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EMG
for Elbow and failed Carpal Tunnel |
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Please
explain which areas of the limb are tested for these problems,
I need to be prepared. |
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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.
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Lost
distal UL sensations with normal electrodiagnostic studies |
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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? |
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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. |
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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.
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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. |
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Comment |
Thank
you, we will look into that. |
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EMG
rules out Ulnar Groove entrapment? |
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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, oppenens
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? |
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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.
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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,
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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. |
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Ulnar
nerve entrapment operated |
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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. |
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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.
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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 |
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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. |
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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 |
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Curious
about EMG testing in CTS |
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My
Doctor wants me to have an EMG test. I have carpal tunnel
syndrome in both hands. I've heard it's very painful and
many times not 100% accurate. Is the test very painful?
and how accurate are they? Is there a surface test that
can be done that's less painful and just as accurate?
Please answer my questions as this test just around the
corner for me, and I'm scared. Thank You |
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Answer |
The
study is divided into 2 parts; the nerve conduction studies,
NCS, (surface test, no needle), where there is little
electric shocks to study the nerves. The other part consists
of inserting electrode (needle) in the muscle, little
distance and it would induce little discomfort and pain.
This pain is quite variable between individuals, but in
vast majority both tests are tolerable and no squeal.
It is important to do in patients with carpal tunnel syndrome
(CTS). It is highly sensitive and accurate in CTS. I would,
personally, say more than 90% (scientifically difficult
to say 100%). Now, it is up to the examiner to perform
both tests or would get away with the nerve conduction
without the needle part. Actually, not every patient with
CTS needs the needle part. It depends mainly on the patient's
symptoms and signs, and obviously, on the obtained results
of NCS, as well.
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EMG
Results with ulnar neuropathy in Guyon’s canal |
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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? |
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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. |
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Numb
hand - please help! |
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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 grabbag 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. |
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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.
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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? |
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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.
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In
need to understand some terms in NCV report for CTS |
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I
have had a nerve conduction study of the upper extremities:
revealed prolonged terminal latencies of the Rt. median
motor, sensory, midpalmer bilaterally; left mid sensory
mildly prolonged as well. Abnormal nerve conduction exam
of both upper extremities are suggestive of focal median
nerve entrapment neuropathy across the wrist (CTS) bilaterally,
Rt. > left. I have yet to actually see the neurologist,
appt set up; however in the mean time, what's the translation
of terminal latencies prolonged, abnormal exam. What is
a large fiber diffuse peripheral neuropathy, (states no
evidence of). The only repetitive motion I have in my
life is 6-8 hours (intermittenly) on my job, I case and
deliver mail. I have filed wc/occupational illness. I
had the NCS done before filing so to have proof of condition.
Talk to me someone! I am in braces 24/7 weight limit 15lbs
lifting until owcp gives an answer. I'm concerned...surely
my job duties has caused this, right? Intimidation is
not a pleasant experience. |
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Answer |
To
be precise and go to the first point, "the terminal
latency prolonged" means that, there is pressure
or entrapment of the median nerve causing slow of conduction
or response on electrical stimulation of the nerve. The
second point, "large fiber diffuses peripheral neuropathy";
there are 2 kinds of nerve fibers; small and large nerve
fibers. The usual nerve conduction studies deal only with
large nerve fibers. Therefore, when those nerve conductions
are abnormal, then we refer to large fiber affection.
Now, the last point. The CTS is very common condition
all over the world. It is related to repetitive actions.
Thus, it can be an occupational illness.
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Comment |
Thank
you so very much for the response. This is about all the
response I can muster right now. |
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