Not open for further replies.


Distinguished member
May 10, 2008
hey, went to Dr. today for stiff neck, knees buckling etc. he did emg. on right arm only? Summary was c/w mild carpal tunnel on right side and C8-T1 Radiculopathy on the right side. He also is schel. MRI of cervical spine to check for compressed nerve. He noted right leg and foot weakness with mild atrophy in foot and hand. Anyone have any ideas?
Hmmm, you have atrophy and weakness in your legs and he didn't EMG them? Was he in a hurry? Don't be afraid to ask your physician questions when you don't understand what they are doing. They work for you and they are getting paid to do a job to your satisfaction.

The only thing I can think of, is that he thought the atrophy in the leg wasn't a big deal and that he's going to do the cervical MRI to check for nerve root impingement (that could explain the arm symptoms) and to check for spinal cord compression (that could explain your leg weakness . . . but would not explain the leg atrophy).

Are you sure you have atrophy in your right leg?

You might also want to go elsewhere and get another opinion.
lets keep each other posted, your alot like me. I have stiff neck (had c-spine mri. it showed "slightly buldging disc c5 & c6 ithink) and my right knee started buckling in Jan. but has been ok the last few weeks, just ache & pain around knee muscle. My lower ankle has lost muscle on the side and i cant move my toes up. When i walk I dont really feel them. The place where the muscle has thinned out is where i would think your toes move, as I moved my toes on the other side and it moved that part of my ankle. The doc also noted slight hand atrophy in palm. (and b/w thumb and pointer-yikes I see this but she is unwilling to say it is that als atrophy. thinks my hands could just be that way. i notice it more becasue i live with my hands and she does not have a reference point. i have looked at everyone i know in that area, not one person has it has thin and sunken in as me)
and note: i had a emg on that hand/arm and my leg with the toe problem and they were clean. it is a little re-assuring but some people have alot emg before it shows.

I go for my lower spine mri today. I will know next week.

we will see.....................


he said slight atrophy in right foot, I think he was looking right under big toe were you start to arch. kind of noticed it myself after he said it. Does it sound like only carpel tunnel in hand. I asked him with surgery for that would I get some of my strength back.He replied, maybe. He said he wanted to rule out compression in spine I told him I wanted him to rule it in.
I have to repeat this:

If you have true muscle atrophy and that muscle is EMG'd and clean, then that is a good sign and shows that the muscle has "healed."

The people that have clean EMG's and then dirty ones, are the ones that had upper motor neuron symptoms only (upper motor neuron death does not show-up on an EMG) and later developed lower motor neuron symptoms OR had upper motor neuron dominant ALS that later developed lower motor symptoms OR had bulbar symptoms that had not yet spread to the limbs and then later did.

Upper motor neuron symptoms can only be diagnosed clinically and not with an EMG.

If someone has lower motor neuron symptoms, it will show-up on an EMG if it is actively happening and if the EMG is done correctly . . . and anyone that goes to a neuromuscular specialist will almost assuredly have the EMG done correctly.

Your symptoms can be consistent with carpel tunnel or a radiculopathy or a number of other things.

If the atrophy was near the big toe, then I can kind of see why he wouldn't stick you there during the EMG because the muscles of the feet are not reliable when assessing denervation because of the stress they are put under. Having said that: I still think he should have done your legs because of your weakness and "signs" of atrophy in your feet and he should have done your left arm to compare to the right arm.

As I said, keep a dialogue with your neuro and make sure he tells you what he's doing and why and also why he isn't doing other things you might think he should. Certainly be polite about it, so as to not cause any conflict. Voice your concerns (and you can voice your ALS concerns to him) and he might then be a little more thorough. if you have atrophy in the shoulder is that considered 'UPN'? and you're saying that would not show on an 'EMG'....OK, now I am confused. :?:

take care
Upper motor neuron versus lower motor neuron has nothing to do with the upper body versus the lower body.

Upper motor neurons are so named because they come from the highest centers of the brain (i.e. the cerebral cortex) and project to neurons in the lower centers of the brain (including the brainstem) and spinal cord (the lowest part of the central nervous system). The lower motor neurons are the ones in the brainstem and the spinal cord that project to our muscles. Therefore, the upper motor neurons help control the lower motor neurons and the lower motor neurons directly control our muscles (the upper motor neurons indirectly control our muscles).

Upper motor neuron symptoms are things like weakness, slowed movements, hyper reflexes, primitive reflexes (e.g. Hoffman and Babinski). Upper motor neuron death will not cause atrophy . . . although you might get a little atrophy from disuse of muscle. As I stated, these are things that can only be diagnosed clinically and not with an EMG. The reason the EMG can't be used, is because the upper motor neurons don't make "contact" with our muscles.

Lower motor neuron symptoms are things like weakness and atrophy. Atrophy of the shoulder muscle will be from lower motor neuron death if it is caused by ALS and it would definitely show-up on an EMG.

So would an EMG with mild Carpal tunnel syndrome on the right side and C8-T1 Radiculopathy be a clean Emg or dirty. He states abnormal. And would this be upper or lower? Sorry real confused.
The EMG is how the doctor is diagnosing you with carpel tunnel or radiculopathy, so yes there would be EMG abnormalities, but it wouldn't be due to lower motor neuron death; the carpel tunnel or radiculopathy would mimic lower motor neuron symptoms, but they wouldn't be due to lower motor neuron death.

EMG abnormalities can be present for reasons other than lower motor neuron death. That is why "dirty" EMG's don't always (and most often don't) mean someone has ALS.
Thank you Wright...although I must confess I am still confused, I will get into it deeper when I get back from vacation. Goodnight! signing off for a week!

take care
Not open for further replies.