Question re: Mistake with EMG Test
 

All - I had an EMG in early March. For various reasons, I have not been able to get back in to see the neurologist who did the study yet. I have an appointment on Monday, May 9th. I did, however, pick up my test results to take to my annual physical so my family doctor could see the results which said it is an abnormal study showing evidence of sensory and motor polyneuropathy and possible myopathy. I looked at it initially and only read the "Summary" and "Impression" sections. However, I just looked at it again tonight and realized that I think my neurologist made a mistake on the test. When I had the test, his technician did the nerve conduction studies on both legs, then the neurologist came in to do the Needle EMG Exam. I distinctly remember that I was lying to the right of the EMG machine facing the doctor and he did the needle test only on my LEFT leg. However, in the section titled "Needle EMG Examination" on the report, it has the letter "R" next to each Muscle listed for the study. Shouldn't the muscles have an "L" next to them if he did my left leg??? I remember asking why he didn't do both legs and the technician said he didn't need to.

I am realizing all this now because I went to UVA today to be evaluated in their Neurology clinic and they say they do not agree with the results. Based on my physical exam, they do not think I have any motor nerve or myopathy issues. At most, they think I have small fiber neuropathy. I didn't mention this whole possible mistake issue while there because I am only realizing it now.

First of all, could someone tell me whether I am right about whether there should be an "L" next to the muscles if he did my left leg? Second, is this an issue? I have neuropathy in both legs anyway, so does it matter? I think it might if the needle results are evaluated against the initial conduction studies that the technician did. If the Needle test results are evaluated against the nerve conduction studies, then this mistake would mean my left leg (mislabeled "right" on the results) needle test results would be measured against my right-side nerve conduction studies.

Please help!! I am concerned. If he made a mistake, then I want another EMG and I don't want to be charged. But it will be my word against the doctor's in terms of which leg it was.

Any advice is appreciated.

Thanks!

I've had a test (can't remember what sort) where they muddled left and right. In my case it didn't really matter as the issue had been treated and resolved, but I do remember my doctor telling me it was not an uncommon mistake to make in medicine.

I have sensory motor neuropathy with myopathy - but my motor damage has always been very obvious on examination so I am not sure what to think about whether or not the L/R confusion could affect the diagnosis. My left leg is more damaged than my right, but that is obvious both on my tests and clinically. So even if they reversed by lefts and rights, they would still know something was wrong.

I'll be interested to hear what you find out on 9th.

best of luck with it all

raglet

I think--
 

--you should at least bring up this issue at your new appointment. As Raglet says, the confusion of left and right is very common in medical testing--far too common, unfortunately. It's one of the reasons patients have to be as alert as feasible and constantly ask/repeat, both to themselves and to those in the "theatre", what is being done. (And if the medical professionals in the "theatre" resent it, that's their problem.)

I'm hoping, if UVA is going to do a comprehensive work-up, that they might do their own nerve conduction testing. Annoying for you, certainly, as that testing is often uncomfortable, but it might be worth it--nerve conduction testing is notoriously variable due to factors such as the skill of those doing it, placement of electrodes, even the temperature in the room (it should be cool, rather than warm, for best accuracy--nerve conductivity tends to decrease with temperature even with "normals").

UVA said they didn't see a reason to repeat the EMG
 

Hi Glenntaj-

I didn't realize the potential mistake with the EMG until I got back from UVA. They did not agree with the results of the EMG and said they don't trust any EMGs except for ones done there. But they refused to consider another EMG because they felt it was not necessary given what they saw when they examined me. They said they only do tests (like EMG) to confirm what they see on exam and they didn't see anything on exam that would prompt them to order an EMG. They also didn't respond to the suggestion from NIH that I be worked up for autonomic nervous system dysfunction except to ask me if my sweating was abnormal. Looking back, I wish I had pushed this harder, but I always think of things after the fact. They did suggest I get a skin biopsy done even though they said most times small fiber neuropathy is limited to the hands and feet and does not migrate up into the thighs and buttocks like mine has. Is that true?

Should I conclude the the EMG test results are wrong if they documented the wrong leg or could they still be valid?

Thanks,
Sarah

Oh, that isn't true that neuropathy can not be in the proximal body, it CAN. It is in my case!

Also, it is essential to get tested for autonomic neuropathy as well. Which I also have.

If you need a good doc and are willing to travel, PM me.

Sfsn
 

my sfsn is all over my body. they made another mistake...

The test could still be valid--
 

--but I suspect you won't know for sure until it is done again--somewhere>

And, small fiber neuropathy definitely does NOT have to be confined to only the extremities. I had a full-body acute onset small-body syndrome, likened to a small-fiber Guillain Barre episode, and one can actually google up entities like acute small-fiber neuropathy (ASFN) and read about it; not common, but it does happen. Neuronopathies/Gangliopathies also can have predominantly small fiber involvement and not be "length-dependent" to the extremities:

http://www.questdiagnostics.com/hcp/...eralNeurop.htm

http://neuromuscular.wustl.edu/senso...tml#idiopathic

http://jnnp.bmj.com/content/72/4/540.abstract