EMG to diagnose TOS?
 

Can anyone tell me what an EMG looks like for someone with TOS?
I know that an EMG is not a commonly used diagnostic tool. Dr Newkirk (TOS neurologist) sent his patients in for the 3D MRI/A/V and not for an EMG.

I had an EMG and the neurologist that ran the test said that it is the ONLY way to diagnose neurogenic TOS. Since my results were fairly normal he tried to tell me that I didn't have TOS. I know that this is not what Dr Newkirk and the Denver and CA surgeons told me and I am just wondering what to do with this information.

My current neurologist (not knowledgable about TOS) sent me for the EMG to try to learn where my elbow and forearm pain is coming from. The PT I had prior said it was definitely from my TOS and not from tennis elbow, etc. I'm just trying to put the pieces together so that I can do what I can to lessen the symptoms. In the meantime the nerve glides are helping me to some degree!:)

I just found this info below on the atosa.org site so maybe I've answered my own question. I've had the scalene blocks, the physical exam, the MRI/A/V, the pec minor block and also the venogram and dopplar ultrasound. the last 2 for the venous component. And they all showed TOS so I was surprised that the dr doing the study would say that I couldn't possibly have TOS. ...not that I'm not hopeful for it to go away but my many symptoms aren't imagined.


"Your physician may order an EMG and/or MAC test. These are nerve conduction studies commonly performed to help rule out other compression neuropathies of the upper extremity. The reliability of EMG studies is of great debate in diagnosing TOS as often times EMG studies are inconclusive. Currently, the Medial Antebrachial Cutaneous (MAC) nerve conduction test is being studied as an alternative or addition to EMG studies in diagnosising TOS."

Fern ,you can have vascular TOS and that have neurogenic involvement.

I had inconclusive EMGs too, four of them, I think. I had elbows, wrists, thumbs & shoulders too.

My good TOS expericenced Dr. Atasoy says all that is a result of the ribs, bracial plexus and scalenes being compressed. That's how he knows I've got TOS. I also have a band-thing between my deltoid and bicep muscle that used to go down to my elbow. Very painful, wilting to say the least. He says if I'd let him do surgery that would go away. he never diagnosed me with carpal tunnel, tennis elbow or shoulder anything, nor tendonitis. TOS related symptoms...

Also "palms up" helped relieve my arms discomfort. Have you see the Human Atlas at a doctor's office or PT, where the standing body has outstretched palms facing you and the toes are pointed straight out? That's the best alignment/posture for TOS I've found, standing or laying.

One the other forum I also noticed where someone used the "Miracle Balls." I swear by them babies too.

LED and infrared lightz gave me new life.

Take care and keep researching.

I'd believe the PT :)

I have found that good PTs & good chiros understand more about the whole in depth workings of the body than most Drs.

I've always read that it is more of a ruling out tool than actual diagnosing tool.

[Patients with other neurological conditions, (e.g., CTS or cervical disk disease) may develop various symptoms as a result of individual provocative maneuvers but the patterns are markedly different than those for thoracic outlet syndrome. It is not clear whether the severity of TOS is indicated by how long the patient can tolerate the test. The symptoms which the patient describes following the EAST maneuver are strong indicators for the presence of TOS.
Other Diagnostic Tests

A variety of other diagnostic tests may be used in assessing patients with signs and symptoms of TOS. None of these tests are specific for TOS but are used primarily to rule-out other possible causes of the signs and symptoms that the patient is experiencing. Testing should be done selectively based on the patient's history and physical exam. The tests may include:]

read more here -
http://www.medifocushealth.com/RT017...-Syndrome3.php

the next page on that site talks about dx Vascular TOS

hmmm- Pec minor syndrome isn't mentioned but the site has some good info - I haven't tracked any of these down for quite awhile - I suppose some of the main ones have been updated. the links in the stickys should go to the updated info as long as the site has the same web ID.

EMGs don't necessarily show TOS. It depends on the skill of the doctor and possibly the underlying cause of the TOS. I don't know why or how my 1st EMG was positive for TOS when it is rather uncommon to have a positive confirmation. My 1st EMG showed problems with the MABC, ulnar nerve, etc. Based on the involvement of different nerves, they can narrow down the site of compression. The doctor who performed my first EMG said I was unusual. He said I was the most "classic" case he has ever seen. He said that most patients present with TOS symptoms but no tests support the suspected problem (TOS). So hang in there!

mine said that too
 

sheri, my first tos emg showed me a classic case of tos, and when repeated by a different doctor, the result was negative for tos. the first guy said mine set records for being a bad case of tos. reading the posts here i tend to agree more with the 2nd doc.

i also had emg for carpal tunnel, and it was always negative. the docs simply said i had a mile case and it was not surgical, thus could (and was) helped by pt.

Thanks everyone. My neurologist phoned and actually said something like --TOS didn't show up on the EMG but you know that an EMG doesn't usually show TOS and you definitely have it. Wow, I thought I had chosen her because she is a nice person and as long as I couldn't find one that new about TOS in my area, I thought at least I could choose a nice person who has a reputation of being a good patient advocate.

I did see the report and the Dr testing said that he couldn't perform the C-8 nerve root test completely due to my pain level during the exam. I have to say that this part of the test was extremely painful and left me with quite a flare.

I'm done testing for now (I think I can safely say I've done them all) and will begin with another course of PT. I'm going to see if I can focus on the nerve glides in PTand continue the Sharon Butler pgm on my own. I know that I have neurogenic and vascular but my vascular issues have decreased some this past year I think by the work I am doing with the lymphedema specialist who also does some myofascial work with me. One goal is to learn to be able to put my arms in the position that B.W. illustrates as palms up is really not obtainable w/o pain or for any duration for me. btw-I do also use those "miracle balls" and find them quite useful as does BW.

Has anyone tried the ART therapy? It seems you can obtain it only fr a trained person at a chiro office which for me is not possible insurance-wise but I thought I had heard that it's quite effective.


I did and still do wonder how tendonitis shows up--as the current neurologist said that I may also have this in addition to the TOS and cervical disc issues.

I think my so called "bi lateral wrist strain & tendinitis" in '99 was actually the beginnings of my TOS- and goes back to the sticky tissues theory of Sharon Butler.

At that time I was doing very intense assembly work - 10 hr days, speed, reps, twisting, grasping, fine finger dexterity, strength and sitting /working with arms forward {table height was just a bit higher than was optimal for me & chair was as high as it could go:(}

anyway after about 2 weeks of same work station and no rotations to other jobs - my fingers just stopped working!
I couldn't pick up any o rings or the small tools we used for the work.
Luckily I still had large motor hand/finger use so i could drive home & to drs office.
That was kind of scary at the time..

off work a couple of months & PT and then 9 months of very light duty work, I finally asked to return to assembly- thinking I could get better rotation than the light duty jobs they were giving me.
If I only knew about the possibility of something chronic like TOS back then..
I would have stayed in the boring easier jobs- well maybe not it was really boring..
I did become an advocate for regular rotations in the assembly area and that made for more cross training for everyone - that opens up better raises or if you can't cut it less raises LOL.

well I am going off the topic of tendinitis LOL:grouphug:

tendonitis
 

my mri on the right showed tendonitis also. the only problem with that diagnosis is that the tendonitis never actually goes away. i think it probably would if that was what it really was. i also have bursitis on the right. again wondering if related to tos. they always want to shoot you up with painful steroids for bursitis, but i find it NEVER works.

Sounds like you've found a good neurologist to guide you. That's most important.

You may need to adjust "palms up" a little at your elbows or use props where you need to. I had to support the back of my arms and shoulders with pillows, balls and hand towels when I would lay down for therapy or other things.

Yoga and stretches helped me a lot. I had to work at that. Slow progress but very helpful.

I also would use 3" balloons in my armpits. That seemed to help some too.

Seemed like propping myself up at a 45 degree angle wasn't as painful for arms, neck and back for many years. I had little nests of pillows and balls everywhere. :D:D Would move 3 to 4 times during the night.

You're probably in a bad shape and it's hard to find any comfortable position. That's miserable. Been there.

I also had laser hair removal and put my blow dryer on a stand. Helped a lot with neck and arm issues.

I have moved a long mirror in my office, a side view at my computer station, so I can use it to help correct my posture. Boy did I need that to catch myself in a bad position. I knew I was doing it but didn't know it was this bad. I am able now to hold my posture up. Just now to that point though. For many years, hard to set uprigth for more than 4 - 6 hours. So much, much improved.