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What Does My MRI Scan Report Indicate?
Question: I had an EMG and NCV done by neuromuscular specialist one week ago tgst came back within normal limits.
I have pain, atrophy and weakness in my right arm and especially palm/thenar pain.
I had an MRI yesterday that showed severe right foraminal encroachment at C5-C6 and moderate at C7.
Wouldnt the NCV have picked up an impinged nerve? It came back normal.
Would the foraminal encroachment be responsible for my pain and atrophy of the hand and weakness in bicep?
I have muscle twitching - should I be confident that the single fiber EMG results just performed would rule out any muscle disease process (it was done at an ALS clinic teaching hospital).
I am concerned that Im twitching, but it dirs seem this new finding on the MRI may explain the weakness and pain in my hand and arm. It is especially in the palm/thumb.
My hand doc suggested i had decreased bicep and tricep reflexes on the same side.
I have pain, atrophy and weakness in my right arm and especially palm/thenar pain.
I had an MRI yesterday that showed severe right foraminal encroachment at C5-C6 and moderate at C7.
Wouldnt the NCV have picked up an impinged nerve? It came back normal.
Would the foraminal encroachment be responsible for my pain and atrophy of the hand and weakness in bicep?
I have muscle twitching - should I be confident that the single fiber EMG results just performed would rule out any muscle disease process (it was done at an ALS clinic teaching hospital).
I am concerned that Im twitching, but it dirs seem this new finding on the MRI may explain the weakness and pain in my hand and arm. It is especially in the palm/thumb.
My hand doc suggested i had decreased bicep and tricep reflexes on the same side.
Brief Answer:
Get an advice from neurosurgeon for surgery
Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
The Mri findings suggestive compression of nerve roots at c5-6 and C6-7 levels explain the pain, weakness and atrophy.
Nerve conduction study may be normal as the damage is proximal to stimulation sites of nerve study.
Emg may have shown some changes.
Fasciculations can also occur due to nerve root compression.
Possibility of Als or motor neuron disease is unlikely if no abnormal findings in nerve conduction study of other limbs.
You should get opinion from a neurosurgeon for operative intervention.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Get an advice from neurosurgeon for surgery
Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
The Mri findings suggestive compression of nerve roots at c5-6 and C6-7 levels explain the pain, weakness and atrophy.
Nerve conduction study may be normal as the damage is proximal to stimulation sites of nerve study.
Emg may have shown some changes.
Fasciculations can also occur due to nerve root compression.
Possibility of Als or motor neuron disease is unlikely if no abnormal findings in nerve conduction study of other limbs.
You should get opinion from a neurosurgeon for operative intervention.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Can you tell me your inpressions of the mri result? The chiropractor said i do not have typical presenting symptoms fir cervical compression as i do not have neck pain. He said he would like to conservatively attempt to treat for 2 weeks to see if improvement. I feel this will end up needing more than chiropractor but want to give it a chance. He seemed surprised my chief complaint is in palm hand little finger and somewhat in bicep. He said typical would be to radiate from neck down arm. There is a feeling from my bicep through my forearm but primary pain in palm thumb hand with grip weakness.
Brief Answer:
Looks like cervical radiculopathy involving nerve roots
Detailed Answer:
Hello,
The nerve supply of neck and hand is different.
Though neck pain is common with nerve root compression but may not be present if lower cervical roots are involved.
You can upload images of Mri for better interpretation.
Visit and examination by a neurosurgeon or neurologist will be more helpful as wasting and thinning of limbs and absent reflex are already occurred.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Looks like cervical radiculopathy involving nerve roots
Detailed Answer:
Hello,
The nerve supply of neck and hand is different.
Though neck pain is common with nerve root compression but may not be present if lower cervical roots are involved.
You can upload images of Mri for better interpretation.
Visit and examination by a neurosurgeon or neurologist will be more helpful as wasting and thinning of limbs and absent reflex are already occurred.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Raju A.T
I couldnt upload the MRI images as there are too many, but wanted to share some to get your opinion. My thenar has a decrease in muscle and has me very worried. I knoe you said generally it is possible to have atrophy but would this be a likely area for pain and atrophy with C5-6 C6-7 compression? I am still worried about motor neuron disease.
The EMG was performed by neuromuscular specialist who tested upper and lower (she put a needle in the thenar area). I just wonder if the EMG could be too soon to pick up problems.
I am hoping this pain and atrophy is linked to the compression, but body wide fasciculations are worrisome. I have had two clean EMGs in three months - at what point should i consider myself safe from possible motor neuron disease? I have been twitching since April and have definite muscle loss in right hand where Im having pain.
I do hope the foraminal encroachment is responsible, but want your opinion.
The EMG was performed by neuromuscular specialist who tested upper and lower (she put a needle in the thenar area). I just wonder if the EMG could be too soon to pick up problems.
I am hoping this pain and atrophy is linked to the compression, but body wide fasciculations are worrisome. I have had two clean EMGs in three months - at what point should i consider myself safe from possible motor neuron disease? I have been twitching since April and have definite muscle loss in right hand where Im having pain.
I do hope the foraminal encroachment is responsible, but want your opinion.
Brief Answer:
Possibility of compressive radiculopathy is more likely
Detailed Answer:
Hello,
I have gone through Mri images but was not of much help as axial images were lacking to assess foramina.
The involvement of muscle most commonly occurs in hypothenar region as compared to thenar region.
Though widespread fasciculations are found in Als but should also be present in emg study.
At present it is hard to rule out monomelic motor neuron disease but possibility of compressive radiculopathy is more likely.
Some patients have slowly progressing variant of Als and will be hard to diagnose early.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist
Possibility of compressive radiculopathy is more likely
Detailed Answer:
Hello,
I have gone through Mri images but was not of much help as axial images were lacking to assess foramina.
The involvement of muscle most commonly occurs in hypothenar region as compared to thenar region.
Though widespread fasciculations are found in Als but should also be present in emg study.
At present it is hard to rule out monomelic motor neuron disease but possibility of compressive radiculopathy is more likely.
Some patients have slowly progressing variant of Als and will be hard to diagnose early.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Priyanka G Raj
I know you dont have a crystal ball, but when you say monomelic motor neuron disease you do not mean ALS, correct?
Should I feel some confidence that my twitching was not picked up on two EMG's? One was April abd the other two weeks ago. The second one was a single fiber EMG, which i understand is more sevsitive.
I am glad you think more likely my pain and weakness caused by compression. I would think thats true because it follows such a specific path down right arm, but i am having some low level pain in right leg occasionally.
I am a little worried after your response that i should take a wait and see approach. I thought the clean EMG should have cleared me as i have been twitching and having these pains for months preceding the EMG and it came back thankfully normal.
I just want to be clear, i know you say possibility of conpressive radiculopathy more likely, but if you were in my place wouod you feel confident about clean EMG or ask for further testing? I had been told the twitches are most likely benign as i have been under extreme anxiety.
I have a followup with the neuromuscular neurologist on August 2nd and want to make the most of my visit.
Lastly, in cases of nerve root impingement, are steroid injections in neck useful or just temporary help?
Thank you so much for your time. XXXXXXX
Should I feel some confidence that my twitching was not picked up on two EMG's? One was April abd the other two weeks ago. The second one was a single fiber EMG, which i understand is more sevsitive.
I am glad you think more likely my pain and weakness caused by compression. I would think thats true because it follows such a specific path down right arm, but i am having some low level pain in right leg occasionally.
I am a little worried after your response that i should take a wait and see approach. I thought the clean EMG should have cleared me as i have been twitching and having these pains for months preceding the EMG and it came back thankfully normal.
I just want to be clear, i know you say possibility of conpressive radiculopathy more likely, but if you were in my place wouod you feel confident about clean EMG or ask for further testing? I had been told the twitches are most likely benign as i have been under extreme anxiety.
I have a followup with the neuromuscular neurologist on August 2nd and want to make the most of my visit.
Lastly, in cases of nerve root impingement, are steroid injections in neck useful or just temporary help?
Thank you so much for your time. XXXXXXX
Brief Answer:
Possibility of Als less likely
Detailed Answer:
Hello,
Monomelic mnd is a type of amyotrophic lateral sclerosis involving only one limb. The prognosis is usually good.
The pain of radicular nature may be due to compressive radiculopathy. Lower limb may also has possibility of compression.
In view of normal emg and absence of other site involvement diagnosis of Als is unlikely.
You can get Thyroid tested for generalized fasciculations.
Steroid injection may abate pain related to radiculopathy but may reoccur.
Physiotherapy and pain modulator drugs like pregabalin or amitryptiline or gabapentin may be required.
Wait for your appointment with neuromuscular specialist as it will clear your doubts and help in planning future work up.
Regards
Dr N Kumar
Neurologist
Possibility of Als less likely
Detailed Answer:
Hello,
Monomelic mnd is a type of amyotrophic lateral sclerosis involving only one limb. The prognosis is usually good.
The pain of radicular nature may be due to compressive radiculopathy. Lower limb may also has possibility of compression.
In view of normal emg and absence of other site involvement diagnosis of Als is unlikely.
You can get Thyroid tested for generalized fasciculations.
Steroid injection may abate pain related to radiculopathy but may reoccur.
Physiotherapy and pain modulator drugs like pregabalin or amitryptiline or gabapentin may be required.
Wait for your appointment with neuromuscular specialist as it will clear your doubts and help in planning future work up.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Prasad
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