EMG in Neck and Arm Problems - Part I

Use of EMG in C Spine problem Top

Question

I need some advice, last year I had my c6-c7 disc removed and fused with hip bone and metal plate. All was well for one year now I have a herniated c5-c6 disc. My doctor wants to do a c6 nerve root block, right now I’m doing traction treatment but that’s not working, I’m trying to get some advice on weather a EMG would be a good idea instead of the nerve root block. Don’t want to do surgery again only as last resort. They brought up the idea of steroid injections to get rid of pain in neck and shoulder so i can continue my career. Any advice please reply

Answer

In situation like yours, I would want to know what is causing the recurrent symptoms before I treat and an EMG (you can't have an MRI because of the metal plate) would be very helpful.

Post cervical disc operation radiculopathy Top

Question

What is usually done for a cervical disc problem that causes Radiculopathy in an extremity?

Answer

The great majority of them get better on their own, with time and conservative treatment (anti-inflammatories, Physical Therapy, changing work habits..). In the more severe cases, or in cases which significantly interfere with daily activities, surgery may be indicated.

Nerve injury due to bulged disc; is it reversible? Top

Question

If a disc has caused nerve damage in an arm, will it be permanent or can it be fixed?

Answer 1

Nerve damage is reversible when the nerve is still connected (in continuity) and the cause of the damage has been removed. Disc bulges usually leave the nerve connected, so when the cause is eliminated (or gets better on its own) the nerve regenerates. Nerve Growth is slow though, about 1 mm/day.

Mixed median nerve neuropathy with demyelinating features Top

Question

I was tested two years ago and just advised today that I have the above diagnosis. I would like more information as I was told there is nothing to do since the damage has been done, except pain control and seeing a neurologist. Where do I find out more about this?

Answer 1

That does not sound like a very good EMG diagnosis because it doesn't tell you much. Usually demyelinating lesions of the peripheral nerves heal very quickly, unlike axonal lesions, where the nerve fiber is cut, which take longer to heal. I would have that report looked at by a qualified EMGer, neurologist or physiatrist

Posterior Interosseous Nerve Syndrome (PIN) Top

Question

I just had an EMG a few weeks after a nerve conduction test revealed concerns in my elbow to wrist area. The EMG Doctor diagnosed me with PIN Syndrome on the spot. I have not heard from my primary care physician yet with the complete analysis; however, I don't know what caused this or what to expect from here. Up till now there has been muscle loss around the wrist area and slight weakness in the hands. Is there a means to predict what I can expect in the future or what possibly causes PIN? Thanks.

Answer 1

Posterior interosseous syndrome can be caused by elbow trauma, fibrous or tendinous compression of the Radial Nerve in the forearm, rheumatoid disease, cysts, etc. and usually consists of the symptoms you describe. Most causes are easily treatable, provided your doctor has determined the cause first. As for predicting what will happen in the future, first thing is to determine the cause and treat, and second thing is to think of nerve lesions in the following manner:

A nerve is like a wire (the axon) covered by a sheath (the myelin). When a lesion involves the myelin only, the nerve heals very quickly (few weeks). When it involves the axon or a combination of myelin and axons, then healing is slower, months, provided the offending lesion is removed.

So you need to know what is causing it and if it consists of myelin, axon or myelin and axon lesion.

Comment

Thanks for the info. I have no recollection of any one event that could have caused this. I have participated in a lot of sports in the past but can never remember any injury or event, etc. It does seem that the outside of my elbow has slight discomfort when I rotate my hand and wrist inward while making a fist. The joints in my hip and ankle on the same side have been slightly bothering me from time to time, especially when I run (about 4 miles per day).

My question is how does one determine the cause you mentioned in your response? Are there additional tests or other means to determine the cause?

Thanks again for the information. It is really helpful.

Answer

My concern in your case is that you haven't heard from your primary care physician yet with the complete analysis. So wait until you find out and make sure you mention the wasting and weakness. The questions you want to ask are:

Is this truly PIN and what is causing it? Could it be something else? Is there anything else associated with it?

Then you will have a better idea as to where you're heading.

Arm-shoulder-neck pain, with no gain from operation. Top

Question

At first they thought it was carpel tunnel but then said it disc C5&6. Oct 97 disc was removed and C5&6 fused and removed 3 sets of bone spurs, however they were unable to remove all sets of bone spurs. Perhaps this is why I am unchanged with my pain? My pain is from my right arm/hand all the way to my neck/head where I have mayofacial pain. I have burning spots here& there up my arm and a major knot in shoulder and occasional pain in left arm/hand from overcompensating. I stepped down from my desk job in '96 (unable to type/write) to a light duty job, which only temporarily gave relief. I had the neck fusion operation in hopes to get my (a) job back. Symptoms started / progressed since '88. Any insight? Thank you.

Answer 1

Please don't feel alone. Though I had carpal tunnel in my left hand. Due to severe pain and numbness in fingers, arm and now shoulder. They gave me an EMG and found my left arm/wrist to be fine and my right hand to have moderate TC. That’s the hand that is good. Then the EMG showed nerve damage/problems in the neck. My spinal x-ray showed c5, 6 &7 to be degenerative and numerous bone spurs. Also, they said it looked like the area the nerve was in was narrowing?? This came on to me like over night after I worked real hard shoveling a long road area. I also had fallen the day before and maybe that jolted the spine. I know there is help out there. We just need to find it.. I am searching all the sights. I can't handle night time.. I cry myself to sleep. It hurts so badly. During the day I can handle it. Take care.

Answer 2

I am not quite sure where to begin. I guess the first thing is to make sure that you do not have a carpal tunnel and the second is to see if your nerve roots (C5-6 and/or others) are not still compressed. An EMG would help answer both. Of course an MRI of the neck would also help to see how the fusion is doing.

Comment

Dear doctor, Thank you for your reply. I have an EMG scheduled now 4/20. My C5-6 fusion (Oct97) is healed per my postoperative x-rays every 4 weeks for 6 months and 1 MRI. I had another MRI from a different doc 8/98, which said other disc is starting to go. My doctor told me he removed 3 sets of spurs. Six months later I found out, when he referred to spurs still in my x-rays, that there were still spurs there. He said that the ones still there had been too dangerous to remove during the operation. If the operation was unsuccessful in stopping my pain he said there was, unfortunately, nothing more he could do. Did the EMG & NCS procedures exist in 1996'97? If so, I wonder why my doctors never thought of my having them before operating? What is the difference between CERVICAL RADICULOPOTHY and DEGENERATIVE DISC and CERVICAL STENOSIS. Also is a slipped disc the same thing as a bulging disc? Thank you again in advance.

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.

Cervical spondylosis, bone spurs & traction Top

Question

I need your help, please tell me is there a site on help for degenerative c5-c6 c6-c7 discs. I am 42 and I was told that my discs have degenerated with bone spurs, which are taking up the room where my nerve is and that is why I am having the severe pain/tingle/numbness down my entire left side. They wrote on my diagnose treatment for PT - cervical radiculopathy -traction machine program. I wish they wrote neater. Please explain this to me. I'm afraid that traction might be the wrong thing?? This sounds like something for a slipped disc. Not degenerative one?? Also thank you for all your prior help. You gave me the courage to go through having these tests.

They stated that my x-ray showed great narrowing. Is there any thing I can do? Such as an exercise or a special diet to dissolve the bone spur matter or prevent more? Thanks again

Answer

There is a wonderful patient education site, which talks about bone spurs etc. I think you'll find it useful. As for traction it is usually prescribed for discs not bone spurs. If you don't find it is helping you, you can stop it. There are no diet exercise / programs that get rid of spurs, these form over years and can only (if need be) removed surgically.

EMG with C disc “Shoulder, arm and neck pain” Top

Question

I am scheduled for an EMG upper extremity. An MRI shows bulges at 5-6 and 6-7. At this time the pain is excessive. It feels like someone has shoved a white-hot branding iron under my scapula. What exactly will the EMG show? And, how painful is the test? I am a surgical assistant; will I be able to return to work the day of the test?

Answer

The EMG should tell you if the disc bulges are causing any nerve damage which is causing your symptoms. The test is uncomfortable (there are a couple of posts above which go into this) and lasts about 30-45 minutes. Normally, you should be able to go to work afterwards because nothing is injected or drawn during the test, but if you are in a good deal of pain to begin with, you may be uncomfortable after the test and my advice to you is to take the day off

Cervical disc with severe UL pain Top

Question

I have nerve damage in arm from a cervical disc. Later, both arms been killing me and feeling dead and cramping up. What’s going on?

Answer

Your problem could be related to the cervical disc, perhaps unusual to be both sides. You should consult neurologist to diagnose and help your pain. EMG should be valuable in your case to point further to the nerve damage.

Tunnel Syndromes Top

Question

I am a 51-year-old male and since the age of 35 I've had several surgeries for nerve problems. First I had two surgeries for Carpal Tunnel of the right wrist, then Radial Tunnel Surgery of the right arm, and this month I will be going in for Tarsal Tunnel surgery. My health is good out side of this I have no major health problems. I did notice within the past few years I've suffered with sever sweating (hot Flashes). My question is, all these nerve problems seem to be occurring on the right side of my body. Included in these problems I've had sever spasms in my right ribs and sever pain on the right side of my neck and shoulder. Why does this seem to be happening to me and have there been any other cases similar to this? This is almost like a chain reaction of nerves, one problem after another. Can you help?

Answer

I am not quite sure why you've had all these surgeries. While Carpal Tunnel is a common one to have, I must admit that I haven’t heard of too many patients having Radial Tunnel surgery. Tarsal Tunnel is another uncommon one.

Sweating on the right side of your body can be caused by a problem in what we call the autonomic nervous system and would be something you need to look into.

My advice to you is to seek a good neurologist and try to let him/her sort these things out for you.

Comment

Thank you for responding. The sweats I'm having are through out by body not just on the right side and have been sever. It keeps me up all night. The Tarsal Tunnel surgery I'm having this month is because I lost the feeling in my heel, big toe and little toe and the ankle is painful. I'm glad that there may be an association between these nerve problems and these sweats this could narrow the search down. I would have never thought of this. And thank you again

Puncture to nerve in inner elbow area Top

Question

I was in for a routine physicial on March 29th. And upon a blood draw I experienced intense pain shooting to my left hand. I thought right away it was my nerve. The lady that took the blood said she had never experienced that either. I have been seeing an intern and he had his dad who semi-retired and is a neurologist do a nerve conduction test last Wednesday. The test came out negative. I have numbness in my hand and fingers I have had what my therapist call a lot of trigger points in all areas of my lower and upper arm all the way to my underarm. I have been going to therapy for three weeks being treated with heat and electro therapy. Should I be as concerned as I’m on Vioxx for the inflammation if I don’t take it by the end of the day my arm is clinched so close to my side because my whole arm hurts.

Is there another test I should have done?

Should I continue the therapy and give it time?

Would an MRI tell me what is going on in there, could she have got a tendon also?

I thought I should give you all of my symptoms. It started with tingling in my hand and fingers shortly after it happened. The tingling started spreading up my arm and I started getting increased discomfort in my elbow area. Within 5 day's the muscles in my arm started hurting.

Today my fingers are numb and are very sore and stiff. My muscles in my underarm hurt a great deal as well as my forearm and bicep. The discomfort in my arm changes spots. The pain in my fingers is consistent

I'm sorry to post twice before a response but I just found this forum and I have been searching for answers to insure I am getting the right treatment. I have never had something like this. It's been a month. I have been told it takes a long time for nerves to heal. I guess I just want to know how long, and is it my nerve.

Will an MRI show what it is or would you recommend an EMG?

Thanks so much, I'm scared!

Thank you for any advises you can give me.

Answer

According to your symptoms, it seems like a nerve lesion by injury or pressure, probably the median nerve was injured during needle puncture. I wonder did you have an EMG needle examination of the muscles or just nerve conduction studies. If it is so, then I think you need to see your neurologist again to do (or repeat) EMG needle examination of the muscles, which should be helpful to exclude nerve lesion and its degree. I think the EMG is more helpful in your case than MRI.

Comment

I went to a Neurologist yesterday and was diagnosed with a median nerve lesion. I have been treated for 6 weeks for ulnar neuropathy. Lots of therapy and taking Vioxx but I still had a lot of pain. You suggested I see a neurologist and get an EMG. I found a sharp Dr. and the Dr. agrees, he will be doing the test on the 22 of May.

My question is He gave me a prescription for Neurontin, I was wondering if it will interfere with the test in any way.

I am very thankful for this forum and for all your help. I will keep you posted. I still have a great deal of pain in my whole arm and I hope the Neurontin will help.

Answer

I hope all the best for you and to get well soon. About the Neurontin, it does not interfere with EMG test at all.

Comment

Hello Dr., I have appreciated all of your advise in the past.

I went to the Neurologist Wednesday he does believe I have a Median Nerve lesion. He did a nerve conduction test and told me it did not show any concerns of permanent nerve damage or motor skill damage. He has me on Neurontin, I am up to 4x/300mg per day. I was told He does believe I have pain and that the nerve will take time to heal. I was very relieved to hear that and left his office feeling good, then when I got home I started thinking why did nothing show up when I have so much pain.

The pain is mostly in my finger index, middle, and ring finger. If I wait to long before I take the medicine I have a lot of discomfort in my elbow and lower arm.

The Doctor said, “be patient”. Those nerves heal an inch a Month.

I called the office back today and asked if he would send me for an MRI and he had the nurse tell me he would not OK it.

I was hoping I would have someone tell me exactly what is happening in there.

Should I just give it time he wants me back in 2 Months.

Thank you in advance,

Answer

Thank you. I am pleased that you feel better. All the best