| |
Possible
double crush to ulnar nerve |
|
| |
|
|
|
| |
Two
years ago this May 17th 2001. I was rear ended by a drunk
driver to make a long story short I have had a long recovery
and am still going threw treatment, My question: After
the accident and to date I've had neck pain and numbness
in my little and ring fingers. I had very severe pain
in my neck so bad that just riding in a car was like having
no shocks, feeling jolts to my neck even gravel seamed
like boulders, and I would get pains in my collar bone
as if it was broken. I went in and had Ulnar nerve surgery
to help the numbness in my arm and fingers and in this
area has helped, the perplexing thing is as I awoke in
the recovery room I noticed a great improvement in my
neck pain? and the pain in my collar bone has not returned,
this is all on my left side. I have been told that the
Ulnar nerve should not effect the neck in this way, but,
I know the relief I have gotten to the neck area since!
I still have damage at the C6,7, and T1 nerve areas. that
I am going threw injections for at present but since the
operation have been able to drive fairly well though turning
of my neck becomes more painful the longer I do. A friend
of mine who has some knowledge in this area has suggested
a "double pinch" of the ulnar nerve that she had heard
of? But I've been unable to find any information in this
area of question. Are there any answers? There must be?
Is there any information I can be directed to? I thank
you sincerely for any help in this area.
|
|
| |
|
|
|
| |
Answer |
The
Double-Crush syndrome is well known and has been described
by Upton and McComas in their landmark paper in 1973
TITLE: The double crush in nerve entrapment syndromes.
AUTHORS: Upton AR, McComas AJ
SOURCE: Lancet. 1973 Aug 18;2(7825):359-62
The basic premise is that when a nerve is injured proximally
(or in this case close to the neck), it makes it more
susceptible to injury distally (away from the neck).
|
|
| |
|
|
|
| |
|
|
|
| |
What
exactly happens to give pins and needles sensation? |
|
| |
|
|
|
| |
When
you experience the sensation of "pins and needles" what
exactly is taking place? Is it a result of the healing
process of the nerve or is it a result of damage to the
nerve. I know when your foot is "asleep", the pins and
needles come after the numbness but before normalcy, as
your foot recovers......so I am wondering if the sensation
might indicate a reactivation of proper nerve impulses?
I'm experiencing pins and needles in association with
lyme disease and am wondering if this could be the reawakening
of my damaged nerves and thus a good thing.....or does
it result as my nerves are damaged, and thus a bad thing?
Thanks. Ruth |
|
| |
|
|
|
| |
Answer |
This
is quite interesting question. Any or all of the sensory
symptoms (pins and needles) and signs are considered diagnostic
for a dysfunctional sensory nervous system or point that
some thing going on with sensory nervous system. It could
either occur at start or later in the process of nerve
affection. Although pins and needles may get less with
recovery. But does not basically or necessarily be a bad
sign. |
|
| |
|
|
|
| |
|
|
|
| |
I
have Left elbow pain. Is it necessary to have EMG? |
|
| |
|
|
|
| |
Do
I really need this test? I have been treating what the
doc thought was tennis elbow. But the cortisone shot I
had didn't help that much. So he wants an EMG. I don't
want it if it is not necessary! I have always had left
neck and upper arm pain (I have Fibromyalgia and injuries
from years ago) The main pain is in the elbow area and
runs down the arm...It is different form my usual pain.
Hurts to use the arm and hand...gripping and pulling mainly!
Any advice out there? Sometimes the hand gets cold and
tingles and turns bluish too. I still think it is a joint
problem. |
|
| |
|
|
|
| |
Answer |
You
are right. It sounds like a joint problem. However, only
tingling suggests nerve problem. Therefore, EMG may be
of help.
|
|
| |
|
|
|
| |
Comment |
Thanks
for the quick response. I am concerned that with the Fibro
pain I already have that the test will make my pain worse
so if I don't need it I don't want it. The arm is also
sensitive to touch. Like skin surface pain...all this
seems to lesson when I don't use it. That tells me it
is a joint problem but the doc said since the marcaine
took the pain away for 3 hours it could be nerve pain???????????
Any input here? It is set up for next Tuesday in the doctor’s
office. (A neurologist) Wouldn't the marcaine take any
pain away???????? |
|
| |
|
|
|
| |
Answer |
Marcaine
should work as local or regional anesthesia and analgesia
for pain of any kind, as you said. However, The EMG study
should not worsen your pain, although it does cause little
pain by itself, which is quite tolerable. EMG is a diagnostic
test only. |
|
| |
|
|
|
| |
|
|
|
| |
Brachial
plexus injury & EMG |
|
| |
|
|
|
| |
My
fiancée was involved a snow mobile accident in January
of this year. He sustained 9 fractured ribs, a fractured
scapula, a bruised lung, weakness in one leg and brachial
plexus injury - all to his right side. It has been 3 months
since his accident and he has not gained any movement
or sensation of touch in the right arm. He continues to
experience severe nerve pain despite taking 50mg nortriptyline
and 3000mg neurontin daily (pain management consult).
His first EMG is scheduled for next week and subsequent
consult with the neurosurgeon. His initial MRI indicated
that root avulsion was not "suspected". Is the EMG test
definitive for his type of injury? Will this test tell
us if he is likely to gain the use of his arm or not?
If there is no sign of peripheral nerve activity - what
is the next step? Is there any advantage to repeating
the EMG at a future date - the first test being a baseline?
At what point is an operative option contemplated and
what would they be? Thank you in advance for your time,
|
|
| |
|
|
|
| |
Answer |
The
answers your questions are as follows: EMG/NCS is very
useful in suspected cases of root avulsion. But clinical
electrophysiological correlation is needed. I mean the
examiner cannot interpret its findings alone but should
utilize the clinical findings with EMG results. EMG would
also help to determine its severity as well as the prognosis.
Also, follow up EMG is useful to see signs of recovery
after nerve injury. Another test; somatosensory evoked
potential is also useful in such cases. Regarding the
surgery, it is up to the neurosurgeon. The neurosurgeon
would assess the case and decide accordingly. |
|
| |
|
|
|
| |
|
|
|
| |
Ulnar
nerve entrapment |
|
| |
|
|
|
| |
One
month ago I had an EMG on my left arm. The results indicated
an ulnar nerve entrapment, and recommended elbow surgery.
I had continual pain in my arm and hand before the EMG.
The pain greatly increased immediately after the test,
and has persisted continuously to date. I understand this
is not normal. What could be the cause? Has anyone had
a similar experience? |
|
| |
|
|
|
| |
Answer |
The
nerve stimulation itself does not cause any lasting damage
and usually the pain and discomfort resolve within 24
hours. In some instances however, nerve irritation during
the test can cause an inflammation around it, especially
if the nerve is already irritated because of the damage
to it. In those instances, anti-inflammatory such as Aspirin
or Motrin might help by reducing the inflammation. If
they don't something else is going in and it is best to
seek a consultation for that.
|
|
| |
|
|
|
| |
Comment
from another
Patient |
I
would suggest caution on this one. I had numbness/tingling
symptoms and a specialist (with good recommendations)
diagnosed Ulnar Nerve problems. I had a release &
transposition on one elbow and a year or so later on the
second. It turns out that more than likely the source
of the problem was c4-5-6 problems, not the nerve. I did
have an EMG to rule out the neck but my guess is the results
were inconclusive or false. This syndrome (from my research)
is not that common. Feel free to mail me for more specifics |
|
| |
|
|
|
| |
|
|
|
| |
EMG
in CTS and double crush syndrome |
|
| |
|
|
|
| |
Hi,
I have had an EMG results show carpal tunnel. I also have
cervical radiculopathy from disc bulge and spurs impinging
on nerve at C5-6 and C6-7.My neurologist does not believe
in the "double crush" theory and states that even if he
did, I did not have impingement of the C7 nerve. He obviously
did not even look at my MRI report, which clearly states
this. He also said that because he tested my median nerve
at the wrist and it showed compression this proved only
Ct. This is not my understanding of the process. My question
is; if it were indeed double crush would the testing of
the wrist median nerve still show entrapment? Thank you
very much |
|
| |
|
|
|
| |
Answer
1 |
I would
say that neurologists are evenly split on the existence
(or lack thereof) of the double-crush syndrome. Let me
quickly explain it. The double-crush theory says that
if your nerve is compromised proximally (up high near
the neck) it is more likely than not to be also damaged
distally (below near the hand), meaning that the existence
of a proximal lesion makes the nerve more susceptible
to damage distally. So in answer to your question, if
you are a double-crush believer, the testing of the median
nerve at the wrist will show entrapment.
|
|
| |
|
|
|
| |
Answer
2 |
The
concept of double crush syndrome is known for many years.
I think from seventies. It means, there are 2 lesions
along one nerve course, i.e. patients with one peripheral
nerve lesion did in fact have a second lesion elsewhere
and they implied that both lesions were contributing to
the symptoms or on another way, somewhat include symptoms
which result from a combination of two separate, local
lesions at different anatomical sites in the same nerve,
whether or not one actually contributes to the causation
of the other. Practically, a patient may have carpal tunnel
syndrome (distal) and another lesion (proximal) of plexus/root
in addition. So, yes, EMG could show a carpal tunnel syndrome
(to answer your question), which is fairly easy to diagnose
by such method. |
|
| |
|
|
|
| |
|
|
|
| |
Reflex
Sympathetic Dystrophy (RSD) and EMG |
|
| |
|
|
|
| |
My
husband has RSD (Reflex Sympathetic Dystrophy) and just
started seeing a new Doctor. This Doctor is ordering EMG
and We're not sure if he should get this test, as you
are never supposed to inject anything into the injured
area. This year we didn't even get his Flu Shot, as no
one really knows if it will hurt him or make the RSD Spread.
When someone has RSD you need to watch what you put into
you body. Please get back to me soon as he goes for this
test tomorrow. |
|
| |
|
|
|
| |
Answer
1 |
In
general EMG is not contraindicated in RSD. Although it
does not test sympathetic nerves, but it is used to exclude
nerve injury. Actually, it is one of the tests in work
up in patients with RSD. |
|
| |
|
|
|
| |
|
|
|
| |
Pinched
Nerve @ C6 when to operate |
|
| |
|
|
|
| |
After
FINALLY getting confirmation that I do have a pinched
nerve at C6 (EMG) I'v had steroid injection directly into
C6. I've experience some relief, but it continues to flare
up. My question: is the next step surgery? And what could
that surgery be for this specific location? |
|
| |
|
|
|
| |
Answer |
It has to
be clear that operation or no operation is a surgical
decision. However, the surgeons usually try conservative
therapy with medications, if no help and pain is severe
with abnormal rediology and usually EMG, then the approach
is called anterior approach; anterior cervical microdiskectomy. |
|
| |
|
|
|
| |
|
|
|
| |
Can
EMG localize if injury level if it is in the spinal cord
or not? |
|
| |
|
|
|
| |
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? |
|
| |
|
|
|
| |
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.
|
|
| |
|
|
|
| |
Comment |
What
symptoms would c34 and c45 bulging cause if these are
two areas that could not be detectable on EMG? |
|
| |
|
|
|
| |
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.
|
|
| |
|
|
|
| |
|
|
|
| |
Weird
Symptoms |
|
| |
|
|
|
| |
I
have been having some strange symptoms for the past 4
years. In 1998, I was tested for possible MS and passed
the MRI and nerve reflex tests. My symptoms are intermittent
tingling in hands and feet, pain on left arm like a sunburn,
weakness in legs, sometimes twist sentences around, vision
looks pixeled when looking at solid colors (white and
blue the worst), easily go into a stare (daze). Memory
really poor. Repeating patterns such as mini-blinds, striped
shirts, louvers cause me to see shimmering/dancing patterns.
Intermittent shake to the hands, some days there's none
at all. At night, the tingling seems to go away. Some
days are much worse than others. I also suffer from Migraine
headaches about once a week since 1990. Just want your
thoughts what I should do, if anything? Possibilities
what it could be? Thanks. |
|
| |
|
|
|
| |
Answer |
Migraine
can explain some of your visual symptoms, but it may not
explain all of them. I think you need another good neurological
examination. EMG may also help to rule out peripheral
neuropathy, as you have some symptoms suggesting it (tingling
and weakness in legs). Some blood tests would also be
useful such as B12 level. All the best.
|
|
| |
|
|
|
| |
|
|
|
| |
Doctors
say I have spinal cord sprain and I cannot understand
that term |
|
| |
|
|
|
| |
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? |
|
| |
|
|
|
| |
Answer |
Well
I suspect he may have said spinal stenosis (? or spondylosis)
causing the increase in your tendon reflexes and the radiculopathies.
|
|
| |
|
|
|
| |
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? |
|
| |
|
|
|
| |
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 "hypereflexia"
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.
|
|
| |
|
|
|
| |
|
|
|
| |
EMG
for Elbow and failed Carpal Tunnel |
|
| |
|
|
|
| |
Please
explain which areas of the limb are tested for these problems,
I need to be prepared. |
|
| |
|
|
|
| |
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.
|
|
| |
|
|
|
| |
|
|
|
| |
When
to operate for radial nerve damage? |
|
| |
|
|
|
| |
Hello, I'm wondering if you can give me any insight to the EMG results I got today. I fractured my mid humerus 7 weeks ago. It was a closed fracture, but at high velocity. Radial nerve damage was apparent with severe wrist drop and some sensory loss in my hand and forearm. Sensory seems to be recovering slowly but no sign of motor recovery yet. The EMG showed fibrillations at rest and no MUPs. I know that there are differing opinions on when surgical intervention is necessary, but in your opinion, are these results a good indication for surgical exploration?
|
|
| |
|
|
|
| |
Answer |
This
is surgical decision. The surgeon takes the EMG results
into consideration. He may wait for sometime, perhaps
several months, to see whether the patient would recover
spontaneously or not. But it's his decision at the end
of the day.
|
|
| |
|
|
|
| |
|
|
|
home
about
us 
patient
forums
doctors
forums
online
store 
contact
us 
