EMG Study: Reasons for Bilateral Test

[johnsoncarter]

My Physical Therapist expressed her concern regarding my fasiciculations and related symptoms of percieved leg weakness. She indicated that she was under the impression that when an EMG study is performed it should be bilaterally, not on one side, which was the way in which this test was performed on me. She also noted that my reflexes seemed hypo-reflexive which she believed may be due to spinal stenosis and to multiple knee and shoulder surgeries. However, she mentioned that there seemed to be a systemic medical issue underlying my feelings of leg weakness and mentioned that it may be due to my pre-diabetic condition (currently this problem has been resolved) and the possibility of my being hypglycemic and having low blood pressure. She inquired as to whether I had a brain MRI to rule out MS(which I did). She also noted that my perception of weakness in the legs may be emanating from the ligaments and muscles in my back that are very tense due to the spinal stenosis. She indicated that by eliminating my intense running and weight training routine it was possible for these symptoms to remit.

Do any of you guys agree that my Neurologist should have performed the EMG on both sides rather than on one? My Neurologist indicated that if neuropathy was present it could be discerned on one side and did not require conducting the EMG on both sides.

 

[ZekesTraveller]

I have asked three neurologis the same question. Answer...."One sided EMGs are good FOR DETECTING ALS/NMD.

They are of little value for detecting entrapments/impingments if the nerve is trapped on a limb that was not tested." But I can't deny that I would prefer both sides be done.

A neurologist test the muscles you complain about. Say you feal your right leg weak then he/she may perform a single sided EMG to eliminate ALS as the culprit. However, if your right legs is weak and he tests your left forearm then no......an entrapment will not show up. But ALS classical waveform distortions would be visible leading him/her to perform further tests on other limbs. The good news is that you don't have ALS. But you could have an impinged nerve! Go ahead get the full EMG treatment! I'll say this much a thourough neurologist would test all limbs just for the sake of being thorough. My neurologist did this on me!

Physical Therapist vs. Neurologist opinion? I'll go with the neurologists opinion!

Yeah, I know you scored 5 touchdowns a Polk High but ease up a bit. When I get to be sixtyish I'll probably need to be wheeled around everywhere on one of those Rascal scooters!

 

[johnsoncarter]

Hi Zeke,

Hope you are doing better. Thanks for confirming the efficacy of the one sided EMG testing procedure for detecting motor neuron disease. The problem I am having with my Neurologist is that when I first met with him over a year and a half ago regarding feeling unsteady, having weak/heavy legs and as if I was about to fall down he indicated that it was due to Fibromyalgia. This was a diagnosis he "borrowed" from a Rheumatologist who diagnosed me with this "disorder". When I asked the Neurologist at that time whether he actually believed in the diagnosis of Fibromayalgia, which is a very controversial disorder, he responded that he did not really know what it is. However, not once did he indicate that spinal stenosis may be a contributing factor to my symptoms even though he had access to my spinal MRI results and the actual MRI images that clearly revealed the presence of this disease process.

When I was examined by the same Neurologist a year and a half later, he stated "you know that you have spinal stenosis and that this may be causing your symptoms". Then, after performing the EMG and relating that I did not show evidence of neuropathy or radiculopathy he indicated " fibromyalgia can cause benign fasciculations". However, when asked again whether he believed in this diagnosis he responded that he did not really know what it is! In effect this Neurologist left me "hanging" for a year and a half with a very vague diagnosis. Instead of informing me to reduce the intensity of my workouts he actually told me to get back to working out! After the EMG study the Neurologist did not prescribe any treatment so I asked him if physical therapy would be helpful and he agreed to give me a prescription. However, when I called this doctor three weeks later to discuss the fact that my symptoms were getting worse and the possiblity of an updated MRI, he shot back that I had spinal stenosis and needed "aggressive physical therapy" (from no therapy to "agressive physical therapy").

Due to ongoing problems with my right leg, two weeks ago I was evaluated by a Neurosurgeon and Orthopedic Spine Surgeon to determine the bottomline regarding my symptoms. Both dismissed the diagnosis of Fibromyalgia, found no evidence of neuromuscular deficits but held that I was not a candidate for surgery at that time (the orthopedic surgeon noted that in five-ten years it was possible that I would need surgery; I disagree, I believe it will be sooner rather than later). However they noted that I may need an updated MRI if my symptoms did not improve after a one month stint of PT.

The failure of my Neurologist to hone in on the critical diagnosis, spinal stenosis, over a year and a half ago contributed to my not taking appropriate and expeditious actions (ie, cutting back on the intensity of my workouts) to prevent an exacerbation of this condition. Now I am left with a significant medical issue due to ommission and neglect by this physician to forthrightly discuss the primary factor that was underlying a number of my symptoms.