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Normal
EMG in CTS |
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Can
you have a normal EMG test yet still have carpal tunnel
syndrome? I have heard of something called Clinical &
have heard about something else that has to do with being
undetectable for some reason? Please advise. Thanks
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Answer
1 |
Yes
there are EMG negative Carpal Tunnel Syndrome in which
the patient has the clinical signs and symptoms (check
out http://www.teleEMG.com/guides/cts.htm)
of carpal tunnel yet have a negative EMG. But it may also
not be Carpal Tunnel. A good way to find out would be
to purchase carpal tunnel wrist splints and wear them
mostly at night for a couple of weeks to see if symptoms
improve. If they do then it is likely that it is carpal
tunnel.
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Answer
2 |
Sure,
NCS may be normal in CTS. But such cases are uncommon
or rare, also has to be mild. The problem there is no
good correlation between symptoms and NCS abnormalities
(if any). I can recall one patient few years ago came
with symptoms of CTS. The study was "normal".
However, the orthopedic surgeon did the median nerve surgery.
The patient improved. The other point which should be
kept in mind is presence of anomalies, that may cause
confusion.
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Electrodiagnostic
assessment & management of CTS |
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I
have been diagnosed with CTS and now am being sent for
an EMG. I would like to know what this test is, the pain
involved and whether or not a positive or negative result
changes the diagnosis. I have done the splints for a long
time with relief way back when but no relief now. I have
had one cortisone treatment which has done nothing except
relieve the nighttime pain but day to day is actually
worse. |
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Answer
1 |
An
EMG, which studies nerve conductions (by delivering electrical
impulses to the nerves) and muscles (by inserting a needle
probe into different muscles), is an uncomfortable procedure
but a very useful and sensitive test for carpal tunnel
syndrome. If your symptoms are as severe as you describe,
then in all likelihood the test will be positive. If it
is not, I would seriously question the diagnosis of carpal
tunnel.
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Answer
2 |
have had EMG testing which resulted in surgically releasing
both my wrists due to CTS. The pain associated with these
tests can be mild to moderate. I would suggest if possible
to take a doctor prescribed pain medication one half hour
before the testing is done. I am going again for further
EMG tests tomorrow as I am still suffering effects of
CTS even after surgery. The testing takes approximately
20 minutes to a half hour and is quite bearable. Good
luck to you with your results. |
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Weakness
and pain months after surgical release of carpal tunnel |
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I
am experiencing medium to severe pain and weakness after
having a surgical release for carpal tunnel in both wrists.
My first one was done over a year ago the second was nine
months ago, shouldn't the weakness and pain be gone by
now? I am a secretary by trade and have to use my hands
in a repetitive manner on a daily basis, I need to elevate
this pain and weakness, can you help or suggest something?
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Answer |
When
the surgery is successful (and if the problem prior to
the surgery was indeed carpal tunnel and not something
else), then all the symptoms, pain and weakness should
disappear. Exceptions to that include such a severe carpal
tunnel that surgery may not be able to restore full function
to the nerve. To verify whether or not the surgery released
the carpal tunnel entrapment, a repeat EMG study on both
hands would be very useful.
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CTS
& Cervical radiculopathy |
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I
had an EMG test last Friday because an MRI showed herniated
discs in C5-6. I was still having considerable pain in
my left shoulder. Since the test I have had significant
pain in my left hand and arm. The test showed I have carpal
tunnel syndrome and some nerve damage in the neck area.
Would the test have aggravated the nerves that are associated
with either of these problems? |
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Answer |
The study
does not cause any lasting damage to either nerves or
muscles but you can be left with some soreness in the
areas that were studied for about 24-48 hours due to local
tissue irritation
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CTS
TESTING |
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A
couple of questions:
1) I have at least a thousand fasciculations a day. How
come during the 3 EMG's (2 partials, 1 full) no fasciculations
were detected? Seems impossible.
2) Besides random fasciculations, I frequently have fasciculations
right after moving a muscle. Is this more problematic
than a "random" fasciculation?
3) Is it likely that twitching can occur for six months
without loss of strength and still get diagnosed with
ALS??? |
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Answer |
Actually
it is not always surprising if the concept of EMG needle
recording is understood. If the tip (or the recording
pick up area) is far from fasciculating potential, then
you do not see any fasciculations on the screen. For the
second question, yes it is possible, and that is why a
follow up EMG is usually needed. Regarding time period
after onset of twitching without weakness or an abnormal
EMG, it is difficult to be absolutely precise in time.
But several months are usually acceptable by the time
fasciculation is seen, but provided no other clinical/EMG
findings.
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Thoracic
paraspinals EMG Specificity in ALS |
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I
am writing you to ask if there is any other way to test
for nerve damage? I have severe wrist and lower and upper
arm pain in one arm. It started in my fingers then after
3 days protruded to my arm and my shoulder and now y breast
is also numb. I just received a crotz shot in my wrist
to supposeively help soon. To hold me until the testing
next tuseday 4/4/00. I can tolerate pain but not anymore
than I have now! Why must they put me through a test,
which could lead to more pain to say yes you have carpal
tunnel syndrome? This pain has been going straight 12
days and night without a break. Help please give me a
solution. I probably won't /can't go for this test knowing
it will induce further deeper pain. Please respond, you
are my last straw for help. I forgot to state that this
started with both hands getting numb two years ago. I
would wear braces to bed at night and they would be better
after 3 nights of doing this. I feel I got this when I
was always using a hand grinder to grind off decks. (Carpenter
work in summers) I also am a tax prep, self employed luckily
my right hand which is my dominant hand can still type.
I used my left hand mainly for holding the phone. So,
this started over a long period of time. |
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Answer |
From what
you describe, your symptoms sound like carpal tunnel to
me and the wrist splints and the cortisone injections
usually help. The EMG (if you haven't had one before now)
will be very helpful to diagnose your condition and therefore
help your doctor develop option plans for treatment. The
idea is to find out what is causing your symptoms first,
and then treat appropriately.
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Comment |
You were
right. The testing was very important. Can there be errors
in the test. It showed my bad arm/wrist being negative
and my good arm being positive? May be as he was looking
at me. His right is my left and his left is my right.
Do you know what I mean?? Well at least it showed nerve
damage up in the neck area. He said the pain was probably
muscle spasms. And that might be why my left side is numb
and paining. Thanks again for replying to my postings. |
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Answer |
Well errors
are always possible but a neck lesion can cause bilateral
symptoms. Doctors are usually very careful in noting the
side they study so I would say the chances of them getting
confused with sides (although not zero) are fairly small.
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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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Curious
about EMG in CTS |
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Hello,
I'm going to take the EMG / Nerve conduction study in
a couple of days for carpal tunnel. I was just curious
in how big the needles are, and how far the needles are
inserted. And how thick they are. I hate needles and I'm
really afraid to take this test, so any information to
help me prepare myself would be appreciated. Thank you
so much. |
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Answer |
In your
case of carpal tunnel syndrome, the diagnosis is dependent
on electrodiagnostic tests. Think that the test will help
to reduce your suffering and does not hurt. One more point,
needle electrode examination is not always performed in
such case, depends on the symptoms and signs. The electrode
(needle), in your case, is quite thin like a small pin
(even thinner) and its length is about 2 cm for hand muscles
and very little of the electrode is inserted. Good luck
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Comment |
Thanks
for the reply. They are going to perform both studies,
needle and just the normal nerve conduction study. But
if the needle isn’t that big I should be okay. But
once the needle is in, does it move around inside the
muscle, if so wouldn’t that be a tremendous amount
of pain? Thanks for any information that you give. Everything
is greatly appreciated.
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Answer |
Thank
you. Once the needle electrode is in, it does not, actually,
hurt more than that, but we do move the electrode little
bit inside.
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Comment |
I
took the test today and it was pretty painful. But the
doctor said that he didnt really see damage but was going
to look over and calculate everything. I know I have the
pain, and every symptom of carpal tunnel. So if it does
come out negative, what do you think the next step will
be? Is it possible for it to come out negative when it’s
really positive? It’s just that this is a workman’s
comp claim and it has been on hold, and they I guess need
some kind of solid proof that something is wrong. Only
I know how much pain it is. But thanks again for the advise.
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Normal
nerve conduction results in tight carpal tunnel syndrome
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What
is the percentage of negative results on a positive finding?
And the percentage of a positive result of a negative
finding? I've gone through 5 nerve conduction tests previously,
and finally was diagnosed with carpel tunnel. The neurologists
said it was because of my small boned structure that gave
a negative result when it was actually positive. When
I received the tunnel releases, it was very tight and
surgeon was surprised that it didn't show up earlier.
I now have possible ulnar nerve problems, but again my
conduction test shows negative. Please give me some information
as why this happens. |
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Answer |
The answer
was offered in the Doctor/patient forum. Anyhow, it was
"The pick up of carpal tunnel or ulnar neuropathies
by nerve conductions is fairly easy so the false negatives
there are very low. For pinched nerves however (root lesions)
the number of false negatives is higher, sometimes up
to 30 or 40%."
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CTS
and proximal radiation of pain |
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My 90-year-old father developed a problem in mid March. He woke up from a night's sleep with swollen middle fingers and pain in his upper arms that only occurred when he tried to lift them at the shoulder joint (no pain with arms at his side). He did have excruciating pain in his left hand, but that has passed (it is swollen however). He still has tremendous pain in his upper arms upon lifting movement.
After two misdiagnoses at the VA Hospital, they now think he has CTS (an EMG was done) and plan on operating. Can CTS cause upper arm pain? He's slowly getting worse. Can this migrate to other parts of the body?
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Answer |
The
presentation of your father's illness (waking up at night
with the swelling you mention) is not CTS, it sounds more
like a joint (arthritis) problem which I take it has now
subsided. Can the swelling cause CTS, the answer is yes
and CTS does give symptoms in the arm and occasionally
the shoulder but does not present itself in this manner.
If the CTS is severe, then surgery is needed but if it
is mild to moderate, you can get away with conservative
treatment for a while at least.
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Comment |
He
still has swelling, mostly in his left hand and arm. And
both hands have lost considerable flexibility (he can't
make a fist nor extend the fingers). But his biggest problem
is the tremendous pain that occurs in his upper arms when
he lifts them (no pain at rest).
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Answer |
would like to say that CTS is common in patients with
arthritis. You said that he is planned for surgery; this
should help to relieve at least some of his symptoms.
All the best.
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