emg (yikes)
 

I think that many people with tos have brachial plexus injuries to start with.

I have a brachial plexus stretch injury and when I had the emg and ncv I had excruciating pain and a big time flare up after. In this day and age modern medicine can't develop a less barbaric diagnostic test?

When you think about what they do, is shoot electrical current through your injured nerve( if that is what you have) The neuro got up to erb's point and there was no reaction in the nerve at all.

I have had one and I have refused the test many times since. It is not necessary in my case. I was told at my physical therapy/pain clinic that emg's can cause rsd.

From what I recall in reading the emg will only be positive if there is really severe long time compression. My injury was 4 months old and my emg was very positive.

Dr Ellis website may show info

www.doctorellis.com
or
www.tellmeabouttos.com

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this is from Dr Ellis' website
"One should also bear in mind that other disorders can cause generally similar symptoms and include pathologies at the neck, shoulder, and shoulder blade, as well as the very rare tumor. A variety of systemic diseases can produce these symptoms through other mechanisms that irritate the brachial plexus. Because of this, a thorough blood and imaging workup is a routine requirement and includes analyses for systemic diseases (autoimmune, hormonal, and tumorous), x-ray for both bony and spinal abnormalities, and electrodiagnostics for frank peripheral neuropathies. Magnetic resonance imaging...(MRI) of the brachial plexus, using 3-D reconstruction or neurography, can often be helpful in determining localized strictures or deviations of the normal course of the nerves in objectively substantiating abnormalities that point at TOS. Doppler ultrasound, comparing flow with the arm extended and flow with the arm to the side, can also be helpful. Electrodiagnostics are not as helpful, but they rule out other potential causes. I have found thermography to be a very sensitive indicator of abnormal peripheral nerve sensory function/irritation and that it objectively substantiates abnormalities much more frequently than any other imaging modality."

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This is from the tellmeabouttos site:
" Diagnosis

Physical examination is most helpful. Common findings are tenderness over the scalene muscles, located about one inch to the side of the wind pipe; pressure on this spot causes pain or tingling down the arm; rotating or tilting the head to one side causes pain in the opposite shoulder or arm; and elevating the arms in the "stick-em-up" position reproduces the symptoms of pain, numbness, and tingling in the arm and hand.
Diagnostic tests, such as EMG's (electromyography’s) or NCV's (Nerve Conduction Velocities), may show non-specific abnormalities, but in most people with TOS, these tests are normal. Neck or chest x-rays may show a cervical rib (extra rib). Loss of the pulse at the wrist when elevating the arm or when turning the neck to the side (Adson's sign), has been thought by some to be an important diagnostic sign. However, it is sometimes unreliable because many normal people also lose their pulse in the same positions, and the majority of people with TOS do not lose their pulse in these positions. Shrinkage of hand muscles (atrophy) occurs in about 1% of people with TOS, and these people will have nerve tests that show a typical pattern of ulnar nerve damage.
To aid in the diagnosis of vascular or arterial TOS, vascular studies may also be recommended by your doctor. The most non-invasive would be a Doppler study, which is an ultra-sound picture of your veins and arteries. An MRA (magnetic resonance angiography) is another option. An MRA is the same as an MRI (magnetic resonance imaging), only a special dye is injected into the veins so they show up during the images. This makes it easier for doctors to see if there is a blockage in the veins. A more invasive test would be a venogram, which requires an IV to be started. Dye is injected into the veins while the images are being taken. This gives doctors a clear picture of the entire vein as it travels through the arm. Venograms are typically a last resort, but are often necessary in the diagnosis and treatment of severe vascular and arterial TOS.

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this is info about Erb's point

"Keywordshistory • anatomy • neurology • nerves • neck • cutaneousAbstractWilhelm Erb is well known for his early contributions to the field of neurology and was an eminent physician of his time. One area described by him and that still bears his name is Erb's point. This point located just superior to the clavicle was used by Erb to transcutaneously elicit contractions of various proximal arm muscles with electrical stimulation. Many have mistakenly interchanged the terms http://www3.interscience.wiley.com/g...y/12/ldquo.gifErb's pointhttp://www3.interscience.wiley.com/g...y/12/rdquo.gif and http://www3.interscience.wiley.com/g...y/12/ldquo.gifnerve pointhttp://www3.interscience.wiley.com/g...y/12/rdquo.gif when describing the point of emergence of the cutaneous branches of the cervical plexus near the posterior border of the sternocleidomastoid muscle. We present a brief history of Erb's adult life and review his original description of his supraclavicular point and contrast this to the so called nerve point of the posterior cervical triangle. Clinicians and anatomists should be aware of the discrepancy often found in the literature between these two terms." Clin. Anat. 20:486-488, 2007. © 2006 Wiley-Liss, Inc.Received: 16 February 2006; Revised: 4 May 2006; Accepted: 23 May 2006Digital Object Identifier (DOI)
10.1002/ca.20385 About DOI

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I've had emg's in the past, the most recent was in 2005 because they thought this was carpal tunnel. Which of course showed damage to the medial and radial nerves. Moderate disease. When my old neuro did it I got a sustained twitch in my hand which he had to reshock it to stop it. I did not however have the ulnar nerve done. I know that emg's can be painful but I'm willing to go thru with it to get to my conclusive answer.
I spoke to my TOS doc yesterday and he agreed to a plain old emg of the ulnar. I'm waiting on my neuro to call and schedule it. again.
I have an appt with the pain management team on 8/1 at which time they will decide if I need a stellate ganglion nerve block. The anesthesiologist may not agree with a pos RSD diagonsis and not do the block. I know it's not RSD, but you have to go thru the whole protocol to be sure.
I do have muscle waste in the palm of my left hand. classic sign of neurogenic TOS along with loss of strength, loss of reflex in my middle finger and thumb, heaviness, cold intolerance and throbbing/aching pain along the ulnar nerve. No burning or hypersensitivity, which is typical in RSD. If I rest, it's manageable but never resolves. RSD never rests or subsides.
So the waiting continues......:(