TeleEMG Patient Education Series
Series Editors: JF Jabre, MD and OS Shams, MD

Carpal Tunnel and Ulnar Neuropathy - Part I

Normal EMG in CTS Top

Question

Can you have a normal EMG test yet still have carpal tunnel syndrome? I have heard of something called Clinical & have heard about something else that has to do with being undetectable for some reason? Please advise. Thanks

Answer 1

Yes there are EMG negative Carpal Tunnel Syndrome in which the patient has the clinical signs and symptoms (check out http://www.teleEMG.com/guides/cts.htm) of carpal tunnel yet have a negative EMG. But it may also not be Carpal Tunnel. A good way to find out would be to purchase carpal tunnel wrist splints and wear them mostly at night for a couple of weeks to see if symptoms improve. If they do then it is likely that it is carpal tunnel.

Answer 2

Sure, NCS may be normal in CTS. But such cases are uncommon or rare, also has to be mild. The problem there is no good correlation between symptoms and NCS abnormalities (if any). I can recall one patient few years ago came with symptoms of CTS. The study was "normal". However, the orthopedic surgeon did the median nerve surgery. The patient improved. The other point which should be kept in mind is presence of anomalies, that may cause confusion.

Electrodiagnostic assessment & management of CTS Top

Question

I have been diagnosed with CTS and now am being sent for an EMG. I would like to know what this test is, the pain involved and whether or not a positive or negative result changes the diagnosis. I have done the splints for a long time with relief way back when but no relief now. I have had one cortisone treatment which has done nothing except relieve the nighttime pain but day to day is actually worse.

Answer 1

An EMG, which studies nerve conductions (by delivering electrical impulses to the nerves) and muscles (by inserting a needle probe into different muscles), is an uncomfortable procedure but a very useful and sensitive test for carpal tunnel syndrome. If your symptoms are as severe as you describe, then in all likelihood the test will be positive. If it is not, I would seriously question the diagnosis of carpal tunnel.

Answer 2

I have had EMG testing which resulted in surgically releasing both my wrists due to CTS. The pain associated with these tests can be mild to moderate. I would suggest if possible to take a doctor prescribed pain medication one half hour before the testing is done. I am going again for further EMG tests tomorrow as I am still suffering effects of CTS even after surgery. The testing takes approximately 20 minutes to a half hour and is quite bearable. Good luck to you with your results.

Weakness and pain months after surgical release of carpal tunnel Top

Question

I am experiencing medium to severe pain and weakness after having a surgical release for carpal tunnel in both wrists. My first one was done over a year ago the second was nine months ago, shouldn't the weakness and pain be gone by now? I am a secretary by trade and have to use my hands in a repetitive manner on a daily basis, I need to elevate this pain and weakness, can you help or suggest something?

Answer

When the surgery is successful (and if the problem prior to the surgery was indeed carpal tunnel and not something else), then all the symptoms, pain and weakness should disappear. Exceptions to that include such a severe carpal tunnel that surgery may not be able to restore full function to the nerve. To verify whether or not the surgery released the carpal tunnel entrapment, a repeat EMG study on both hands would be very useful.

CTS & Cervical radiculopathy Top

Question

I had an EMG test last Friday because an MRI showed herniated discs in C5-6. I was still having considerable pain in my left shoulder. Since the test I have had significant pain in my left hand and arm. The test showed I have carpal tunnel syndrome and some nerve damage in the neck area. Would the test have aggravated the nerves that are associated with either of these problems?

Answer

The study does not cause any lasting damage to either nerves or muscles but you can be left with some soreness in the areas that were studied for about 24-48 hours due to local tissue irritation

CTS TESTING Top

Question

I am writing you to ask if there is any other way to test for nerve damage? I have severe wrist and lower and upper arm pain in one arm. It started in my fingers then after 3 days protruded to my arm and my shoulder and now y breast is also numb. I just received a crotz shot in my wrist to supposeively help soon. To hold me until the testing next tuseday 4/4/00. I can tolerate pain but not anymore than I have now! Why must they put me through a test, which could lead to more pain to say yes you have carpal tunnel syndrome? This pain has been going straight 12 days and night without a break. Help please give me a solution. I probably won’t /can’t go for this test knowing it will induce further deeper pain. Please respond, you are my last straw for help.

I forgot to state that this started with both hands getting numb two years ago. I would wear braces to bed at night and they would be better after 3 nights of doing this. I feel I got this when I was always using a hand grinder to grind off decks. (Carpenter work in summers) I also am a tax prep, self employed luckily my right hand which is my dominant hand can still type. I used my left hand mainly for holding the phone. So, this started over a long period of time.

Answer

From what you describe, your symptoms sound like carpal tunnel to me and the wrist splints and the cortisone injections usually help. The EMG (if you haven't had one before now) will be very helpful to diagnose your condition and therefore help your doctor develop option plans for treatment. The idea is to find out what is causing your symptoms first, and then treat appropriately.

Comment

You were right. The testing was very important. Can there be errors in the test. It showed my bad arm/wrist being negative and my good arm being positive? May be as he was looking at me. His right is my left and his left is my right. Do you know what I mean?? Well at least it showed nerve damage up in the neck area. He said the pain was probably muscle spasms. And that might be why my left side is numb and paining. Thanks again for replying to my postings.

Answer

Well errors are always possible but a neck lesion can cause bilateral symptoms. Doctors are usually very careful in noting the side they study so I would say the chances of them getting confused with sides (although not zero) are fairly small.

EMG for CTS & Spinal Stenosis vs. Hip Replacement Top

Question

My mother broke her hip and her wrist in 1993. She has since been diagnosed with CTS and Spinal Stenosis. She is in quite a bit of pain and has just been referred for an EMG for the arm and the leg. Is there any reason that both could not be done on the same day? Also, will the EMG help to resolve the question of whether the stenosis or the hip is causing her pain?

Answer 1

Usually the EMG of the arm and leg are done in a single session. Also the EMG will be able to determine whether or not the spinal stenosis is causing nerve damage which in turn causes pain.

Curious about EMG in CTS Top

Question

Hello, I’m going to take the EMG / Nerve conduction study in a couple of days for carpal tunnel. I was just curious in how big the needles are, and how far the needles are inserted. And how thick they are. I hate needles and I’m really afraid to take this test, so any information to help me prepare myself would be appreciated. Thank you so much.

Answer

In your case of carpal tunnel syndrome, the diagnosis is dependent on electrodiagnostic tests. Think that the test will help to reduce your suffering and does not hurt. One more point, needle electrode examination is not always performed in such case, depends on the symptoms and signs. The electrode (needle), in your case, is quite thin like a small pin (even thinner) and its length is about 2 cm for hand muscles and very little of the electrode is inserted. Good luck

Comment

Thanks for the reply. They are going to perform both studies, needle and just the normal nerve conduction study. But if the needle isn’t that big I should be okay. But once the needle is in, does it move around inside the muscle, if so wouldn’t that be a tremendous amount of pain? Thanks for any information that you give. Everything is greatly appreciated.

Answer

Thank you. Once the needle electrode is in, it does not, actually, hurt more than that, but we do move the electrode little bit inside.

Comment

I took the test today and it was pretty painful. But the doctor said that he didnt really see damage but was going to look over and calculate everything. I know I have the pain, and every symptom of carpal tunnel. So if it does come out negative, what do you think the next step will be? Is it possible for it to come out negative when it’s really positive? It’s just that this is a workman’s comp claim and it has been on hold, and they I guess need some kind of solid proof that something is wrong. Only I know how much pain it is. But thanks again for the advise.

Normal nerve conduction results in tight carpal tunnel syndrome Top

Question

What is the percentage of negative results on a positive finding? And the percentage of a positive result of a negative finding?

I've gone through 5 nerve conduction tests previously, and finally was diagnosed with carpel tunnel. The neurologists said it was because of my small boned structure that gave a negative result when it was actually positive. When I received the tunnel releases, it was very tight and surgeon was surprised that it didn't show up earlier. I now have possible ulnar nerve problems, but again my conduction test shows negative. Please give me some information as why this happens.

Answer

The answer was offered in the Doctor/patient forum. Anyhow, it was "The pick up of carpal tunnel or ulnar neuropathies by nerve conductions is fairly easy so the false negatives there are very low. For pinched nerves however (root lesions) the number of false negatives is higher, sometimes up to 30 or 40%."

CTS and proximal radiation of pain Top

Question

My 90-year-old father developed a problem in mid March. He woke up from a night's sleep with swollen middle fingers and pain in his upper arms that only occurred when he tried to lift them at the shoulder joint (no pain with arms at his side). He did have excruciating pain in his left hand, but that has passed (it is swollen however). He still has tremendous pain in his upper arms upon lifting movement.

After two misdiagnoses at the VA Hospital, they now think he has CTS (an EMG was done) and plan on operating. Can CTS cause upper arm pain? He's slowly getting worse. Can this migrate to other parts of the body?

Answer

The presentation of your father's illness (waking up at night with the swelling you mention) is not CTS, it sounds more like a joint (arthritis) problem which I take it has now subsided. Can the swelling cause CTS, the answer is yes and CTS does give symptoms in the arm and occasionally the shoulder but does not present itself in this manner. If the CTS is severe, then surgery is needed but if it is mild to moderate, you can get away with conservative treatment for a while at least.

Comment

He still has swelling, mostly in his left hand and arm. And both hands have lost considerable flexibility (he can't make a fist nor extend the fingers). But his biggest problem is the tremendous pain that occurs in his upper arms when he lifts them (no pain at rest).

Answer

I would like to say that CTS is common in patients with arthritis. You said that he is planned for surgery; this should help to relieve at least some of his symptoms. All the best.