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AndyDJX

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Hi folks--

I recently went to a hand doctor to take a look at the wasting of my thenar muscle and to discuss my fingers falling asleep at night, as well as my intermittently weak pinkie finger. He saw me very briefly and ordered an EMG to test for ulnar neuropathy. I saw him today and he discussed the EMG with me. The results said:

"Nerve conduction studies in the upper extremities and right leg are normal, with one possible exception: left ulnar ADM CMAP revealed conduction velocity across the elbow that was more than 10 m/s slower than the forearm segment. Left ulnar ADM inching across the elbow, however, did not reveal any segments with significant slowing (latency difference of >0.8 msec.) Concentric needle EMG of the right arm was normal.

Normal study with a single borderline result of uncertain significance. Clinical correlation is advised. There is no electrophysiologic evidence of brachial plexopathy on either side, or of a disorder affecting cervical roots or motor neurons on the right."

I know that none of us are doctors, but many people on here are more familiar with EMG results than I am. Is any of this what they look for in MND? The fact that it says "no sign of...disorder affecting cervical roots or motor neurons on the right" obviously makes me concerned about the left.

By and large this is a good report, but it's not great. The funny thing is my right side has been more symptomatic than the left; they even stuck a needle right where the muscle wasting/fasiculations always are in my right thenar muscle and that was fine. And the doctors said that my thenar atrophy is "minimal." He is also a hand doctor and said he has no idea what they look for on EMGs to indicate ALS.

Once again, no real answers. Problems are there, but they are subtle. Those doing the EMG initially said it was normal, and I basically decided to not worry anymore as best I could. But on the report they noted this issue and my doctor made note of it. Now I'm worried that this is an early sign of something worse, progressing slowly. My previous EMG of 1.5 years ago was clean.

I'm trying to figure out what to make of "minimal" atrophy, "borderline" normal EMG results with "one possible exception," weakness that comes and goes and of course, tons of fasiculations and twitches, both diffuse and focal.

Any input would be much appreciated.

Andy
 
maybe what the bordrline thing is that emg was normal and your ncv had an issue over ulnar? and that is what they are referring to? I had/have the same ncv findings at my local neuro and she told me I had ulnar nerve irritation. When I went to the als/neruro muscular teaching hosp. and they did the ncv and that same thing happen on my arm/hand, they brought in some other docs to show them that it was a martin gruber varient and 25% of population have it. And that if you stimulate the nerve from under the elbow in a different way that you can get the right velocity. My point is that local nurto says my hand problem is ulnar nerve, then go to specialist and my ulnar nerve is fine and not the cause. Did you ask your hand doc what that ment? and if he had seen that.

april
 
ncv is nerve conduction correct? He said the issue was found in the needle part, not the electrical charge portion.
 
Are you confusing Nerve Conduction Study with EMG? They are different tests.

If the nerve conduction test showed abnormalities, that would be better than abnormal EMG, at least in the case of ALS.
 
Unfortunately the abnormality was in the EMG, not the nerve conduction test.
 
Andy,

I don't think so. From your original post it sounds like the NCV portion was boderline abnormal, and the EMG portion was normal.

"Nerve conduction studies in the upper extremities and right leg are normal, with one possible exception: left ulnar ADM CMAP revealed conduction velocity across the elbow that was more than 10 m/s slower than the forearm segment."

The above indicates borderline abnormal NCV (nerve conduction velocity).

Concentric needle EMG of the right arm was normal.

The above indicates normal EMG.

With ALS there will be abnormal EMG and the NCV is normal. Keep searching for a reason for your symptoms, but you don't have to worry about ALS.

-Tom
 
No, according to what you wrote, the abnormality was in the nerve conduction study and what you wrote doesn't make too much sense. You state the CMAP revealed a slowed conduction velocity. The CMAP is measured in amplitude and not velocity, so I'm not sure what that means. Are you sure you copied it down correctly?

Slowed conduction velocity would indicate a loss of myelin, which is not consistent with ALS, especially in the early stages of the disease.

There was absolutely nothing said about denervation (positive sharp waves and/or fibrillations) or reinnervation (increase in the amplitude and/or duration of motor unit action potentials) in the report. Therefore, the EMG was normal.

Now read the report again: "NORMAL STUDY with a single borderline result . . . " The borderline result was a slight decrease in conduction velocity, which again, is not consistent with ALS. Congratulations!
 
TMasters- Thanks for your input. This stuff can get confusing; to the point that maybe even my doctor was confused? You're right-- when I read that it does sound like nerve conduction was where a minor problem was found, but I specifically asked my doctor if it was in the "shocking" or "needle" part of the test and he said "needle" and I believe he noted because it was in the motor fibers.

The needle EMG of the right arm was normal, but it's the left arm that's apparently problematic.

Wright--I'm glad you chimed in, as I know you are very knowledgeable about EMGs. I just triple checked the report and it does say "left ulnar ADM CMAP revealed conduction velocity across the elbow that was more than 10 m/s slower than the forearm segment."

Now, this is the summary of the report. There are charts and images included, but I barely paid any attention to them because I'm not versed in what they mean and I figure my ignorance could do more harm than good! But would it be helpful to list some of them here? It's broken down into different sections: Sensory NCS, Motor NCS, F Wave and EMG Summary. On the chart, it does list both Amp (mV) and Vel (m/s) I did take notice that there was no mention of those keywords: denervation, reeinervation, fibrillations, shap waves, etc; but honestly I didn't know if "conduction velocity > 10 m/s slower" was medical talk for denervation or something along those lines. Like I said, it's simple ignorance and it's exactly the type of info I was hoping to clarify here.

Thank you all for helping me figure this out, I can't tell you how much I appreciate it. My doctor was super quick with me, and he's a hand specialist surgeon so I don't think this stuff is his specialty.
 
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