What does my NCV/EMG report means?

[xyz14]

Hi Everyone,

I have some issues with my right arm/hand/shoulder that has been for 2 months. I recently did an NCV/EMG. I am wondering if you can help me interpret it?

A brief history of my conditions:

2.5 months ago: pin and needle on my right pinky finger and ring finger.

2 month ago: pain of right elbow

1.5 month ago: the pin and needle of the fingers have been largely (even though not completely) relieved. But I feel my right fingers are not as dextrous as before. I still have pain around the elbow.

1 month ago: pain of right upper arm and right shoulder. Twitching on right upper arm and right shoulder. I saw a neurologist. She does not find anything from the clinical examine and ordered blood test and found that I have vitamin D insufficiency (mine is 23 and the normal range is 30-70). So she prescribed vitamin D pills.

3 days ago: The pain on my arm and shoulder and elbow is kind of improved. However, I still feel my fingers are not very dextrous and furthermore, I feel my right upper arm and right shoulder is kind of "weak". (My right upper and shoulder becomes shaky when I did 3 push up. I feel like the muscle of right upper arm and shoulder is stretched closed to limit when I grab a gallon bottle of milk. For my fingers, I feel that my right fingers need to use more effort when typing and they make mistakes more often than the left ones and the my right hand muscles get tired more easily when typing.) So I see another neurologist. She did an clinical examine on me and did not see anything related to upper motor neuron. For the weakness part, she asked me to do an NCV/EMG.

(The report is not in English. So I have translated it. If you have any questions about the terminology, please message me and I will try my best to find the good translation):

1. sensory nerve:
right side median nerve, ulnar nerve conduction is normal; SNAP amplitude is in normal range.
2. Motor nerve:
right median nerve MCV is normal, CMAP amplitude is in normal range; left side ulnar nerve below elbow - wrist MCV normal; left side ulnar nerve above elbow - below elbow MCV normal; right side above elbow - below elbow MCV is slower than left side by 9.5m/s
3. F-wave study
left side median nerve and ulnar nerve is normal.
4. EMG
right side palm muscle below pinky finger (ulnar side of the palm): insertion potential is normal, no spontaneous potential, MUP latency is normal; amplitude is slightly high (+1); multi phase wave is increased (+2); maximal contraction is fully united (Note: not sure about the translation of "fully united").

Impression:
1. right side above elbow - below elbow MCV is slightly decreased.
2. ulnar side palm muscle shows damages in neurological nature.

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My questions:
1) Do you think the ulnar side muscle issue is related to the slow conduction of the ulnar nerve or something serious like ALS?
2) I am not sure why the doctor did not EMG on my muscle on upper arm and shoulder. Does ALS affect the fingers first and then the upper arm or shoulder?

 

[Alyoop]

In answer to your specific question
1. The distribution of the pins and needles that you had and the pain in your elbow can be directly attributed to an ulnar nerve issue. Sounds not even likely to be ALS related.
2. Your clinical examination did not show anything to indicate a need for an EMG of your upper arm and shoulder. The pins and needles that you had however would have led to the checking of your ulnar nerve. Als most commonly starts with weakness distally, such as fingers or toes, but can however occasionally start proximaly, shoulders or hips.

I will add that none of your symptoms point to ALS in any way, shape or form. So that is fantastic news.

 

[notme]

I see no mention of denervation and renervation. That's what it's going to show in ALS.

What did the DOCTOR say about it? An abnormal NCV (the electrodes part-not the needle part) is abnormal, I'd wager? That is a trapped nerve--usually ulnar. Muscle weakness and muscle fatigue are different things. Muscle weakness is noted on the check by the doc. None was noted, apparently--which is good, as Aly said.

No--it's not likely to be Als

 

[Nighthawk]

I will never forget this phrase from my EMG: "Chronic Denervation".
Had that phrase been on your EMG, then you would've had reasons to worry but, since your EMG doesn't even mention that, then you've got nothing to worry about.

NH

 

[xyz14]

It could be a while before I see my neurologist...

What concerns me is that the sentence "ulnar side palm muscle shows damages in neurological nature. " Does it mean chronic denervation?

Here is the table from the report about the EMG of ulnar side palm muscle:
insertional potential: normal
Fibrillation Potential: 0
Fasciculations: 0
Positive sharp wave: 0
Myotonia: 0
Normal MUP: "blank"
polyphasic wave: +2
low amplitude: "blank"
high amplitude: +1
duration: normal
contraction potential: interference
interference: interference

Are "polyphasic wave" and "high amplitude" in MUP indicative of chronic denervation?

Thank you very much in advance.

 

[oscar1]

Im not a docti0 but
I think that the worrying signs as far as als are fbrilation , fasciiculations and positive sharps waves . these are all clear for you
I have polyphasic units and Mups which i think denote nerve injury which could be hundreds of things.
Im afraid its a waiting game untill the test point to a diagnosis which they may never.
as i said im no doctor but you may have some minor nerve issues but no reason to worry about ALS, the worry will destroy your life and wont help in anyway
wish you the best

 

[wright]

I got your public message but thought I'd just reply here.

There is absolutely nothing in that EMG and nothing about your story that should alarm you in the least. The reasons have already been stated as to why. You ask specifically about the sentence "ulnar side palm muscle shows damages in neurological nature" and if it means chronic denervation: all it means is that you damaged your ulnar nerve, most likely by pinching it. That's it. It is most likely chronic in nature but who cares . . . you have chronically pinched it. A lot of people have chronically pinched ulnar nerves that present with the same exact symptoms you have. Your neuro isn't concerned because there's nothing that concerns him given your signs and symptoms.