crossing leading to foot drop |
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My
teenage daughter recently had to observe her dance classes
for 4 weeks instead of participating because of a healing
stress fracture and while doing so continually crossed
her bony long legs resulting in a peroneal injury affecting
her toes and top arch. We had noticed a foot drop but
thought it was related to adjusting to walking in an air
cast for the opposite leg stress fracture. After noticing
drop (into third week) of repetitive leg crossing, we
backtraced the cause of the peroneal pressing and she
is on the road of recovery. She went from a grade 0 of
extreme weakness with no strength to a grade 3 - 3 1/2
of being able to lift her foot and flex toe in about three
days of corrective behavior. Can we continue to see immediate
and fast recovery as we have seen or will the recovery
slow as the complete heal is in sight? Do you have any
insight as to what we should do to help her recovery along?
Her stress fracture on her opposite leg is healed after
the six-week rest and she hoped to get back to dancing
this week. Should she dance while holding onto the dance
bare or would you recommend a complete recovery of the
peroneal nerve before returning to dance. By the way,
she is able of get on toe point and has not loss any leg
muscle strength. We consider ourselves very lucky to notice
this and stop the leg-crossing activity, although not
quite soon enough. |
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Answer |
Thank you
for a great description. Most likely, as you have figured
out, this was due to her leg crossing behavior, specially
if she doesn't have much fat padding which makes the nerve
especially vulnerable to leg crossing. The rule of thumb
is that if recovery begins early and fast, it will continue
to do so because it is likely the lesion just involved
the nerve sheath (the myelin) not the fibers the themselves
(the axons) and the nerve will return to full function.
I would be more careful on her returning to the dance
floor however for the following reasons. She has a (freshly
healed) fracture on the other side and she is not back
100% on the peroneal nerve lesion side, so you don't want
her to fall at this point. I, personally, would wait until
she got back 100% of her peroneal nerve function back
before returning to the dance floor.
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Abnormal
foot movements after EMG & NCV; is it due to the test? |
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I
had an EMG and nerve conduction test done for ALS because
of some minor fasciculations The EMG found fasciculations,
no fibrillations, so the neuro felt I was clean. But just
4 days after the test my foot, where most of the testing
was done on, (at least five separate sets) started vibrating
and fasciculating like crazy. It then spread after a month
to my other foot. Is this not an uncommon reaction to
the test? Thank you |
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Answer |
This is
not a common reaction to the test; in fact I have never
seen it happen. I cannot tell you what this is due to
but if you feel that this is way out of the ordinary for
you (and it has lasted this long) I would get in touch
with your doctor and tell him/her about it.
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Babinski
sign |
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I
have a question, which I can't find an answer in none
of the medical books. A negative Babinski is when your
toes crawl downward. A positive one is when your toes
crawl upward What is the meaning of no movement at all??
Does it completely o.k. (Like crawling downward!) THANKS
IN ADVANCE |
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Answer |
Neurologists
always have wild discussion on the misnaming of the "extensor"
sign. (Flexion shortens a limb; extension lengthens it).
It is therefore more appropriate to note that the toe
goes up or down, instead of using the word "flexion"
or "extension" alone. A "plantar flexion"
and "dorsiflexion" are equally clear. But the
key muscle is the extensor hallucis longus. Babinski--a
French neurologist of Polish descent and a pupil of Charcot--was
the first to differentiate between a normal and pathologic
response of the toes and recognize its clinical implication.
To answer your question, in a mute response, check that
no paresis or weakness in effector muscles (e.g. peroneal
nerve palsy, severe radiculopathy or peripheral neuropathy).
Make sure that the foot is not cold.
I hope you will find a lot of information in this book:
The Babinski Sign: A Centenary
By J. van Gijn. 176 pp. Utrecht, Heidelberglaan, the
Netherlands, Universiteit Utrecht, 1996. $49.95. ISBN
90-9008908-X
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Numbness
after a myeloscopy |
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After
a lamenectomy in 1992, I began having severe pain in my
left leg. I started getting steroid injections, which
lasted only a short time. Was told I had a lot of scar
tissue pressing against my nerve and a myeloscopy would
remove some of the scar tissue. After having this done,
I woke up having decreased feeling in my left leg and
mostly my foot. It has s been 15 months and there is no
change. I limp and have limited flexion in my ankle. I've
been through therapy and it hasn't helped. Doctor is not
mentioning an EMG, could I request this or even demand
that I want it done? This is compensation and I have been
back to work but it is very difficult to function. |
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Answer |
EMG should
be helpful in your case to confirm the lesion and how
severe particularly because you have numbness and limited
flexion of the ankle, suggesting muscle weakness. At this
stage (15 months passed from second procedure), if EMG
changes seen could be related to lesion 15 months ago
or from the older lesion of 1992.
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Effect
of hand Squeezing on LL NCV |
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When
Having my conduction velocities study, It seemed that
the neuro could not get what he wanted when giving me
the electric stimulation to my legs (peroneal, tibial
nerves), he then told me to squeeze tightly my hand and
only then did he got what he wanted to get and said all
was fine. Dear doctors! What do you think he could not
get (I think I recall he said It was the Amplitude)? Was
it "legal" - I mean I am just curious whether getting
"the wanted NCV result" that way is all right and not
"cheating"? THANK YOU FOR READING THIS AND RESPONDING!
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Answer
1 |
That's is
usually to get the F-wave (http://www.teleEMG.com//jbr070.htm)
in the lower extremity, and it is a "legal"
maneuver.
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Answer
2 |
Squeezing
the hand during EMG helps to get better amplitude fro
the evoked response: F-wave, H-reflex or a motor evoked
response. Squeezing the hand is also asked to at times,
by physicians during a clinical examination to obtain
better deep tendon reflexes. |
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Hand
contraction with EMG of LL |
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In
read in previous post that it is quite common to ask the
patient squeeze his hand in an EMG. A month ago I had
my EMG and the neuro said he was not getting good CAMP
amplitude as He had wished to, so told me to squeeze my
hand. He also "hit" me with tremendous currents, and then
he got normal CMAP. (Also read posts in this forum about
it) About the nature of CMAP amplitude - A. How far can
it change with higher currents, can it get from 2 to 15
MV (in supramaximal stimulation+25%)? in MU - How much
can it change in low and high currents? B. In which current
does he have to stop? Is there a "limit current" in which
more current would not produce higher amp or "the sky
is the limit"? C. And about the "squeezing the hand" thing
- IN MV- HOW higher can it get? I mean, how much additional
MU can squeezing the hand yield? (2,5,10,15)? And MOST
importantly for me why some people get the right CMAP
amplitude without squeezing the hand while others should
do so - Does it depend on the physical condition of one's
nerves or not - I mean if he asked me to do so - Is there
a problem (even minor) with my nerves? Hope to get your
insights on these "CMAP THINGS" |
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Answer |
As
pointed out in previous posts that squeezing increases
the motor response, it works by enhancing the response.
Of course it will work to certain limits. To answer your
point, it may increase from 2 mV to 15 mV. Once the maximum
level or value is reached, then any further increase of
current will lead to stimulation of the nearby nerves
giving a false result. Therefore, only a 25% increase
of stimulus is added after obtaining the maximal CMAP
response to avoid such stimulation of other nearby nerves.
All commercial EMG machines have limit of stimulation,
which cannot be exceeded for patient safety. This squeezing
method does not reflect any pathology of the nerves but
just a physiological variation between individuals.
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Comment |
What
do you mean by maximal response? How can the examiner
know when is the maximal response for a certain nerve?
Because as you said, the higher current you give the higher
amplitude you get! So how Does the examiner know when
he had reached the point where he gets false increase
from nearby nerves? How does he know what is the real
"maximal CMAP response for a nerve”?? (And that
from now on he crosses the limit of stimulating neraby
nerves)
* What would be the range of normal CMAP for the peroneal?
, Tibial? And ulnar? |
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Answer |
The
following should help to get the best response. First
of all the examiner should be familiar with the anatomy
of the peripheral nerves. A surface electrode is used
for stimulation; it is easier and less uncomfortable for
the patient. The cathode of the stimulating electrode
should be placed over the nerve closet to the recording
electrode. The anode is placed parallel to the nerve,
away from recording electrode, you may rotate it to minimize
stimulus artifact. The nerve should be stimulated with
stepwise increasing strengths. Enough current must be
applied to activate all of the axons of the nerve. This
amount, called supramaximal response can be obtained with
an electrical stimulation of 10-75 mA and pulse duration
of 0.1-0.5 ms. Over stimulation would produce latency
artifactually short or a conduction velocity too fast
for that nerve. Also, stimulation of adjacent nerves could
produce CMAP larger than expected and has initial positive
deflection (except tibial nerve). That how I would make
sure it is a response from that particular nerve and no
contribution from other nerves. This problem is encountered
commonly between unlar and median nerves at thr wrist.
Normal values from Liverson and Ma 1992: ulnar CMAP between
4-22 mV. Tibial CMAP 5.8-32 mV. Peroneal CMAP 2.6-20 mV.
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Nerve
damage and treatment for severe pain in LL |
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Had
ACL reconstructive surgery 7 months ago and about 5 months
ago I started having severe burning pain in my thigh.
Like someone holding a branding iron to it. The pain is
from my hip to my knee in varied spots. My neurologist
has done many tests and his conclusion is that I probably
injured it in PT. The nerve either got compressed or stretched.
Is this something that goes away on it's own. He has suggested
that I take steroids. Should I stay off of my legs? Because
walking really irritates it. What are some other things
I could do to help this heal? Thank you I'm so desperate |
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Answer |
In
your case seems to be compression of the lateral femoral
cutaneous nerve (meralgia paresthetica). But please tell
me what is ACL stand for?. If it is meralgia paresthetica,
then usually the symptoms would ease with the time which
is variable between one patient and another. About the
steroids, it is actually up to your treating doctor to
decide the best treatment for you. Nerve conduction studies
may help to diagnose although technically may be difficult
and EMG needle examination may be done to rule out other
causes. However, it is primarily a clinical diagnosis.
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Comment |
Thanks
so much for your reply. ACL is one of the ligaments in
the knee. I tore it in an injury and bruised my shinbone.
So I had surgery to replace the ligament on 10/18/99 and
the pain in my thigh started around mid Dec. For nerve
damage is it usually recommended to stay off your feet?
Cause it seems to hurt so much more after walking etc.
If not, should I use it as normal and exercise as well?
Is icing recommended for nerve damage? Thanks again for
your comments. |
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Answer |
Thank
you Laura, gradual building up of excerice is good idea,
but of course this depends much on your knee. I would
also recommend the cooling therapy. All the best. |
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Can
exercise delay or will it help to nerve healing after
damage? |
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I am so confused about what to do to help with the healing process of a compressed or stretched nerve in my thigh. It hurts so much after walking. The pain has neither gotten worse nor better in 7 months. But it does subside if I don't use my leg at all. As soon as I go back to regular activity the pain starts. My question is this: Can exercise prolong the healing or will it help to heal it. So should I grin and bear the pain and eventually it will go away or should I stay off my leg. Am I damaging it more by exercising? My thigh muscle is just about gone at this point form atrophy. Help!!
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Answer |
I
think physiotherapy would help but it should be under
care of physiotherapist. Taking advice from Pain clinic
is another option.
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