Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Does The My EMG Report Indicate?
Question: Progress Notes Info
Author Note Status Last Update User Last Update Date/Time
XXXXXXX S. Foley, MD Signed XXXXXXX S. Foley, MD 5/6/2014 6:42 PM
Progress Notes
Community Spine Center
7120 Clearvista Drive, Suite 1500 XXXXXXX Indiana 46256
(317) 621-9292
Patient: XXXX XXXXXXX Date of Birth: 2/10/1957
Sex: Male Age: 57 Years 2 Months
History: He c/o right upper limb numbness. H/O cervical stenosis and cord compression.
Sensory NCS
Nerve / Sites Rec. Site Peak Lat Peak Ampl Duration Distance
ms µV ms cm
R GENERAL NERVE - CTS Panel
Median@wrist Digit I 2.90 13.5 3.65 10
Ref. 3.10 10.0
Radial@wrist Digit I 3.10 10.4 1.70 10
Ref. 3.10 5.0
Median@wrist Digit III 3.30 11.3 2.05 14
Ref. 3.80 20.0
Ulnar@wrist Digit V 3.65 18 1.60 14
Ref. 3.80 20.0
Motor NCS
Nerve / Sites Latency Ampl. Dur. Distance Velocity
ms mV ms cm m/s
R GENERAL NERVE - CTS Panel (1)
Median@wrist 3.50 7.9 5.65 8
Ref. 4.20 4.0
Median@elbow 7.45 6.6 6.65 20.5 51.9
Ref. 48.0
Ulnar@wrist 3.05 9.0 5.95 8
Ref. 3.80 4.0
F Wave
Nerve Min F Lat XXXXXXX F Lat Mean FLat
ms ms ms
R GENERAL NERVE - Default 29.20 30.15 29.60
EMG Summary Table
Spontaneous MUAP Recruitment
IA Fib PSW Fasc H.F. Amp Dur. Poly Pattern
R. DELTOID 1+ None None None None N N 1+ N
R. CERV PSPINAL N None None None None N 1+ 1+ N
R. INFRASPINATUS N None None None None N N N N
R. TRICEPS N None None None None N N N N
R. BICEPS 1+ None None None None 1+ 1+ 1+ 1-
R. EXT DIG COMM 1+ None None None None 1+ 1+ 1+ 1-
R. BRACHIORADIALIS 1+ 1+ None None None 1+ 1+ 1+ 1-
R. PRON TERES 1+ 1+ None None None 1+ 1+ 1+ 1-
Comments:
The median, radial, and ulnar sensory responses were normal. The median motor latency, amplitudes, and conduction velocity across the forearm was normal. The ulnar motor distal latency, amplitude, and F-waves were normal. The needle EMG of his right upper limb showed only very mildly reduced recruitment in several muscle groups.
Impression:
Normal right upper limb nerve conduction studies.
Mildly abnormal right upper limb EMG which –given the clinical scenario- is suggestive of a mildly neuropathic recruitment pattern associated with central stenosis/myelopathy.
There was no EDX evidence of plexopathy, acute mono-radiculopathy, or generalized peripheral neuropathy seen in the areas tested.
Hi Doctor, you have been advising me for a while, so I am forwarding the results of an EMG test I had last week. I received these results by email; yet I have not talked with the physician yet. I respect your opinion and you are very aware of my concerns. Please give me your impressions in layman's terms. As always, thank you!
Thank You
XXXXXXX S. Foley, M.D.
ABPM&R and ABEM Certified
Author Note Status Last Update User Last Update Date/Time
XXXXXXX S. Foley, MD Signed XXXXXXX S. Foley, MD 5/6/2014 6:42 PM
Progress Notes
Community Spine Center
7120 Clearvista Drive, Suite 1500 XXXXXXX Indiana 46256
(317) 621-9292
Patient: XXXX XXXXXXX Date of Birth: 2/10/1957
Sex: Male Age: 57 Years 2 Months
History: He c/o right upper limb numbness. H/O cervical stenosis and cord compression.
Sensory NCS
Nerve / Sites Rec. Site Peak Lat Peak Ampl Duration Distance
ms µV ms cm
R GENERAL NERVE - CTS Panel
Median@wrist Digit I 2.90 13.5 3.65 10
Ref. 3.10 10.0
Radial@wrist Digit I 3.10 10.4 1.70 10
Ref. 3.10 5.0
Median@wrist Digit III 3.30 11.3 2.05 14
Ref. 3.80 20.0
Ulnar@wrist Digit V 3.65 18 1.60 14
Ref. 3.80 20.0
Motor NCS
Nerve / Sites Latency Ampl. Dur. Distance Velocity
ms mV ms cm m/s
R GENERAL NERVE - CTS Panel (1)
Median@wrist 3.50 7.9 5.65 8
Ref. 4.20 4.0
Median@elbow 7.45 6.6 6.65 20.5 51.9
Ref. 48.0
Ulnar@wrist 3.05 9.0 5.95 8
Ref. 3.80 4.0
F Wave
Nerve Min F Lat XXXXXXX F Lat Mean FLat
ms ms ms
R GENERAL NERVE - Default 29.20 30.15 29.60
EMG Summary Table
Spontaneous MUAP Recruitment
IA Fib PSW Fasc H.F. Amp Dur. Poly Pattern
R. DELTOID 1+ None None None None N N 1+ N
R. CERV PSPINAL N None None None None N 1+ 1+ N
R. INFRASPINATUS N None None None None N N N N
R. TRICEPS N None None None None N N N N
R. BICEPS 1+ None None None None 1+ 1+ 1+ 1-
R. EXT DIG COMM 1+ None None None None 1+ 1+ 1+ 1-
R. BRACHIORADIALIS 1+ 1+ None None None 1+ 1+ 1+ 1-
R. PRON TERES 1+ 1+ None None None 1+ 1+ 1+ 1-
Comments:
The median, radial, and ulnar sensory responses were normal. The median motor latency, amplitudes, and conduction velocity across the forearm was normal. The ulnar motor distal latency, amplitude, and F-waves were normal. The needle EMG of his right upper limb showed only very mildly reduced recruitment in several muscle groups.
Impression:
Normal right upper limb nerve conduction studies.
Mildly abnormal right upper limb EMG which –given the clinical scenario- is suggestive of a mildly neuropathic recruitment pattern associated with central stenosis/myelopathy.
There was no EDX evidence of plexopathy, acute mono-radiculopathy, or generalized peripheral neuropathy seen in the areas tested.
Hi Doctor, you have been advising me for a while, so I am forwarding the results of an EMG test I had last week. I received these results by email; yet I have not talked with the physician yet. I respect your opinion and you are very aware of my concerns. Please give me your impressions in layman's terms. As always, thank you!
Thank You
XXXXXXX S. Foley, M.D.
ABPM&R and ABEM Certified
Brief Answer:
The EMG is like 95% normal.
Detailed Answer:
Hey there. Thanks for the follow-up. I went through your EMG and I agree with the findings they have given.
So it looks like TECHNICALLY.. you are suffering from a very very mild form of myelopathy secondary to the narrowing of the spinal canal in your neck. Some of the muscles in your arm are having trouble setting up to move as a group when your brain sends impulses to them. That's what they mean by the 'neuropathic recruitment pattern'.
Let me put it another way. When your brain sends a command to your arm to do something.. it doesn't sweat the details.. the region of your brain send a simple signal to that region saying "contract"... it's up to two other parts of your body.. the cerebellum and the spinal cord to refine the message and activate each group of muscle fibers in a controlled manner so that you will have a graceful movement.. This process is called 'recruitment'. The cord in that region of your neck has been compressed a bit and it shows from the MRI (we've talked about that part so i won't torture you with it again).. so any recruitment work that has to be done in the arm which is served by that part of the cord is going to be slow or not as efficient as it could be.
Now.. 3 questions
1) Does it matter?
2) Should be do anything about it? (surgically i mean)
2) What can we do about it? (what kind of surgery)
1) YES! it matters because it means that we have a signal to watch.. if this recruitment pattern gets worse.. you will have difficulty moving that arm, you will become progressively clumsy and you will know that it's time to reassess the situation.
2) Depends on how your arm is treating you now. If you're plugging along and doing your swims with ease.. i don't really think we should do anything beyond your physical therapy.
3) The surgical option in this case would probably be called a LAMINECTOMY. Its a pretty low invasive procedure (as neurosurgery goes) where they decompress that region of the spine and allow the cord some more space. But we can discuss this in detail if and only if you feel that surgery is an option for you at this time.
I'm hoping that this made some sense to you. Let me know what you are thinking.
Vin
The EMG is like 95% normal.
Detailed Answer:
Hey there. Thanks for the follow-up. I went through your EMG and I agree with the findings they have given.
So it looks like TECHNICALLY.. you are suffering from a very very mild form of myelopathy secondary to the narrowing of the spinal canal in your neck. Some of the muscles in your arm are having trouble setting up to move as a group when your brain sends impulses to them. That's what they mean by the 'neuropathic recruitment pattern'.
Let me put it another way. When your brain sends a command to your arm to do something.. it doesn't sweat the details.. the region of your brain send a simple signal to that region saying "contract"... it's up to two other parts of your body.. the cerebellum and the spinal cord to refine the message and activate each group of muscle fibers in a controlled manner so that you will have a graceful movement.. This process is called 'recruitment'. The cord in that region of your neck has been compressed a bit and it shows from the MRI (we've talked about that part so i won't torture you with it again).. so any recruitment work that has to be done in the arm which is served by that part of the cord is going to be slow or not as efficient as it could be.
Now.. 3 questions
1) Does it matter?
2) Should be do anything about it? (surgically i mean)
2) What can we do about it? (what kind of surgery)
1) YES! it matters because it means that we have a signal to watch.. if this recruitment pattern gets worse.. you will have difficulty moving that arm, you will become progressively clumsy and you will know that it's time to reassess the situation.
2) Depends on how your arm is treating you now. If you're plugging along and doing your swims with ease.. i don't really think we should do anything beyond your physical therapy.
3) The surgical option in this case would probably be called a LAMINECTOMY. Its a pretty low invasive procedure (as neurosurgery goes) where they decompress that region of the spine and allow the cord some more space. But we can discuss this in detail if and only if you feel that surgery is an option for you at this time.
I'm hoping that this made some sense to you. Let me know what you are thinking.
Vin
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
As always, thank you for the excellent explanation. These are my thoughts: my right arm may be functioning at 95%; yet if it is I am not noticing a difference in my function in that arm/hand and the left arm/hand. 1. I guess I am wondering if that type of diminished recruitment pattern has been present for a long-time and the situation is stable, or if it is a worsening situation. (You will recall that I had a very hard collision playing basketball, 25 years ago, when running at full speed, directly on the right deltoid) What are the odds of each possibility? Beyond that, I have additional questions:
The two surgeons I saw locally thought the pain in my right arm and deltoid was a result of a radicuopathy rather than pressure on the cord, or at least that was my impression of what they were both saying. The first surgeon only spent 10 minutes and of course he did not have the benefit of the EMG results. The second surgeon, a Nuerosurgeon, spent much more time and I think he had the same conclusion, again before the EMG results.
The Rehabilitiation physician thought the symptoms in my right deltoid were a result of the compression all along. 2. How can we now know from my EMG results that the 5% deficiency in recruitment function is related to compression on the cord and not compression on the nerve roots that serve that area? 3. Why would I only have pain and discomfort in the right upper back (virtually gone now) if those symptoms are being caused by the cords compression; shouldn't I have pain and diminished function in other muscle groups in other part of the body? 4. Should we be testing other muscle groups and not just my right arm? 5. From the results, it appears as though my right bicep is more effected than my deltoid; yet I have never had pain in the bicep at all, why would the pain manifest in an area that seems less effected than another muscle group that has no pain.
Finally, and my most important question of all: early in this process, the two surgeons both told me if the pain in my right upper back and right deltoid improved that "did not" necessarily mean there was diminishing pressure on the cord because they thought the right side symptoms were related to a radicuopathy rather than cord compression. The Rehabilitiation physician, from the start, said diminished pain in the areas where I was having pain, could indicate less pressure on the cord as well. I remember this distinctly because as my pain was improving I became hopeful and when I asked Doctor Foley if diminishing pain could mean less cord compression he said yes. I asked this question more than once and he responded affirmatively each time. What is your opinion of this consideration now? Could I have less pressure on the cord now than I had three months ago as indicated by less pain the areas where I initially had pain?
Finally, I mentioned to you that my best friend is a local hand surgeon. He reviewed my MRI results and said I think you have had this for a long time and you body has adapted. He is saying the same thing I think you were saying in one of your earlier communications to me, that if certain spinal nerve pathways are compressed the body adjusts and forms other channels. He thinks I am stable and will not need surgery for a long-time; yet he typically downplays all health issues in everyone. His wife, my wife and I have always joked about that. I should mention that he and I used to cycle together before my MRI and that he has seen me play tennis and has always commented that I still have my fast twitch muscles due to my quickness etc. I think his overall opinion relates to my first question to you, 6. Do you think my cord compression is a recent development, or is a condition that has been there a long time that my body has adjusted to. Is there a way to test for this?
The two surgeons I saw locally thought the pain in my right arm and deltoid was a result of a radicuopathy rather than pressure on the cord, or at least that was my impression of what they were both saying. The first surgeon only spent 10 minutes and of course he did not have the benefit of the EMG results. The second surgeon, a Nuerosurgeon, spent much more time and I think he had the same conclusion, again before the EMG results.
The Rehabilitiation physician thought the symptoms in my right deltoid were a result of the compression all along. 2. How can we now know from my EMG results that the 5% deficiency in recruitment function is related to compression on the cord and not compression on the nerve roots that serve that area? 3. Why would I only have pain and discomfort in the right upper back (virtually gone now) if those symptoms are being caused by the cords compression; shouldn't I have pain and diminished function in other muscle groups in other part of the body? 4. Should we be testing other muscle groups and not just my right arm? 5. From the results, it appears as though my right bicep is more effected than my deltoid; yet I have never had pain in the bicep at all, why would the pain manifest in an area that seems less effected than another muscle group that has no pain.
Finally, and my most important question of all: early in this process, the two surgeons both told me if the pain in my right upper back and right deltoid improved that "did not" necessarily mean there was diminishing pressure on the cord because they thought the right side symptoms were related to a radicuopathy rather than cord compression. The Rehabilitiation physician, from the start, said diminished pain in the areas where I was having pain, could indicate less pressure on the cord as well. I remember this distinctly because as my pain was improving I became hopeful and when I asked Doctor Foley if diminishing pain could mean less cord compression he said yes. I asked this question more than once and he responded affirmatively each time. What is your opinion of this consideration now? Could I have less pressure on the cord now than I had three months ago as indicated by less pain the areas where I initially had pain?
Finally, I mentioned to you that my best friend is a local hand surgeon. He reviewed my MRI results and said I think you have had this for a long time and you body has adapted. He is saying the same thing I think you were saying in one of your earlier communications to me, that if certain spinal nerve pathways are compressed the body adjusts and forms other channels. He thinks I am stable and will not need surgery for a long-time; yet he typically downplays all health issues in everyone. His wife, my wife and I have always joked about that. I should mention that he and I used to cycle together before my MRI and that he has seen me play tennis and has always commented that I still have my fast twitch muscles due to my quickness etc. I think his overall opinion relates to my first question to you, 6. Do you think my cord compression is a recent development, or is a condition that has been there a long time that my body has adjusted to. Is there a way to test for this?
Brief Answer:
By the numbers...
Detailed Answer:
Hey, Thanks for following up. I'm going to try and address you questions in the same order that they were asked. But there is a common vein between all of these issues that we can go into further after that.
1) It's probably been around since the injury. The cord compression would have been worst then. Spinal issues tend to degenerate over time (the spine is a complex active organ) but the fact that the neurological symptoms in your case have been mild to nothing to for the last 25 years, i would guess that they will stay stable for a good time yet. Just a guess though.
2) Compression of cord and compression of nerve root have the same effect clinically. The difference lies in the way we deal with the problem.
3) I remember your MRI, the compression and signal changes were pretty specific o the region of the cord that supplies neural connectivity to your arms and the skin of your back. The spinal cord is organized into very specific segments (since we are doctors.. we don't call them segments.. that wouldn't justify the 7 years of residency.. we call them Dermatomes). One dermatome supplies one part of the body.. that includes the muscles, glands and skin in that region of the body. So you don't have to worry to much about other parts of the body being affected.
4) I don;t think testing other areas would find anything significant. There's an old saying in medicine.. don't test for something unless the result is going to make you change your management. In this case... if the EMG turned up some funny signals in the nerves supplying the chest or abdomen.. the dotors would go back to the MRI... see that theres no signal change in the cord segments supplying those dermatomes and ignore the EMG. The more we test stuff.. the more noise gets added to the whole diagnostic effort.
5) It all depends on which nerve fibers are being compressed. If the fibers of the deltoid that supply pain sensation (just for the fun of it.. we call them XXXXXXX III fibers).. then the deltoid will hurt. If the fibres that supply actual motor signals to the Bicep are compressed.. then the Bicep gets weaker. Our brains love to put everything together into a coherent map of the body.. But the reality is the nerve 'wiring' in our body is a complex tangle that sometime makes NO sense whatsoever...
For example.. the nerves that supply motor innervation to 2 of the muscles of your larynx.. travel down all the way into the chest.. take a U-turn and travel back up. While the nerves for the other muscles in the larynx all travel straight from the brain.. no u-turns..
Why is a big question and it has to do with evolutionary development.. but we will save that for when you are suffering from insomnia or something.
6) I'm going to side with your hand surgeon friend here. I strongly disagree with Dr. Foley. i have never seen any evidence to suggest that physical therapy and rehab actually DECREASE cord compression. That having been said, to be fair.. i haven't seen any evidence that it doesn't. Its just that there is enough evidence to show that pathways are being rejiggered to route around the affected spinal segments. So that's what I stick to.
7) in my opinion.. you're cord compression happened when you were playing basketball... the injury led to inflammation and swelling in the cord that (at THAT time) probably looked really bad on MRI.. but over the years has diminished to this. Your spinal cord has rerouted around the injury and the recruitment issue was something that it couldn't deal with. Plus there is new research which shows that any rerouting or healing that happens will have to happen in the first 2 years after a nerve injury.. Almost like there is a timer on the process.
So the basic idea behind all this is.. is it going to get worse.. and how will i know when / if it does?
Well is it going to get worse.. probably.. yes.. you will eventually start suffering from osteoporosis and spinal degeneration in old age and that will compress the cord / nerve roots and make the situation worse..
How will you know... Your arms won't work the way you expect them to, you won;t be able to do the fine things that a person is expected to do.. push a button, write legibly.. etc.. You will see it or others will.
When it becomes enough of an issue that it BOTHERS YOU though.. that will be decision time.
Make sense?
Vin
By the numbers...
Detailed Answer:
Hey, Thanks for following up. I'm going to try and address you questions in the same order that they were asked. But there is a common vein between all of these issues that we can go into further after that.
1) It's probably been around since the injury. The cord compression would have been worst then. Spinal issues tend to degenerate over time (the spine is a complex active organ) but the fact that the neurological symptoms in your case have been mild to nothing to for the last 25 years, i would guess that they will stay stable for a good time yet. Just a guess though.
2) Compression of cord and compression of nerve root have the same effect clinically. The difference lies in the way we deal with the problem.
3) I remember your MRI, the compression and signal changes were pretty specific o the region of the cord that supplies neural connectivity to your arms and the skin of your back. The spinal cord is organized into very specific segments (since we are doctors.. we don't call them segments.. that wouldn't justify the 7 years of residency.. we call them Dermatomes). One dermatome supplies one part of the body.. that includes the muscles, glands and skin in that region of the body. So you don't have to worry to much about other parts of the body being affected.
4) I don;t think testing other areas would find anything significant. There's an old saying in medicine.. don't test for something unless the result is going to make you change your management. In this case... if the EMG turned up some funny signals in the nerves supplying the chest or abdomen.. the dotors would go back to the MRI... see that theres no signal change in the cord segments supplying those dermatomes and ignore the EMG. The more we test stuff.. the more noise gets added to the whole diagnostic effort.
5) It all depends on which nerve fibers are being compressed. If the fibers of the deltoid that supply pain sensation (just for the fun of it.. we call them XXXXXXX III fibers).. then the deltoid will hurt. If the fibres that supply actual motor signals to the Bicep are compressed.. then the Bicep gets weaker. Our brains love to put everything together into a coherent map of the body.. But the reality is the nerve 'wiring' in our body is a complex tangle that sometime makes NO sense whatsoever...
For example.. the nerves that supply motor innervation to 2 of the muscles of your larynx.. travel down all the way into the chest.. take a U-turn and travel back up. While the nerves for the other muscles in the larynx all travel straight from the brain.. no u-turns..
Why is a big question and it has to do with evolutionary development.. but we will save that for when you are suffering from insomnia or something.
6) I'm going to side with your hand surgeon friend here. I strongly disagree with Dr. Foley. i have never seen any evidence to suggest that physical therapy and rehab actually DECREASE cord compression. That having been said, to be fair.. i haven't seen any evidence that it doesn't. Its just that there is enough evidence to show that pathways are being rejiggered to route around the affected spinal segments. So that's what I stick to.
7) in my opinion.. you're cord compression happened when you were playing basketball... the injury led to inflammation and swelling in the cord that (at THAT time) probably looked really bad on MRI.. but over the years has diminished to this. Your spinal cord has rerouted around the injury and the recruitment issue was something that it couldn't deal with. Plus there is new research which shows that any rerouting or healing that happens will have to happen in the first 2 years after a nerve injury.. Almost like there is a timer on the process.
So the basic idea behind all this is.. is it going to get worse.. and how will i know when / if it does?
Well is it going to get worse.. probably.. yes.. you will eventually start suffering from osteoporosis and spinal degeneration in old age and that will compress the cord / nerve roots and make the situation worse..
How will you know... Your arms won't work the way you expect them to, you won;t be able to do the fine things that a person is expected to do.. push a button, write legibly.. etc.. You will see it or others will.
When it becomes enough of an issue that it BOTHERS YOU though.. that will be decision time.
Make sense?
Vin
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Once again, an outstanding summary of my questions. My only question now is this, if I am having less pain now than I was having 3 months ago, could that mean there is less pressure on the cord than there was 3 months ago? I am having much less pain and that could be attributed to any number of things, I am simply wondering if the pain I experience, at a given time, is a gauge regarding the extent of cord compression at a given time? Your the best, thank you for all of the time you have spent!
Brief Answer:
Pain is not a good sign of severity of compression
Detailed Answer:
Hey there, I see where you are going here. I've never seen that pain is a good indicator of severity of disease. You would think.. more compression. more pain... But the nervous system isn't set up like that. Pain impulses seem to spike the same from minor issues to major ones.... the differentiating factor is the focus the neocortex gives it.
Anyways, i don't want to put you to sleep here. Lets just put it like this. Pain is never a good indicator if severity. Your compression could be getting worse.. while the pain gets better.. all your brain has to do is ignore the pain.
Neurological function is a much better indicator.. strength of the muscle group and the ability to make our fine touch are the best.. if you feel your arms getting numb or weak.. then the compression is definitely getting worse.
Stop thanking me.. will start expecting that of all my patients here. Take care and lemme know if there is anything else you need
Vin
Pain is not a good sign of severity of compression
Detailed Answer:
Hey there, I see where you are going here. I've never seen that pain is a good indicator of severity of disease. You would think.. more compression. more pain... But the nervous system isn't set up like that. Pain impulses seem to spike the same from minor issues to major ones.... the differentiating factor is the focus the neocortex gives it.
Anyways, i don't want to put you to sleep here. Lets just put it like this. Pain is never a good indicator if severity. Your compression could be getting worse.. while the pain gets better.. all your brain has to do is ignore the pain.
Neurological function is a much better indicator.. strength of the muscle group and the ability to make our fine touch are the best.. if you feel your arms getting numb or weak.. then the compression is definitely getting worse.
Stop thanking me.. will start expecting that of all my patients here. Take care and lemme know if there is anything else you need
Vin
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
