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Myelogram |
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I
just got my myelogram back reads: Extradural defects located
at the C 5/6 level of disc. What does this mean?
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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. |
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EMG
in pelvic floor pain and spasm in 4 year old child |
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My
4-year-old daughter suffers from pain "spasms" that have
been identified through urodynamic testing as irregular
muscle contractions in the pelvic floor. She has had 2
serious bladder infections and has a great deal of pain
going to the bathroom. The spasms also happen at other
times. Her neurologist has recommended an EMG to evaluate
the muscle functioning. Have you ever encountered this?
How would the abdominal/pelvic muscles be evaluated? |
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Answer |
I
am not too sure what is causing pain "spasms"
in your child. However, it could be related to serious
bladder infection. The EMG of either abdominal or pelvic
muscles could be examined by needle electrode. The abdominal
muscle is not a regular muscle to be examined in EMG laboratory,
but fairly easy to do by electromyographer hand and even
pelvic muscle is more frequently examined in EMG lab.
A reflex pelvic muscle activity can also be examined by
applying little electrical pulses. It is up to examiner
to decide about this. All the best.
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Possible
causes for foot drop |
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My
husband has experienced foot drop and numbness from mid-calf
through ankle on his left foot for about a month. Two
weeks ago, he had a Nerve Conduction Study, and the physician
doing the test suggested he had injured his peroneal nerve:
he said the charge "decreased from 64 to 40, calculated
over 14 centimeters". (I may have this wrong, as I'm just
reading from notes.) Today, though, my husband had a follow-up
with his internist who said his blood tests came back
border line for lupus. He was also referred to a neurologist.
I understand that the possibilities range from neuropathy
to MS or even ALS. Can you give me any guidance about
what we can expect from the neurologist? (This is the
same neurologist who treated my mother for a malignant
brain tumor, so I am terrified.) Thanks so much for your
help. |
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Answer |
I
do not think there are any evidences from your email to
suggest MS or ALS. The peroneal nerve injury is not a
serious problem. Perhaps the neurologist would reassure
you regarding the peroneal nerve after full neurological
examination. He may need to check into borderline results
of lupus. |
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Value
of EMG in monitoring syringohydromyelia (mine in the conus
medullaris) |
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Was
diagnosed with cystic dilation of the spinal cord in the
conus medullaris (lumbar spine, 2 cavities) in 10/1999.
Have had problems (and horrible flare-up episodes) for
well over 10 years though. Am now 36. Plus there is degenerating
disc (herniated) at L5/S1 where I have a spina bifida
occulta (hemangioma also marks the spot) a 1cm left leg-length
difference and the sacro-iliac joint has "jumped" a few
times, and the facet joints show arthritic at L5, L4.
I might sound a bit of a croc but I did lead a pretty
active life until some 18 months back, flare-ups aside.
My question: I have often during these flare-ups of pain,
burning into my stomach, stabs just below my ribs, to
the left and right, and gnawing in my back "kidney area".
I was seen by a gastroenterologist a few weeks ago and
had all the tests (echography, blood tests, endoscopy.
They came back "super perfect" and he thinks the pain
is coming from my back. This pain into my internal organs
is also usually accompanied by horrible aching into my
legs. So basically everything below 2/3rds of my torso
hurts when I get a "crisis" and I get very panicky then.
A narcotic (pentazocine) plus voltaren (injected into
my bum) enabled me to sleep but the pain kept coming back
for about 5 days. Can an EMG with the needles placed in
my scalp and in my thighs and calves detect nerve irritation
occurring mid-torso level? Or should they be placed in
a different way to help get to the bottom of this pain
that goes into my internal organs. With syrinxes (SM),
I know the cavities can heal, but wouldn't there be some
trace left on an EMG? The reason I ask is that back in
February 1999 (having had a bad episode of pain early
January and having even been in the hospital for at total
of a week at the time!)the EMG was very good. So can the
syrinx in my spinal cord at lumbar level be causing all
this pain but the EMG doesn't/can't detect it? I have
always been a hardworking, self-motivating individual
and enjoyed good jobs but now it is my body and pain that
determines what I do. I haven't worked for a year and
every time I get more active, all the problems come back.
So I try and be a useful member of society by doing a
bit of charity work from home when I am able. I find it
is also good for my moral. I am going to be monitored
by EMG again this coming Tuesday (16th January)but honestly
if it comes out very good after the last episode of pain
(some 9 days ago) that had me going to the ER on a Sunday
evening and being put on a pretty strong narcotic I will
go spare. I know syringomyelia is a complicated disease
but surely if it causes so much pain, the root cause must
be detectable by a machine like EMG. The MRI scans show
the syrinx but I was told EMG is best used to monitor
it. But can the pain it causes be independent of the change
in size. Do you see where I am coming from? Thanks in
advance for your help. |
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Answer |
EMG can evaluate
all muscles of extremities but not the scalp. Certainly,
EMG can monitor and detect a damage or pressure on nerve
roots caused by SM. It seems that several of your symptoms
can be explained by SM, but is up to neurologist to finalize
that. |
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Need
For EMG due to multiple sensory & motor complains |
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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! |
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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 demeylination at the Central Nervous System level
which is not investigated by EMG.
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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! |
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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. |
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Nerve
Pain in Both legs and tingling with doctors saying it’s
alright |
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I
have pain and tingling in both of my thighs. But recently
I've been feeling the tingling in my fingers and other
parts of my upper body. I'm really starting to get concerned
because I've been to my primary doctor at least ten times
and a neurologist at least four times and they found nothing
wrong. Well I know I'm not crazy and I'm not one f those
people who goes to the doctor for every little ache. THis
is serious because I KNOW something is wrong. I eat right,
exercise, and is a very active person. I even take vitamins
and minerals as a supplement. So totally confused and
worried. |
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Answer |
It would
be good to have nerve conduction and EMG at least as a
baseline studies. However, it might be difficult to point
to the cause of your problem. I think, second opinion
with a neurologist is worthwhile. |
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S1
radiculopathy and EMG Findings |
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I
have ongoing problems with left gluteal and leg pain (burning,
stabbing) at times severe, and sensory disturbances (decreased
sensation in certain areas) also in the left leg. This
is following a laminectomy/diskectomy at L5/S1 to correct
a disc rupture with free fragment in October 1996. My
surgeon said that at the time of surgery, he discovered
a ganglion in my spinal canal (most are outside the canal,
he says) that was directly compressed by the disc material
that had ruptured. After the surgery, I improved, but
began to get worse again about 2 months after surgery.
An EMG in December showed that the gastroc area had improved,
but that there was more irritability in the paraspinal
muscles. An MRI in February 1997 showed scar tissue, mild
in extent, surrounding the S1 nerve root. A new EMG in
November 1997 showed no electrodiagnostic evidence of
ongoing nerve damage, but did show electrodiagnostic evidence
of old S1 radiculopathy on the left, according to the
doctor's report. My question: I continue to have the server
burning, stabbing pain in my left leg. Is the November
EMG study saying that this is or is not being caused by
a radiculopathy? Any other light you might be able to
shed on my ongoing problem? Thanks very much for the service
you are providing. |
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Answer |
Regarding
the November EMG report. It is not uncommon to find such
findings in patients following surgery. This EMG is probably
reassuring. The point to remember, that EMG is very sensitive
test, it can show mild changes (acute or chronic). It
did help in your case to say that you had old lesion,
the radiculopathy (or related to previous surgery) but
no new significant nerve lesion despite some symptoms.
I think some physiotherapy would help in your case. However,
you had the last EMG in 97. So, if your symptoms are worse,
then it is time to consult your doctor, repeat the EMG
and even MRI. |
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Comment |
Thank
you for your response. I want to make sure that I correctly
understand your answer. Is the November EMG study saying
that I still have a radiculopathy (even though there is
no new significant nerve lesion)? |
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Answer |
Yes,
but a chronic (or old) one. As said in the "EMG in
November 1997 showed no electrodiagnostic evidence of
ongoing nerve damage, but did show electrodiagnostic evidence
of old S1 radiculopathy on the left". From EMG point
of view, generally, it is fair to say in radiculopathy
that EMG findings could indicate whether the abnormalities
are due to acute (=new=fresh) or chronic (=old) lesion. |
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Comment |
Hi
again,. Thanks for responding again. I understand and
will follow up with my doctor. I really appreciate your
time and the service you're providing. |
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Can
bone gap in old nonunion fracture cause nerve damage? |
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Broke
my tibia in 3 places. I had surgery to set the bone and
implant a titanium rod and screws. I have 2 non-unions
(bones aren't healing) so I have to have another surgery.
I can't even be seen for several more months. In the meantime
I've been walking on the broken leg with no assistance
for the last 2 months. My accident was in July of last
year. There is a sizeable gap in between the bones but
the titanium rod gives me the support I need to enable
me to walk. Here's my question, is there anyway that my
nerves, tendons, muscle, veins, can get caught in between
the bones and by continuing to walk I will pinch or sever
something vital? I don't have another appointment with
doctor until July. Would like some feedback before then.
Thanks in advance. |
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Answer |
Even
if there is a gap between bones (I assume seen in X ray)
but that gap is filled with soft tissues and you have
the rod fixed. The point that if fracture fresh it may
injure nerves, vessels, etc. Therefore, I do not expect
that to happen in your case at this stage. |
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Leg
is worse after EMG test done for hypokalemic periodic
paralysis |
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My
14-year-old daughter was hospitalized a month ago after
experiencing paralysis in her arms and legs. A pediatric
neurologist determined that she suffered from a condition
known as hypokalemic periodic paralysis. An EMG was performed
the first night in the hospital, which confirmed the doctor's
suspicions. An MRI, EEG, EKG and a pulmonary function
test were also done to rule out anything else. Her arm
function came back by the end of the first evening in
the hospital. However, her legs came back a little slower.
Her right leg came back suddenly three days later, however
her left leg did not come back for another three days
but the function came back floppy weak and painful to
walk on. The neurologist scheduled another EMG five days
later to again test her muscle function. Although the
first test was three hours long and quite uncomfortable
for my daughter, she was able to endure the pain. However,
the second test was so agonizing with excruciating pain
that my daughter was unable to complete the test. She
only lasted about 30 minutes until it was so unbearable
she could not breathe. After that second test, her left
leg was worse with extreme pain. It has been almost a
month now and it has not gotten any better and she is
unable to bear her weight on it without pain. Could the
doctor have damaged her sciatic nerve? The pain is from
her hip all the way down her leg. She is on Diamox and
Potassium to treat the hypokalemia. The other symptoms
she had been having prior to being diagnosed with hypokalemia
have disappeared (body pain and fatigue, insomnia, headaches
and muscle and bladder spasms) except for this leg problem.
She is receiving physical therapy twice a week and the
therapist is as baffled as we are to why is not getting
better. Please advise. |
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Answer |
Nerve
conduction studies and EMG are useful to diagnose hypokalemic
periodic paralysis during the attack. This should reverse
back to normal between the attacks. But, I am not aware
of any case got sciatic nerve injury during such procedure.
Please consult a neurologist to verify the problem. |
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Can
EMG localize if injury level if it is in the spinal cord
or not? |
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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? |
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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.
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Comment |
What
symptoms would c34 and c45 bulging cause if these are
two areas that could not be detectable on EMG? |
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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.
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Outer
lower leg pain with normal studies |
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I
have a pain in the middle of my lower leg that sometimes
runs down to my ankle. Never above. I have no back or
upper leg pain. It occurs when I walk around 1 or 2 miles
or stand for a while. An awareness of the area also occurs
when lying down. When sitting everything is fine. I am
only in my 40's and have had vascular tests, MRI and an
x-ray nothing on any of these tests was wrong. It was
suggested perhaps it is nerve pain and I should go to
for an EMG. I don't know what to do. Could this be nerve
pain? The pain is not unbearable. But does make me not
want to walk for a while any distance. |
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Answer |
The
pain you describe does not sound like it would be "nerve
pain". The work-up you have had, vascular and MRI
is appropriate for the symptoms you describe.
Sometimes electrolyte imbalance may cause muscle symptoms
such as cramps or fatigue, which usually cause vague
symptoms of pain and ache in the muscles.
A good internist may focus more on the general aspect
of your symptoms and maybe helpful in your case.
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What
does an absence of H Reflex mean? |
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I
had an EMG after laminectomy, spinal cord stimulator,
and spinal fusion I am having a lot of pain and a gripping
pain in left leg and foot at times. The EMG shows increased
polyphasics and increased amplitudes of the medial gastroc
and peroneal. Interference pattern however was normal/
Impressions: Bilateral S1 radiculopathies chronic appearance.
Values were all within normal limits. The only abnormalities
found were absent bilateral H-reflexes. What does this
mean? Sounds like I have no problems, but I hurt all of
the time. And sometimes excruciating. |
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Answer |
Absent
(or delayed) H-Reflexes are seen with S1 radiculopathies
and are an indication that the sensory and/or motor arcs
of the reflex pathway are damaged. So these findings on
the Nerve Conductions are compatible with the symptoms
you describe and do not indicate any other problem besides
what you already know you have.
As for the pain, this question is best addressed by
your treating doctor who seems to be quite familiar
with your case having performed all these procedures
and would be in a better position to answer the question.
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Doctors
say I have spinal cord sprain and I cannot understand
that term. |
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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? |
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Answer |
Well
I suspect he may have said spinal stenosis (? or spondylosis)
causing the increase in your tendon reflexes and the radiculopathies. |
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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? |
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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 "hyperreflexia"
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.
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