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Is
EMG test painful? |
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Can
anyone help me interpret this: triceps has a mild increase
in recruitment, amplitudes and 70% polyphagia. The only
definition that I can find for "polyphagia" is food related
eg. hungry. These segments are from my EMG. Thanks for
any ideas or help.
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Answer |
I
am scheduled for an EMG on Wednesday the 11th. They are
looking at my neck. I was rear ended in an accident and
this caused a disc to protrude and touch my spinal cord.
I have been having trouble with weakness and numbing in
my left arm. I'm a little nervous (also, I'm a wimp) and
would like to know if it is painful.
Thank you in advance. In conclusion, I wanted to know
if the EMG was painful (not the neck injury).
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Comment |
Thank
you for responding. I went through the test and it was
quite tolerable. A couple of times I had pain, but mainly
that was the needle. Thank you again.
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Comment
from another
Patient |
I
am quite upset. I just had an EMG today performed by my
doctor's associate....another doctor. He briefly explained
the test. He did explain the first part about the electric
current, etc., which was uncomfortable, tolerable. However,
he then proceeded to unwrap a needle. I asked if it would
hurt, he said "no...I'm just going to listen to changes
in sound waves of the nerve." I must have asked him
three times if he was going to keep sticking me with that
needle and he said "no." But, as you know, he
did stick me several times in my left and right arm...performed
the test quickly, and I feel haphazardly. Two of the spots
where he inserted the needle bled a lot and became swollen.
(A hematoma, I think.) He wants me to go back for a test
of my spine, which I don't want to do. I have 2 bruises
and want to know how common this is with this test. I
am duly upset because of his not being honest, him hurting
me, and the bruises. Thanks for your feedback. |
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Comment
from another
Patient |
I
had an EMG and NCV about two weeks ago. The NCV was, to
me, worse than the EMG, yet even the NCV itself wasn't
that bad. I certainly do NOT dread my next EMG. There's
just a minor pain at insertion, which I found less irritating
than, for example, the needle prick associated w/ giving
blood. |
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Comment |
Thank
you so much for responding. Yes, I do have to agree that
it was the needle that caused the most pain, but I got
through it just fine. Thank you again. |
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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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Help
w/ Interpretation of EMG Results please is it really poor |
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Can
somebody help me interrupt the following EMG results?
"Mild denervation potentials were identified in
the left tibialis anterior alone. Changes of denervation
with reinnervation were seen in the tibialis anterior
and EDB."
Also:
MUAP
L. TIB ANTERIOR Amplitude: Few+
L. EXT DIG BREVIS Amplitude: Few +, Polyphasia Few +
RECRUITMENT
L. EXT DIG BREVIS Pattern: - (minus sign)
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Answer |
EMG
interpretation is best left to professionals who have
performed the test and should give you an impression and
interpretation of what they found. It is best to have
your doctor explain it to you. |
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Comment |
The
sad part is this impression was likely written by his
physician. Poor reporting. |
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Answer |
That's
possible in which case it is not an adequate report, and
it is certainly incomplete. |
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Variation
in normal EMG |
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My
daughter age 19 had an EMG today due to a cervical spine
injury 2 years ago. MRI shows minimal bulge at C4-5, 5-6,
spur at C2 and an annular tear HIZ at c 5-6. She has complained
of pain in her neck, shoulders, and right arm with numbness
and tingling of her right 3rd, 4th, and 5th fingers. The
EMG was read as normal but in looking at the numbers there
was variation in the conduction velocity in her arms.
Right Median 56.5
Left median 57.5
Right ulnar-elbow to wrist 64.4
Left ulnar-elbow to wrist 59.2
Right ulnar-across elbow 65.4
Left ulnar-across elbow 58.7
I understand these are normal ranges but should there
be this much difference between right and left or could
this be an indication of some early damage? She believes
that the pain and sensory deficits are getting worse.
On physical exam she has hyper-reflexia of her upper extremities
and bilateral positive Hoffman's sign. The neurologist
that did her EMG today said that she may have had some
bruising of the cord resulting in these symptoms of cord
compression. Thanks in advance for any information you
can give me. |
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Answer |
These
values are still normal. The variation does not indicate
damage in this case. You see, the difference has to reach
certain value such as 15 m/s, to be significant or by
itself reach lower certain values. However, the treating
doctor always would take the findings within the clinical
context. |
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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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Please
don't take Offense at this question! Can EMG be Rigged? |
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What
about Valium / Xanax / or others before the test to calm
the patient who has a driver???? I am rather needle phobic
(though getting less each test) If a drug will help me
feel better about the test and will not interfere with
the test results than I would like some feedback. I am
currently taking Vicadin and Oxyctin 10(at night time
only). Anything with the word "NEEDLE" freaks me out.
Sticking me multiple times, and leaving it in seems worse.
Though many have told me that the EMG is not pleasant
but bearable I still would like to know about possible
med's for scary cats like me. |
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Answer |
First
of all; I do accept your question, no offense, it is nice
interesting question. Now, back to question, EMG and nerve
conduction studies are done under strict internationally
controlled criteria, similar to operating computer or
driving a car. You must follow rules. In our field, therefore,
EMG and nerve conduction studies follow 2 lines: one is
technical which cannot be rigged; we go by numbers and
parameters. Having said that, we should always know that
these studies have limitations and can be normal even
if the patient has symptoms. This brings me to the second
line, the interpretation part. Here the doctor explains
the findings and then would attempt put data or findings
together for certain disorder and to correlate the findings
with the patient symptoms. Here, comes the experience
of the examiner and "tailoring or rigging",
but do not get me wrong, even here we follow rules of
medicine in interpretation but of course depends on experience
and knowledge of examiner in putting the data together
and considering some findings as significant or not. That
is why, in our reports we always have the technical data
are written down for the referring doctor to see, followed
by examiner report and interpretation, this may vary but
usually well agreed upon. You see we do, with God help,
our best for the patient care.
Regarding your other point, EMG can be normal if you
have tingling in both little fingers. EMG is useful
to diagnose a lesion of the nerve itself or radicular
lesion. But, if due to central lesion (spinal cord or
brain), then EMG does not help, other radiological evaluation
is needed, but it is up to treating doctor.
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Comment |
Hello.
Could you provide reference to the criteria which you
refer to - i.e. what is the governing organization or
standard? And is there a web site? Also, is there a type
of EMG which does not have any numbers of a graph associated
with it- and if so when would this be the case. Thanks
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Answer |
The website of American Association of Electrodiagnostic
Medicine is useful: www.aaem.net, especially go to practice
parameters (http://www.aaem.net/practice_parameters.htm)
or (http://www.aaem.net/publications/
practiceaids.html#Guidelines%20in%20Electrodiagnostic%20Medicine).
Regarding your last point, I am not aware of EMG without
numbers or graph.
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Comment |
I
am thinking those machines are messed up also cause I
have severe pain and numbness in my right leg and foot
and they said that everything showed normal but I told
them that something isn’t normal. |
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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 (intermittently) 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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EMG
Technique (description) |
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I
am scheduled for an EMG Test after some concerns were
noted in my nerve conduction test in the upper extremities.
Could someone explain his experiences with the test? Painful?
How long does it take? In general, what can I expect?
Thanks. |
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Answer |
The
needle EMG part of the test consists of inserting needle
probes in the muscles, usually, 4-5 such insertions per
extremity. No electrical currents are delivered by the
needle, no blood is drawn and nothing injected; just a
sampling of the muscle to see if it is normal or not.
Though the sticks are less painful than injections, they
are nevertheless uncomfortable. One extremity needle testing
takes about 10-15 minutes and usually reveals very useful
information about the nerves and muscles.
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EMG
Technique (use in determination of injury duration) |
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Can
an EMG and nerve conduction test tell if nerve damage
is from an old injury or a new injury? |
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Answer |
Yes,
the needle part of the test can usually tell whether an
abnormality is from an old injury or a recent one (under
6 months old) |
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Heat
role in EMG results |
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I
was given an EMG test, the doctor did not like the results
of the test. So he placed heating pads on both of my hands/wrists/arms
for about 10 minutes & re-took the test, right side first.
I passed on the right side but again failed on the left.
So he heated me left side up again & I passed. Is this
a normal procedure to heat up the arms & etc. I was not
cold nor cold to the touch? What is the reasoning behind
the heating procedure if it is normal? |
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Answer |
The
change in temperature can affect the nerve conduction
studies to great deal even in normal persons; the cold
(even if you do not feel it) can cause slowing in nerve
conduction. Therefore, it is important to check the temperature
(skin temperature) before, during the test or at least
in case of slow nerve conduction.
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Practical
use of EMG in trauma |
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Can
an EMG and NCS differentiate when an injury actually occurred?
I would like to email someone to discuss this more |
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Answer |
Yes,
EMG and NCS studies are helpful in nerve injuries, for
instance after trauma |
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Nerve
injury due to bulged disc; is it reversible? |
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If
a disc has caused nerve damage in an arm, will it be permanent
or can it be fixed? |
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Answer |
Nerve
damage is reversible when the nerve is still connected
(in continuity) and the cause of the damage has been removed.
Disc bulges usually leave the nerve connected, so when
the cause is eliminated (or gets better on its own) the
nerve regenerates. Nerve Growth is slow though, about
1 mm/day.
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Mixed
median nerve neuropathy with demyelinating features |
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I
was tested two years ago and just advised today that I
have the above diagnosis. I would like more information
as I was told there is nothing to do since the damage
has been done, except pain control and seeing a neurologist.
Where do I find out more about this? |
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Answer |
That
does not sound like a very good EMG diagnosis because
it doesn't tell you much. Usually demyelinating lesions
of the peripheral nerves heal very quickly, unlike axonal
lesions, where the nerve fiber is cut, which take longer
to heal. I would have that report looked at by a qualified
EMGer, neurologist or physiatrist
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Increased
insertional activity |
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How
does increased insertional activity sounds like? (The
one, which is seen early in the course of denervation)?
Does it sound different than cramps - poorly relaxed muscle?
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Answer |
That's
a tough one to describe in words, but basically what I
call increased insertional activity is when I begin to
see insertional potentials (and I am away from an end-plate
zone) which look like fibs and positive waves but which
never become spontaneous and persist after I stop the
insertion. The sound is a bit similar to a brief end-plate
zone noise, which does not persist. It is a much "quieter"
sound than that of a cramp or a poorly relaxed muscle.
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Comment |
Hi!
Thank you for your elaborated answer. I know that a cramp
(or poorly relaxed muscle) sounds like a high frequency,
repetitive bursts very very very fast (like a machine
gun fire)-does increased insertional activity SOUNDS also
like that? |
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Answer |
No,
nothing like a cramp, much quieter. |
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Normal
EMG in a complaining patient |
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Well I had my EMG done and it wasn't too painful but they didn't find anything in it so they really don't know what's wrong with me. My orthopedic now suggests physical therapy. This is driving me crazy I've had this injury since November. I just want to know what's wrong with me.
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Answer |
An
EMG can still be negative and you may still have a pinched
nerve. But in situation like yours the pain may also be
musculo-skeletal in nature, that means from muscle spasm,
local joint inflammation or a sprain. If Physical Therapy
doesn't help, an MRI of the spine would be useful to make
sure there is no pinched nerve.
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