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Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 19th, 2015, 3:11 pm
by Xina535
Hi all, I am going to see a self pay neuro for my left arm/shoulder/neck and left leg/lower back weakness, twitching and pain. I want to get the most of my visit, of course.

I will get a full clinical (never had a real full one before) and a thorough EMG.

In physiotherapy, the therapists have found one point around c5/c6 neck, that when they press on it, even gently, I freak out in pain and tears. They are saying this is what is causing my left arm pain, twitching and weakness. There is another point on my lumbar spine, to the left, that is the same as my neck, and small amount of pressure in the spot and I'm in tears from pain. They feel this is what is causing my left leg twitching, pain/hardened muscles and weakness - they said where I have the pain and hardened muscles is the exact pathway of nerves coming from that spot in my lumbar spine. They believe in each spot that it is highly likely facet joint problems.

I have no MRI of either areas to determine what is really going on. The orthopedic just took an xray of my cervical spine and found "postural" issues with tight muscles. He said he would have seen any facet joint or other abnormalities on the x-ray, which I (and the physiotherapists) don't buy. They believe he is trying to save money by not ordering a MRI or CT for me (it would come out of his budget).

So, back to the neuro and EMG. I've learned it can detect issues coming from the spine, so I assume that the EMG will not be clean. It would or should show something that is going on.

So that I don't lose it, can anyone help me determine, in the case of an abnormal EMG, what terms do I want to hear and what I don't want to hear? Example, I am almost sure I do not want to hear "fibrillation" from the neuro's mouth. What about "denervation"? Is that always a bad thing, or can it be many things? Or what about "chronic denervation" or "renervation"?

If I am going to have a dirty EMG, I'd like to try to prepare so that I don't freak out over something that could be 1,000 other things. Or is it more complicated than that...example, a dirty reading could be 1,000 things, including MND?

Thanks!

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 19th, 2015, 3:24 pm
by nickston
Merely hearing "fibrillation" or "denervation" isn't automatically bad. The context is what matters. If you have spine narrowing or other nerve compression problems that are manifesting elsewhere in the body then I would expect to hear any or all such words at your EMG. Widespread fibs, denervation, etc. without any apparent nerve compression would be what is concerning.

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 19th, 2015, 3:27 pm
by Xina535
Can they tell nerve compression with an EMG?

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 19th, 2015, 3:44 pm
by misterjuanperalta
C5, C6 spine problems can cause hyperreflexia, dysphagia, arm/hand twitching, pain, weakness, atrophy.

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 19th, 2015, 3:46 pm
by nickston
Xina535 wrote:Can they tell nerve compression with an EMG?



yes. emg is frequently used for that. far more frequently used for that than diagnosing mnd.

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 19th, 2015, 5:11 pm
by Xina535
Really?! Like how an MRI would detect, but instead of on a picture, it's "seen" and determined by the waves? Can they tell WHERE the compression is happening, like at which vertebrae?

Oh, yea, another thing: aren't there some specific waves (positive sharp?) that almost always indicate MND?

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 19th, 2015, 6:40 pm
by physerv24
Xina,

If you go back and look at my posts, you will see the exact terminology used by the Cleveland Clinic for my EMG. I have cervical problems that have caused weakness and atrophy in my left hand. My problem is that the MRI, although it showed disc bulge, stenosis, canal narrowing, etc., was not "serious" enough to warrant surgery so I'm left with dealing with the weakness until it progresses to the point of not being able to use my hand. It's frustrating but that's where I am with this. I hope you have good results.

Vince

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 20th, 2015, 12:44 am
by Yuliasir
Xina,
with full sympathy to your situation I must admit that until your EMG report would not state something like "possible motor neuron degeneration", there would not be a reason to panick specifically. As the fellows mentioned already, mechanical issues could be bad enough to cause weakness, etc. but without progressing to toal disability and death like in MND. So please do not look for EMG details, listen to the overall summary, otherwise you would be mislead and get to another circle of fears.
One of my doctors has denervation in her leg. Seen on EMG, yes. Clinical weakness in the leg - seen on clinical exam. Does she has ALS? Nope, she has severe disk problems (two surgeries in fact). Denervation in the long axons is common in people after approx. 25 or so because neural tissue has very slow rate of regeneration and it is prone to natural degeneration - that is why older people are slower in muscular reaction, weaker in hands and legs etc.

in other words, listen to the summary your neuro will tell you. he or she knows the job and knows which combination of signals on EMG means mechanical damage and which is from MND.

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 20th, 2015, 5:11 am
by Xina535
Vince - I read your older post about your EMG results. I see you had an EMG and Nerve Conduction Test. My question is: do I Need a nerve conduction test too? I was thinking just Clinical and EMG. The nerve test would cost extra. I also see that there were two clear sentences that said no MND, so congrats! I do see though, that the EMG had findings, but related to compression. About your compression: Did you or do you have any pain? Also, I find it hard to believe that you are just left to deal with it - and just wait until the weakness gets worse. Are they not trying physiotherapy or traction with you? Injections?

I do have pain in my neck. This whole Thing in my left arm started with immense pain in my neck/shoulder that radiated into my arms. The pain has let up, but Comes back, and the twitching is still there, but was worse before. What is constant, is the weak/shakiness.

Thank you Yuliasir. Indeed, I shouldnt care what is found as Long as they can say "findings are not related to MND".

BUT I have another, new concern and would like everyone's advice. I got the Name of this doctor from a member on here who has already seen him. She told me he is known for not really experienced in EMGs. Or he performs them poorly. I am waiting to hear more Information from her about what she means, but I, I am going there FOR an EMG specifically. I will put lots of trust into it and the findings. Now I am wondering: Is it worth going?

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 20th, 2015, 5:16 am
by Xina535
Oh and to add to that - the Website in Germany where doctors are reviewed by patients has this doctor with a 1.7, with 1.0 being the best Review you can have. BUT there are two very bad Reviews, and for "some unknown reason" they were both removed from his Review list.

Hmmm??

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 20th, 2015, 6:12 am
by Xina535
I've asked more about the EMG Thing and this is the Response:


he does EMGs - mostly on request. As you know, clinical is more valuable then other things. But in general there are just a few very little good EMG performers. In Bochum (ALS Clinic) the neuro knows this neuro and gives a lot on what he says. But she mentioned that he is not the world best EMG performer. So I would value his general statement more than his EMG. Hope that clarifies...This is also what she (a friend) thinks, I guess. She was at his office quite often. He is good...Whait on what he says.


I am going there specifically for an EMG, and paying for it. I am wondering if this is worth it? I see my neuro who gave me my EMG last year on Feb 6 and wonder if I should just wait until then? What would you guys do?

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 20th, 2015, 7:20 am
by misterjuanperalta
It's good to know if EMG results are stable and steady. Don't use them to ease anxiety. I can guarantee you have C5, C6 spine problems.

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 20th, 2015, 7:48 am
by Xina535
Thank you, this is reassuring. It was also partly due to your advice in my other post that I decided to go to a neuro. Ultimately, I need to know what is going on and how to properly treat this. I can hold anything in my left hand steadily. I am on sick leave right now because of the ganglion cyst removal in my right hand, so I figured while I don't have to work, now is the best time to go. I guess I will go and see how I feel about him and only agree to the EMG if I feel comfortable. :?:

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 20th, 2015, 9:52 am
by physerv24
Xina,

Yes I have had neck pain for years. I've tried chiropractic and deep tissue massages but to no avail. Cleveland Clinic stated that I could try physical therapy and that I should go to a spine specialist. I went to a neurosurgeon closer to my home who specializes in spine disorders and he told me "most of your problems are degenerative and will only get worse with time". "I would recommend that as long as you still have use of your hand you should put off surgery as long as you can". So, that's where I am right now. The atrophy in my left thenar is very prominent. If I posted a picture it would freak people out. My twitching is constant and body-wide, although more so on my left side. None of my neurologists looked at my MRI, only the radiologist's interpretation. I only had the MRI of my cervical spine and not thoracic or lumbar. The medical bills for me over my nine month journey have been pretty high. At this point, I'm just trying to learn to live with what I have.

Best wishes,

Vince

Re: Dirty EMG Questions - for my neuro appt Thurs

PostPosted: January 20th, 2015, 9:54 am
by physerv24
Forgot to mention, nerve conduction tests usually go hand in hand with the EMG. This would show any conduction blocks in the myotomes in your spine.