EMG Interpretation after worrying symptoms

[LoganB]

Hello All,

Just had an EMG and was wondering if anyone could help interpret the results. I’m a 41M that started having fasiculations in my shoulder 3 weeks ago. 1.5 weeks ago they spread to my whole body and I had right hand and right leg weakness. Not clinical yet, but soreness like the muscle has been cramping or worked out in my calf, quad, and forearm. My EKG (which was coincidentally already scheduled due to herniated discs) read the following and I was wondering if someone could clarify point #2 specifically. Is a “chronic neurogenic finding” a possible denervatiom? Thanks for any help that can be provided.

“Electromyography:
Extremities: 1 and 2
Site: Right Leg and Right Arm
Number of right arm muscles studied: 5 or more
Number of right leg muscles studied: 5 or more
Nerve Conduction:
Nerves tested: 11-12
Findings/Interpretation:
Abnormal study:

1. There is a mild right ulnar neuropathy at the elbow.
2. Chronic neurogenic findings were noted in the EDC. No other muscles tested showed significant poly phasicity or large motor units. This could be seen with a mild chronic right C7-8 radiculopathy. No active denervation was noted.
3. No evidence of lumbar radiculopathy.
4. There were scattered rare or occasional fasciculations noted in several muscles tested but these did not persist and were not associated with significant other neurogenic findings other than that seen in the right EDC. Fasciculations can be seen in multiple conditions and often associated with benign fasciculation syndrome. We did discuss the link of stress, poor sleep, fatigue excess caffeine and dehydration. He is trying daily magnesium which seems to help a little bit. Other causes of fasciculations were reviewed with the patient including chronic radiculopathy, peripheral nerve entrapment or motor neuron disease. I did recommend MRI imaging of the thoracic and lumbar spine.
Patient tolerance: Patient tolerated the procedure well with no immediate complications“

 

[lgelb]

"Chronic neurogenic findings" corresponds with chronic denervation. ALS entails both acute and chronic denervation, which is why they noted the lack of the former.

Soreness and weird feelings can mushroom without their being anything sinister. Stretching regimens esp in the morning like tai chi may help.

The approaches the doc discussed with you are good. You might also want to ask about a hand therapy evaluation to set you up with a home regimen to keep things from progressing. They can also discuss your arm positioning with you.

 

[LoganB]

That makes a lot of sense. Thank you so much for the information. Googling “chronic denervation without acute denervation” helped a lot.

I know I’m being paranoid. It’s extremely unlikely I get multi limb onset in 2 weeks. I watched my dad waste away from primary progressive MS and certainly have some unresolved PTSD from it.

Thanks again and I hope you’re well.

 

[LoganB]

Curious if you know the difference between active and acute denervation? Google seems to suggest active denervation means ongoing, where acute means sudden. Can the EMG tell if the chronic denervation in my EDC was sudden/acute?

 

[lgelb]

I'm sorry about your dad. Maybe some counseling or a support group/forum for children who have lost parents would help.

A sign of denervation is either acute or chronic. It can't be both. So by definition, the EDC finding as reported represents a chronic, not acute condition. Chronic means you didn't develop this yesterday and it's not time-limited, though the effects may be reduced with some kind of intervention like positioning changes/PT/taking breaks between repetitive motion sessions.

Think of sudden blood loss in an accident (acute) vs. chronic anemia or an old injury that bothers you.

 

[LoganB]

Thank you so much. I guess my confusion stems from your other comment that ALS involves chronic and acute denervation, so my EMG would be okay because despite chronic there was no acute noted? Would both be present in different locations?

 

[Nikki J]

In als you see acute and chronic denervation in the same muscles across multiple muscle groups. Acute denervation has a specific appearance and chronic has too but they are completely different and wouldn’t be confused with each other.

To take the anemia example. If I get a complete blood count it might show anemia. It also might show infection. Those are seen in different parts of the test. You could just be anemic. You could just have an infection You could have both. For denervation on an emg you can see just chronic ,just acute or acute and chronic. You don’t even begin to think als unless there are both but even then you have to look at the pattern and rule out other things that look similar

 

[LoganB]

Thanks you so much for the response. That clarifies it completely.