| |
EMG/NCS
& MRI positive for cervical radiculopathy but normal
myelogram |
|
| |
|
|
|
| |
I
had EMG and NCS done in november99 positive for c6-7 radiculopathy
also an MRI showing c 6-7 bulging disc. Just had a myelogram
recently and the doc said it looked "real good", and I
don't have a disc or nerve problem. Now I'm confused
|
|
| |
|
|
|
| |
Answer |
Diagnosis
of radiculopathy or disc herniation (root lesion) depends
on clinical examination, EMG and radiology including MRI
and Myelogram. The myelogram is most accurate way to detect
disc herniation. Now an abnormal EMG can result from herniated
disc in your case but the herniated disc may be too small
to be significantly "appreciated" by myelogram,
so considered insignificant by myelogram, although it
is causing nerve root pressure symptoms and abnormal EMG.
Furthermore, an abnormal EMG can be explained by other
causes distal to roots, which could give similar EMG findings
such as Brachial plexus or peripheral nerve lesions.
|
|
| |
|
|
|
| |
|
|
|
| |
Needle
EMG and Radiculopathy and who is authorized to perform
EMG? |
|
| |
|
|
|
| |
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? |
|
| |
|
|
|
| |
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.
|
|
| |
|
|
|
| |
|
|
|
| |
30-40%
false negative in detecting root lesion |
|
| |
|
|
|
| |
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? |
|
| |
|
|
|
| |
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
|
|
| |
|
|
|
| |
|
|
|
| |
Posterior
Interosseous Nerve Syndrome (PIN) |
|
| |
|
|
|
| |
I
just had an EMG a few weeks after a nerve conduction test
revealed concerns in my elbow to wrist area. The EMG Doctor
diagnosed me with PIN Syndrome on the spot. I have not
heard from my primary care physician yet with the complete
analysis; however, I don't know what caused this or what
to expect from here. Up till now there has been muscle
loss around the wrist area and slight weakness in the
hands. Is there a means to predict what I can expect in
the future or what possibly causes PIN? Thanks. |
|
| |
|
|
|
| |
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..
|
|
| |
|
|
|
| |
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? |
|
| |
|
|
|
| |
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. |
|
| |
|
|
|
| |
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.
|
|
| |
|
|
|
| |
|
|
|
| |
Cold
blue hands with severe pain |
|
| |
|
|
|
| |
I
am a 31-year-old female and have been diagnosed by 4 different
doctors with abnormal nerve conduction. They are now checking
chromosome 17 and a couple of them say my arms will only
get worse. I am in extreme pain most of the time, I have
muscle spasms in both my forearms, At times I cannot move
my hands at all and the veins or nerves get so swollen
they look like they are going to come out of my skin.
My hands are constantly cold and my fingernails turn blue
to the point where people have thought I was wearing nail
polish. It pains me just to type this. The pain goes no
higher than the elbow. Are there any answers you can give
to me? Thank you for your time. |
|
| |
|
|
|
| |
Answer |
I
am not quite sure what the abnormality is on your nerve
conductions but symptoms you describe involve more than
just your nerves and at least involve collagen tissue
and your blood vessels (the coldness you describe and
the change of color sounds like Raynaud's phenomenon).
Usually Rheumatologists are specialists in this area.
Any nerve or nerve conduction abnormality is a secondary
phenomenon and can be diagnosed/treated by a Neurologist.
|
|
| |
|
|
|
| |
Comment
from another
Patient |
A
friend’s daughter has those symptoms and she was
diagnosed with Raynaud’s. Have you been checked for
that? Good luck |
|
| |
|
|
|
| |
|
|
|
| |
MRI
& EMG positive while myelography negative in cervical
radiculopathy |
|
| |
|
|
|
| |
I
had EMG and NCS done in november99 positive for c6-7 radiculopathy
also an MRI showing c 6-7 bulging disc. Just had a myelogram
recently and the doc said it looked "real good", and I
don't have a disc or nerve problem. Now I'm confused |
|
| |
|
|
|
| |
Answer |
Diagnosis
of radiculopathy or disc herniation (root lesion) depends
on clinical examination, EMG and radiology including MRI
and Myelogram. The myelogram is most accurate way to detect
disc herniation. Now an abnormal EMG can result from herniated
disc in your case but the herniated disc may be too small
to be significantly "appreciated" by myelogram,
so considered insignificant by myelogram, although it
is causing nerve root pressure symptoms and abnormal EMG.
Furthermore, an abnormal EMG can be explained by other
causes distal to roots, which could give similar EMG findings
such as Brachial plexus or peripheral nerve lesions.
|
|
| |
|
|
|
| |
|
|
|
| |
Conservative
Vs. surgical management for c. radiculopathy & myelopathy |
|
| |
|
|
|
| |
I
had an MRI with the following impression: Narrowed right
C5-6 neural foramina from osteophytes. Slight flattening
of the central and left Paracentral thecal sac at C5-6
from disc bulge. I saw a neurosurgeon who recommended
surgery after evaluating the history since onset (3 months
ago) of arm numbness/tingling stabbing spasms, reflexes
and MRI. Neck pain in almost not present now. Arm numbness/tingling
pain spasms continue but are less frequent and intense.
Do you think I am a candidate for surgery? |
|
| |
|
|
|
| |
Answer |
Tough
call. Generally speaking, neurosurgeons recommend surgery
when they think surgery will help. They do not like bad
outcomes. One thing for sure, if you start developing
arm weakness/wasting, it is a sign that you're developing
nerve damage and surgery becomes more of an indication.
If your symptoms are improving however, waiting it out
(if no weakness or wasting develops) may give you an idea
if it is going to heal by itself or not. Nothing can replace
a good exam however and if you are unsure of what to do,
seek a second opinion.
|
|
| |
|
|
|
| |
Comment |
I
forgot to add that the end of my thumb, the last knuckle,
is "always" "constantly" a little
numb now, since mid June. Which the neurosurgeon said
I would never get back because the nerve root was damaged
not just irritated & inflamed. Sometimes I feel as
if it's creeping up my arm and my wrist is ever so "a
tiny bit" numb all the time now too (as it feels
just a little off). Would this information increase your
opinion that surgery would be helpful to prevent and improve
my situation? Thank you by the way for your thoughts on
the subject. |
|
| |
|
|
|
| |
Answer |
Nerve
damage, with no prospects of it getting better on its
own, is usually an indication for surgery. Again, if you
are at all unsure, it is best to seek a second opinion.
It would be useful to get an EMG before the surgery however
to determine the amount and location of nerve damage.
Best of luck. |
|
| |
|
|
|
| |
Comment |
Thank
you again for your advice. I saw an orthopedic spine surgeon
and he prescribed VIOXX and 3X's a week (for six weeks)
of PT (physical therapy); heat, massage, traction and
so on before re-evaluating surgery need in six weeks.
My right arm reflexes are still there--- but way off,
the numb/tingling stabbing pains are less intense and
they now only come with certain head/neck/arm positions.
I'm hopeful the PT will do the trick. Thanks again!
I have another question. What is the significance of
a diagnosis of cervical spondylosis with myelopathy?
What is Myelopathy and how does a neurosurgeon diagnose
it. Another words what are the symptoms of cervical
myelopathy (at the C5-6 level for example)?
|
|
| |
|
|
|
| |
Answer |
Cervical
Spondylosis with myelopathy means that you have a tight
spinal canal in the neck area. The spinal cord is inside
that canal of course and it comes under pressure because
of the lack of space. This is what is referred to as a
myelopathy (myelo refers to the spinal cord and pathy
is used to indicate disease). The diagnosis is made by
CT or MRI and or myelogram. The symptoms may involve root
symptoms (the ones you described above) and also some
weakness and increased reflexes in the legs if the canal
is too tight. |
|
| |
|
|
|
| |
Comment |
Thanks
for all your input. Seeing another doctor helped. After
6wks of PT I saw the Orthopedic doctor yesterday again,
for re-eval after PT. He said I have beaten the odds..
Considering how large my disc bulge was, the swelling
has gone done enough so that I no longer have myelopathy
nor is there permanent damage. He did say that I had about
a 30% change of needing the surgery sometime in the future,
due to the nature of cervical spondylosis.
In your experience would you agree or disagree with
the likelihood of future surgery need in such cases?
And what would be the best course of action to optimize
my continued recovery, non-recurrence (including myelopathy)
and therefore the need of surgery (ACDF)? Thank you!
|
|
| |
|
|
|
| |
Answer |
I
cannot say what the chances exactly are but I think 30%
is about right. I also understand your concern about doing
the right thing to avoid recurrence. In such cases however
it is difficult to predict what may cause such recurrence.
Needless to say staying fit and getting right away in
treatment (PT, anti-inflammatory etc.) when symptoms develop
would help. Other than that, in all practicality, there
is little you can do to prevent events outside of your
control.
|
|
| |
|
|
|
| |
Comment |
Thanks
again; gee I've said that a lot. My doctor advised me
also about staying fit. I am slowing entering back to
my workout routines. He also gave me an "ER"
prescription (fill only if symptoms come back) for anti-inflammatory
and advised me to 'save up' PT visits encase of reoccurrence;
as insurance cuts one off after X amount of visits per
contract year. Should symptoms reoccur would you advise
getting a myelography before surgery this time? And why? |
|
| |
|
|
|
| |
Answer |
If
you mean a myelogram, that's a purely surgical decision,
in most instances an MRI will suffice to see if there
are any significant changes since your last visit. |
|
| |
|
|
|
| |
|
|
|
| |
Husband
EMG who has shoulder neck and elbow pain with negative
MRI |
|
| |
|
|
|
| |
I'm
concerned over my husband. He had a negative MRI and had
following EMG findings. He has gone through Facet block
with no relief and has bad L Shoulder, neck, and L elbow
pain going down two small fingers with positive Tinel
sign. Other options we could look for it has been a year
now. Test was 4 month after accident. Muscle Ins Act Fibs
PSW FASC CRD AMPL Duration Poly REC The reading for his
lumbar area was L Tib anterio I 0 0 0 0 n n I rr R " "
I 0 0 0 n n I rr L Medial Gas I 0 0 0 n n n rr R " " I
0 0 0 n n n rr L Vastus Med n 0 0 0 0 n n n rr L Bicep
Fem I 0 0 0 0 n n n rr L Paraspinal I 0 0 0 0 R " " I
0 0 0 The upper area showed L deltoid I for insertion
and rr for recruitment, rest normal L Infraspinatus all
normal L tricep I for insertion and rr for recruitment,
rest normal L flexor carpi ulnaris I for insertion, PSW,
RR recruitment, rest normal R flexor carpi ulnaris I for
insertion, rr for recruitment L & R first dorsal interosseous
I for insertion, PSW, rr for recruitment, rest normal
L & R extensor digitorum communis I for insertion, rr
recruitment, rest normal L paraspinals I for insertion,
rr recruitment, rest normal. My husband had no readings
for any fibs or fasc just 0. Any help appreciated thank
you |
|
| |
|
|
|
| |
Answer |
It is very
difficult to interpret an EMG study over the web. Naturally
the EMGer who performed the test is best qualified to
give you the definitive answer.
From the limited information I have, these findings
(PSW, polyphasic units.) can be seen when there are
pinched nerves in the back and the neck. In the example
you give me, the muscles involved point to the L5-S1
nerve roots in the low back and to the C8-T1 nerve roots
in the neck.
|
|
| |
|
|
|
| |
|
|
|
| |
Radiculopathy
with negative EMG for nerve damage |
|
| |
|
|
|
| |
I
have constant numbness/tingling in my R LE (bi lateral
at times), increased with activity. Can you explain how
I can have the diagnosis of radiculopathy with a negative
EMG? What exactly does it mean, and will epidural steroid
injections help? Does it mean it's permanent? Also, how
could a sensory root lesion be detected, by NCS? |
|
| |
|
|
|
| |
Answer |
To explain
further why the EMG is negative in some cases with radiculopathy.
The medical reasons were pointed out in previous posting.
But I would like to say, if you have a car with maximum
speed limit of, say 120, then it cannot go faster than
that. Similarly, in EMG it has its own limitations we
cannot exceed. We cannot do more than what it could give;
otherwise, we do not need any other tests. The EMG is
complementary or extension to medical examination and
it does not replace or substitute a good medical examination
by all standards. To go back to your question of epidural
steroid injection, it may help, and it is up to your treating
doctor to decide. A negative EMG in your case does not
mean that your symptoms are permanent. On the contrary,
a negative EMG can be reassuring. Finally, I am sorry,
I do not know how to help you with the last point.
|
|
| |
|
|
|
| |
|
|
|
| |
Puncture
to nerve in inner elbow area |
|
| |
|
|
|
| |
I
was in for a routine physical on March 29th. And upon
a blood draw I experienced intense pain shooting to my
left hand. I thought right away it was my nerve. The lady
that took the blood said she had never experienced that
either. I have been seeing an intern and he had his dad
who semi-retired and is a neurologist do a nerve conduction
test last Wednesday. The test came out negative. I have
numbness in my hand and fingers I have had what my therapist
call a lot of trigger points in all areas of my lower
and upper arm all the way to my underarm. I have been
going to therapy for three weeks being treated with heat
and electro therapy. Should I be as concerned as I'm on
Vioxx for the inflammation if I don't take it by the end
of the day my arm is clinched so close to my side because
my whole arm hurts. Is there another test I should have
done? Should I continue the therapy and give it time?
Would an MRI tell me what is going on in there, could
she have got a tendon also? I thought I should give you
all of my symptoms. It started with tingling in my hand
and fingers shortly after it happened. The tingling started
spreading up my arm and I started getting increased discomfort
in my elbow area. Within 5 day's the muscles in my arm
started hurting. Today my fingers are numb and are very
sore and stiff. My muscles in my underarm hurt a great
deal as well as my forearm and bicep. The discomfort in
my arm changes spots. The pain in my fingers is consistent
I'm sorry to post twice before a response but I just found
this forum and I have been searching for answers to insure
I am getting the right treatment. I have never had something
like this. It's been a month. I have been told it takes
a long time for nerves to heal. I guess I just want to
know how long, and is it my nerve. Will an MRI show what
it is or would you recommend an EMG? Thanks so much, I'm
scared! Thank you for any advises you can give me. |
|
| |
|
|
|
| |
Answer |
According
to your symptoms, it seems like a nerve lesion by injury
or pressure, probably the median nerve was injured during
needle puncture. I wonder did you have an EMG needle examination
of the muscles or just nerve conduction studies. If it
is so, then I think you need to see your neurologist again
to do (or repeat) EMG needle examination of the muscles,
which should be helpful to exclude nerve lesion and its
degree. I think the EMG is more helpful in your case than
MRI.
|
|
| |
|
|
|
| |
Comment |
I
went to a Neurologist yesterday and was diagnosed with
a median nerve lesion. I have been treated for 6 weeks
for ulnar neuropathy. Lots of therapy and taking Vioxx
but I still had a lot of pain. You suggested I see a neurologist
and get an EMG. I found a sharp Dr. and the Dr. agreed
he will be doing the test on the 22 of May.
My question is He gave me a prescription for Neurontin,
I was wondering if it will interfere with the test in
any way.
I am very thankful for this forum and for all your help.
I will keep you posted. I still have a great deal of pain
in my whole arm and I hope the Neurontin will help.
|
|
| |
|
|
|
| |
Answer |
I
hope all the best for you and to get well soon. About
the Neurontin, it does not interfere with EMG test at
all. |
|
| |
|
|
|
| |
Comment |
Hello
Dr., I have appreciated all of your advise in the past.
I went to the Neurologist Wednesday he does believe I
have a Median Nerve lesion. He did a nerve conduction
test and told me it did not show any concerns of permanent
nerve damage or motor skill damage. He has me on Neurontin,
I am up to 4x/300mg per day. I was told He does believe
I have pain and that the nerve will take time to heal.
I was very relieved to hear that and left his office feeling
good, then when I got home I started thinking why did
nothing show up when I have so much pain.
The pain is mostly in my finger index, middle, and ring
finger. If I wait to long before I take the medicine I
have a lot of discomfort in my elbow and lower arm.
The Doctor said, “be patient”. Those nerves
heal an inch a Month.
I called the office back today and asked if he would send
me for an MRI and he had the nurse tell me he would not
OK it. I was hoping I would have someone tell me exactly
what is happening in there.
Should I just give it time he wants me back in 2 Months.
Thank you in advance, |
|
| |
|
|
|
| |
Answer |
Thank
you. I am pleased that you feel better. All the best |
|
| |
|
|
|
| |
Comment
poster later
by the same
Patient |
I
have post several times in the past and you have been
very helpful. I currently am healing I hope from a puncture
during a blood draw. I am concerned and have asked my
Doctor about a tingling in my cheek that started shortly
after the injury. It is not always there and changes to
different areas of my left cheek. The elbow that was injured
is my left elbow. It has been 5 months.
Is this something that can happen when you have an
injury of this kind?
I have the physical therapist tell me everything is
connected and as long as I take the Neurontin I am on
regularly it is not as noticeable.
|
|
| |
|
|
|
| |
Answer |
I
cannot see a relationship between the problem at the elbow
and the tingling in your cheek. I am not sure why do you
have cheek tingling. It seems coincidental.
|
|
| |
|
|
|
| |
Comment |
I
got my injury to my nerve back at the end of March (blood
draw, elbow). I have had a lot of different stages of
healing, and strange feelings at different times. I get
jabs and pains in my fingers but I also get jabs and pains
in my toes. Do you think this is all a normal part of
healing? I had an EMG in May and I was told it did not
show any sign of Permanente damage.
Should I have another test done? I am on Neurontin
600 mgs three times a day. I get these pains if I go
to long between doses.
Should I get another EMG?
Is this normal?
Should I see another Doctor?
|
|
| |
|
|
|
| |
Answer |
I
can understand the pain in the fingers but not the pains
in the toes. Therefore, it would be good idea to consult
another doctor before you proceed to another EMG. |
|
| |
|
|
|
| |
Comment |
I
have posted before and you have given me good advice.
I the best advise you gave me was to see another Doctor.
I did and was given diagnoses of Venipuncture RSD, are
you at all familiar with this? I am hoping I have not
waited to long to get the right Doctor. I have had two
visits with Dr. who is in Florida and he has treated RSD
in patients for 30 years. I feel I am getting the proper
treatment although he has said that my type of RSD is
the most vicious type to have. He has me on 4 medications
and I am in Physical therapy and I am using a heat pad
and feel somewhat better. I have stopped taking the Neurontin
that was making me very tired all the time and that caused
me to gain 20 lbs. in 8 months. I have a very scary health
problem that might be with me for life.
I had told you and you asked me to keep you posted
so I am doing that. I hope that if there are other patients
out there that don't feel the Doctor understands their
pain that they get other help and with someone that
knows about RSD.
|
|
| |
|
|
|
| |
|
|
|
| |
Neck/Arm
Nerve damage from Anesthesia Needle |
|
| |
|
|
|
| |
Hello,
I have a friend that was to undergo surgery about 5 weeks
ago. In the course of having the anesthesia put into his
neck, the anesthesiologist hit a nerve. My friend's arm
became uncontrollable and through some very scary moments,
the anesthesiologist succeeded in applying the full anesthesia
-- but the surgery was canceled due to the immediately
obvious consequences: right arm in severe pain, limp and
no motor control. After 5 weeks, the pain is at a constant
level - no change. He still has virtually no motor ability
in his right arm. He describes what he feels this way:
"It is like my arm is going to explode from pressure."
He has the sensation of his arm being completely "inflated",
though there is no inflation apparent on the outside.
Multiple physicians have been consulted. Everyone has
a "wait and see" conclusion, as this is such a rare thing,
and none consulted have had any experience with this kind
of incident. At this point in time, my friend lives with
pain every second. He is looking for ideas -- directly
or anonymously -- as to how he can 1) perhaps stimulate
nerve regeneration, 2) expedite nerve regeneration, 3)
any experiments. |
|
| |
|
|
|
| |
Answer |
It
is difficult to imagine exactly what happened, but in
such instances, it is not uncommon that the nerve can
get damaged as a result of the puncture or the injection.
Nerve damage resulting from puncture or injection can
take a long time to recover. In such cases I recommend
seeing a neurologist to get an EMG and assess the amount
of nerve(s) damage and then a Neurosurgeon who specializes
in peripheral nerve surgery in particular. This will be
useful to determine if any surgical intervention may be
necessary, now, or after a certain period of time has
elapsed to give the nerve enough time to heal on its own.
|
|
| |
|
|
|
| |
|
|
|
home
about
us 
patient
forums
doctors
forums
online
store 
contact
us 
