EMG questions
 

I had an EMG/NCS this morning and have some questions. I had several of these about 15+ years ago for carpal tunnel syndrome and today's test didn't seem to be as thorough as the one I had done back then (different doctor).
That leads to my first question. They said they were doing this to rule out TOS. Even if the tests were negative, that doesn't necessarily rule out TOS does it? From all I've been reading, I didn't think there was a conclusive test for TOS or am I wrong about that?
I'm also wondering about the test itself. It seemed like most of the test was concentrated from the elbow down. They only positioned the electrode on the scalene area once and the needles were only inserted in my neck from about C5 & above. Is this normal? I had expected that they would be testing some in the brachial plexus area and the C8 area but those were completely avoided. I go back to my doctor Thursday and will get the results then but I just wanted to be prepared to ask the right questions.

I'm wondering about the protocol for the EMG test that Dr Annest does.
Has anyone had it? I think if I am going to get an EMG it would be useful to get the one he does. Does it confirm TOS? I wonder if another doctor could perform that protocol as well as the drs in denver that he refers to? His office staff suggested it but they didn't seem to know if anyone else had it done successfully at another facility.

KLS-what kind of a doctor ordered or performed yours? Are they profs who deal w/TOS all the time?

I've only had one of those and mine was focused on checking the ulnar nerve - that's where my symptoms were presenting the most at that time.

and I didn't have a clue about TOS yet then - just thought it was a spreading RSI problem - duh:Scratch-Head:

As I take it the test would be more likely to rule in/out - if the nerve is trapped at elbow or wrist.
I recall something about C8 testing can help to show TOS as more of a possibility.

I had one Dr. just look for CTS on very short EMG's and he found CTs, But he never checked further and I had plexus, ulnar, radial and median nerve problems that went on worsening until new Dr. did full EMG and found the root of problem. They must check the whole arm and shoulder/neck areas with EMG. Some see lower problem and stop, thinking they found problem. I had 3 CTS surgeries based on this mistake and other problems worsened and CTS is even worse now.

The WC physiatrist ordered the test and it was done mostly by the tech woman in the neurologist office & a med student...the neurologist only did the last few needles in my neck & read her results. I ended up with bruises from all the ones the med student did, I think she needs some more practice! LOL

That's what I'm worried about...that they will concentrate on CT rather than the TOS. I had 3 surgeries for CT back in the late 80's and it's to be expected that the EMG in that area would be abnormal. Since so much of the EMG was concentrated below the elbow I'm afraid they were only testing what was already known to be damaged.

Thats exactly what happened to me. After the cts surgeries I complained about continuing symptoms and the dr. didn't believe me and did more emg's and they showed abnormalties but he didnt follow up the arm. New dr. did and found more serious problems. They must test brachial and shoulder too.

The neurologist Dr Annest refers to is really good - but he's older, like maybe
late 60's. He told me he doesn't usually do EMG's any more, but he'll do them for Dr Annest. He asked me if other Drs aren't doing this test, he says it's very simple to do. I wonder if they aren't being trained in it. I do know it's in a rather risky area, and wonder if the younger Dr's just would rather avoid the possible problems if they misplace the needle. Gives you a lot of confidence in today's Drs, doesn't it?

My local neurologist is roughly the same age, and a prof at the univerity medical school, highly thought of. But when I asked if he wd do the C-8 study across the ulnar nerve, he said he doesn't do that and mentioned that it's a very difficult place to test.

So I have a dx of cubital tunnel, even though my pain begins at the neck, and Dr Togut has dx'd severe TOS, but the EMG evidence only shows a problem at the elbow. And the neurologist wants to send me to an elbow guy!! I said I think I'd like to have a consult with Dr Annest first, thanks. :rolleyes:

It's scary to think of the few "good guys" retiring....

beth

I hoped they tested across the brachial area too. The EMG is important for evidence to insurance/workers comp and should be done thoughly.

Mine showed many problems and it was thorough-took at least an hour. Its worth the pain to get definete results.

I am going to look for a few post, on why the EMG is not a good diagx tool for TOS and the article from Tom Tolson that was published.
Basically, there are larger nerves that make the muscles move like feeling heat of a candle, these are the nerves tested in EMG, the smaller sensory nerves can not be tested. They are the ones if you touched the flame and turn red and hurts sends the pain impulses to the brain. They are the first affected in TOS.

Tolsons article is excellant to take to the doctors with you.
Hands on testing to reproduce the symptoms, checking to see sensory where you are as far as feeling dull and sharp pain, along with a detailed history is a large part of diagx TOS.
I will go search for the ppost now.
Good luck
dianne
Oh, when they did my EMG I had a NVC test too that put a probe, not the needles, on the collar bone area and sent a signal, to the palm of my hand. This diagx type should my brachial nerve problem.