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Is
it neuropathy or not? |
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In
letters to my G.P. my neurologist has noted that I have
"decreased pin sensation, temperature distally in the
lower extremities. Position sense and vibration sense
are normal. Deep tendon reflexes are absent in the lower
extremities and +1 in the upper extremities..Babinski's
sign is absent." He recommended EMG/NCS. After testing,
he reported ". Normal sensory nerve conduction in the
left superficial peroneal nerve with distal latency of
3.68mS..motor nerve conduction in the right peroneal nerve
is within normal limits with a velocity of 40 meters per
second and distal latency of 6.40 mS and left peroneal
nerve with a velocity of 44 meters per second and distal
latency of 5.20 mS. The H-reflex in the right and left
tibial nerves is abnormal in that there are no responses.
He concluded ". Not enough findings to really indicate
definite neuropathy since the sensory and motor nerve
conduction are normal." Entering the left superficial
peroneal nerve distal latency of 3.68mS and the appropriate
age, sex, and height (41, M, 190cm) into the appropriate
boxes on your lower extremity sensory/H-Ref teleEMG calculator
(thank you very much) produced an MRV of -4.2. I wasn't
sure how to use the lower extremity motor calculator,
but it may have produced negative MRVs of -1.1 or closer
to zero. Three questions: 1) Neuropathy or not? , and
2) Can you recommend an unrelated source for normal values
of EMG/NCS (I'm looking for corroboration) including books,
and 3) recommend additional means of investigation and/or
wait for progression. Based solely on reported findings
(no foot problems, though arches somewhat high, thanks
for asking), and slow progression over perhaps eight years
or longer (just detected this, though deep tendon reflexes
gone for at least six years), I am inclined to suspect
some sort of very mild hereditary sensory neuropathy?
Please reply. Thank You.
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Answer |
Looking
at your history and NCS data; you have some symptoms and
signs to suggest neuropathy, and some data in NCS to support
that (absent H reflex, right peroneal latency of 6.4 ms
and CV of 40 m/s). Absent H reflex is definite abnormality
(neuropathy is one cause but not the only one), and peroneal
nerve, to me, it is slightly slow but it varies according
to laboratory normal limits, but anyhow, not enough by
itself to say peripheral neuropathy even if abnormal.
However, additional information would be useful and important
for instance, sural nerve, amplitudes of motor and sensory
responses, F wave and needle EMG examination and perhaps
additional test for small fibers (sympathetic skin response).
Looking at the duration of symptoms seems to be very slowly
progressive if any. I think a follow up study is worthwhile
after several months. About the last point being hereditary
or not, I would say, this study cannot tell you that,
you need more information in the history and further genetic
study that could be discussed with your neurologist. I
hope this is helpful.
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Comment |
Isn't
a conduction velocity of 40 completely normal for the
preoneal nerve?
If not what are the limits for this nerve in your laboratory? |
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Answer |
MCV
for peroneal nerve is 41 m/s or faster. |
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Relationship
between Sciatic Nerve Problems and Femoral Nerve Problems |
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I
recovered from Sciatica about 6 weeks ago, thanks to a
series of acupunture treatments (Which I highly recommend
to anyone with this problem). I was told this could be
due to problems with one of the discs slipping slightly
in my lower back and resting on the Sciatic Nerve. I now
have pain in the front of the same leg due to I think
Femoral Nerve Problems. Are both these afflictions related?
Could it be the same disc slipping in another direction?
I am currently taking anti-inflammatories and will be
attending the acupuncturist again, but I would like to
know what preventative therapy I can do in order to not
have either problem recur? |
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Answer |
Sciatica
is common problem, derived from sciatic nerve as the name
implied, but actually it is not compression on sciatic
nerve but due to slipped disc at lumbosacral level. Other
synonyms are radiculopathy, prolapsed intervertebral disc.
According to your description, your symptoms are closely
related but due to adjacent slipped discs. However, I
assumed that your pain in the front of "leg"
is related to the slipped disc and not due to femoral
nerve because the later one would have the pain in the
front of the "thigh" and not the leg. Clinical
examination and EMG will be very helpful in your case.
General measures to avoid or prevent disc problems are
rest, give up smoking (to reduce coughing), avoid constipation,
avoid lifting heavy objects, to pick up something kneel
rather than bending your back, etc. Other instructions
and exercises could be obtained usually from physiotherapist.
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Goosebumps
on thigh |
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For
the last three months or so, my husband and a friend of
mine have been experiencing goosebumps on their right
thighs. No pain involved, but it happens whether they
are sitting or standing. Both are pretty muscular. |
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Answer |
As
there is no pain (or other symptoms), these Goosebumps
seems to be?” Fasciculation=twitching" confined
and repeated at single same place, this is benign, and
physiological or could be related to exercise. If they
are widespread, then you may seek neurologist advice.
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EMG
Test after injury to Cauda Equina |
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I
had a laminectomy 8 months ago to relieve compression
of my L5/S1 nerve root and L4/5 large herniation. I have
bladder, bowel, sexual dysfunction and numbness in both
my saddle area and left foot. What can EMG tell me about
my prognosis? |
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Answer |
EMG can
be used to assess the extent and severity of the lesion,
these are important in determination of prognosis. Also,
it could detect the signs of nerve regeneration. Thus,
it can predict functional recovery.
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Fever
and Jaundice followed by abnormal gait |
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My
son is a 13-year-old Pakistani boy- 4 years ago he had
2 episodes of prolonged fever and 1 attack of Jaundice
and 1 attack of Measles in 3-4 consecutive months....
Since then he has developed a gait - he puts all his weight
on the toes and his feet are flat- he walks abnormal dragging
his feet and legs stiffened... Please if you could do
anything to help my son - I'd be grateful - if You would
like to have a chat with me on the internet about his
reports - u could write me back the time and date - or
if u want to view some of his reports of his tests in
India - I could mail them too- whatever it is - I need
your help, support and guidance - Please!! |
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Answer |
I read your
note and I am not sure I would be able to help but I can
give you some ideas. The symptoms you describe in your
son's gait seem to originate from the spinal cord. In
some of the infections you describe, involvement of the
nervous system, particularly of the spinal cord may occur.
Some of these diseases may be treatable by antibiotic
and some may not. My advice to you is to seek the help
of a physician who specializes in infectious diseases
that are common in your area, and they will be able to
put the whole group of symptoms together, not just the
neurological findings, which I do not believe are isolated.
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Needle
EMG and Radiculopathy |
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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? |
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Answer
1 |
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.
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Answer
2 |
For
your second question, the chiropractor or a podiatrist
is not allowed to perform EMG needle examination. It is
only allowed and practiced by a qualified medical doctor
all over the world. |
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30-40%
false negatives |
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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? |
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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..
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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?
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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. |
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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. |
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Role
of EMG in Lower back pain |
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Is
there discomfort with EMG for lower back problems? What
can I expect and what is procedure? What can EMG diagnose
for lower back? Have small herniated disc L5 S1. Orthopedist
can't find reason for continuing back problems. Symptoms
recently changed following physical therapist realigning
hip joints. Now on L side with pain on buttocks and thigh
almost like a mild leg cramp when standing or sitting
for more than a half hour, which intensifies with time.
Relief after a few hours only by lying flat on back with
pillows under thighs. If I get up to stand or sit discomfort
comes back. |
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Answer |
EMG
is important tool in diagnosis of radiculopathy. It will
help you to confirm the root involvement, its level and
severity, sometimes when even the imaging studies are
normal. The EMG examination utilizes an electrode or needle
probe, which is inserted in a muscle. It is not that bad
but does cause little discomfort. This discomfort is variable
between persons. But it is well tolerated in majority
of cases.
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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. |
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Comment
from a third patient |
I
experienced similar pain, after pt. It should improve
in a few weeks or may be a two months at most. Don't be
alarmed. If the pain persists see another physical therapist,
the one you saw may have over did it. |
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Leg
tingling and numbness 6 months after lumbar fusion |
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About
16 months ago, I underwent Lumbar fusion on L4/5, and
S1 with steel rods. I did well until about 6 months ago.
I began getting tingling and numbness in my right leg.
With physical activity it intensifies, so I am having
a difficult time with PT. My doctor ordered a Myelogram
and said it revealed nerve root interference from epidural
scarring. However, I had an EMG done and it revealed no
nerve root interference. Can you explain why this might
be the case? I still have the symptoms, but sort of feel
like I'm being second-guessed since the EMG. |
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Answer |
The
discrepancy between your physical symptoms and the EMG
findings is unfortunately not uncommon. There are several
reasons for that:
One is that the EMG appropriately tests motor fibers
only when it comes to root lesions so if you have primarily
a sensory root lesion, it will be missed most of the
time.
Two is that, even with motor root lesions, EMG can
be negative is as many as 40% of the time so a negative
EMG does not rule out a root lesion.
The Myelogram however (and certainly the clinical symptoms
you have) are very sensitive however and I would go
with those over the negative EMG. I hope this helps.
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Comment |
Thank
you for that response. I'll ask for a second opinion.
Thanks you so much!
I failed to mention that he did a NCS too. That too,
was also negative. Should that have shown some positive
results?
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Answer |
The
answer is no, generally speaking NCS are negative in root
lesions. One exception to that is some abnormalities in
late responses such as F-waves and H-Reflexes. |
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Curious
about ankle tapping during Neurological examination |
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During
examination, neurologist detected some diminishment in
right arm; he also tapped the inside of my left ankle
5-6 times (only once on right)- what does the tapping
on the left ankle give clues to? Am scheduled for EMG/NCS,
but curious about the ankle tapping. Hope I've provided
enough info. Thanks |
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Answer |
My
guess is he was trying to elicit your ankle reflex and
compare it to the one on the right. |
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Right
thigh numbness |
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I
am 35 years old man; complain from tingling and needles
feeling in the right thigh for the last 3 weeks. It was
not continuous but for the last week it is continuous.
It gets worse on standing and goes up to lower part of
my back. It gets better if I bend forwards or sit down.
I had surgery for my right knee last year due to ruptured
ligaments (ACL). The doctor fixed nails in my knee. They
should remove them next September. My knee is OK at present
time. Please help. Thank you for this wonderful site.
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Answer |
Your
symptoms sound like a condition called meralgia paresthetica,
which means a compression of a sensory nerve in your groin.
This nerve supplies the front of your thigh and gives
symptoms similar to the ones you describe. Treatment usually
consists of finding whatever is causing the pressure in
your groin and treating it and if that does not work to
take some medications which will decrease the feeling.
This however may also be due to something else, like a
pinched nerve, so it is best if you see a neurologist
to get a better idea of what's going on.
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Lumbar
fusion/military discharge with normal EMG but persistent
pain |
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I
had an L4/5/S-1 fusion with Texas instrumentation about
16 months ago. The shooting pain down my legs has stopped,
but I'm having problems with numbness/tingling in my legs/feet,
and pain that works its way downward with prolonged standing
or walking. Any kind of Physical exercise exaggerates
these symptoms, which makes PT difficult, but I'm sticking
with it. A Myelogram with CT reflected bilateral lower
nerve root impairment from epidural scarring. However,
an EMG/NCS was unremarkable, an "essentially normal study",
"no nerve damage". Now, I'm being discharged from the
military after 18 1/2 years with no compensation for "failure
to meet physical fitness standards" (3 mile run, sit ups,
push ups). I Realize that you're not in the legal profession,
but can you offer some explanation for my physical findings,
and symptoms? Be frank please, if you think it's all in
my head I need to know. That's obviously what the military
thinks, and since I am not afforded any legal representation
or recourse like a typical civilian would be I'm scared.
I'm worried about supporting my family. I have a lot at
stake here! Should I continue physical therapy even though
it causes me pain and discomfort? I want to do what I
need to do to get well, but I also have concerns of causing
further aggravation and damage, which would only further
reduce my physical limitations and impact negatively on
my physical abilities once I'm discharged and have to
go to work and support my family. One other thing, I just
had my first epidural steroid injection yesterday. Am
I wise to try these? Can they help with nerve root impairment?
I'm willing to try anything, please tell me where to go
for some help! |
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Answer |
EMG
can be 30-40% false negatives in radiculopathies. As pointed
out by, 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. The point is that EMG, then, can be negative
although there are symptoms as in your case. Although
you have problem with physio, but I think very careful
and gradual step by step physio may help but it is up
to your treating doctor.
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Comment
from another patient |
I
have the exact symptoms as you do, have had EMG's done
all came back normal but I insisted on MRI and found that
I have degenerative disc disease, which cause what you
are describing. It sounds to me that’s what you need
to have done is an MRI hopefully it will show something.
Have they tested you for arthritis as well cause pain
as you are saying also comes from that as well, Which
I also have. I know this isn't really good information
but hopefully it will help you with your problem and the
military do go and have a second opinion done as well
cause I was working with military doctors as well and
it seems they got the name doctor from a bubble gum machine
at times, request a doctor from the outside. Good luck
on all your pain and with the military.
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