EMG qestion

[Wonderer]

Can I trust an EMG performef according to standard needle placement, in spite of the fact that no needles were placed in the area were I am clinically weak (gluteus medius) and percieved weak (abductor hallucis)?
Is it enough to stick in side of tounge to assess for bulbar involvment?
Needle placement were thighs, calves, hands, fascial muscle and side of tounge. Qualified doctor performed the test and said no signs of ALS.
Thanks!

 

[AtTheCircleK]

It is frustrating that there's no universally accepted EMG test that accesses the strength of all major muscles groups: thighs, calves, hands, arms, paraspinals, facial, and tongue. I'm not sure why some neurologists just simply refuse to test the area you have weakness in (for me, bulbar and neck muscles had perceived weakness, but despite my insistence, only my arms and legs were tested). You however were given a very thorough EMG, which I'm sure most of which was done just to put your mind at ease.

 

[ottawa girl]

Wonderer - you are lucky! ALS is off the menu for you it seems.

My symptoms were only on my left side and mostly only my right side was needled.

Neuros are very well trained over many years. While I appreciate some are more capable than others, just as in all professions, I'm not one to second guess them and I would not be telling them how to perform a test either... Especially when there's a needle involved! :lol:

 

[paul71]

Believe it or not, I have had 5 EMGs since October by 3 neurologists.

1) late october - legs - peripheral neuropathy found. I found later that the doctor was not qualified (not even a board certified neurologist).

2) early november (2nd neuro) - arms - myopathy and chronic and active denervation

3) early november (2nd neuro) - legs - normal

4) late december (3rd neuro) - arms and legs both normal. I felt that this test was rushed. I just KNEW that the problem was overlooked

5) this week (also 3rd neuro) - legs normal, myopathy found in arms. This EMG took much longer (90 minutes). The doctor stated that he must have missed something back in december but added that the symptoms are much more apparent now. Because of the latest abnormal EMG, I am getting a muscle biopsy.

So I would say that EMGs are part art, part science. Also not all doctors are created equal. Many neurologists are not board certified and not AANEM accredited.

If you really think something is wrong, you have to be relentless. Research your doctors. And don't take no for an answer. You know your own body. You may or may not have ALS, but if deep down you just know something is wrong, there probably is. That's my experience anyway.

 

[vickim]

I agree with Paul. Even my neuro (3rd one) says he doesn't trust another drs emg, he does his own. And I must say his emg was a lot different than the others. Longer and quite uncomfortable.

 

[Wonderer]

Thank you so much for replies, I greatly appreciate it. Paul: why have you done so many EMG:s? What did your clinical examinations show? Have you gotten a Myophaty diagnose? I have not the oppertunaty to reasearch my doctors, I live in Sweden where private practitians are rare, you have to go to the doctor in your community. I have been examined by two neurologists at the region hospital and had two EMG:s, both performed by doctors specialiced in neurophysiology. In Sweden neurologist do not perform EMG themselves, a neurophysiologi speciality exam is required.

 

[vickim]

I have had 3 emgs. 2 by one dr and the other by the dr I see now. I am scheduled for another in oct. As some illnesses progress they have to repeat tests. I have a myopathy diagnosis.

 

[JustTrying]

I wonder the same thing. I have a lot of bulbar symptoms: weakened hoarse voice, lump in throat, worsening swallow, tight neck, I feel like wasting, popping joints, scalloped tongue. And yet they only tested my legs, one hand and two places in my back. So I wonder the same thing. Maybe the ones in the back would test bulbar region?

I was also not seen by an als specialist.

 

[JustTrying]

Do you also have fasiculations on your face/mouth?

 

[Wonderer]

JustTrying: I dont know if I have fasciculations in mouth/face, have some kind of twitches there though. I think Trapezius in the back/shoulder could show bulbar involvment but i am not sure. Both my EMG:s have been clean, so has my clinical exams. But I do have a lot if symtoms; shaking and trembeling right leg (hard to stand up without support, easier to walk than stand still), weakness in hips, especially the right (confirmed by physioterapist), fasciculation constant at inside of right foot, random fasciculations in calves, thighs, gluteus and trapezius, troubble swallowing, cracking joints and sometimes cramps and spasms.

 

[paul71]

Wonderer, I have had so many EMGs because the first wasn't done correctly. The 2nd and 3rd showed evidence of chronic and active denervation in my arms and a myyopathic pattern in my shoulders. My clinical exam showed UMN symptoms - hyperreflexia, spasticity, and slight clonus.

So I was referred to the ALS clinic for further examination in December. I felt the exam was rushed. My upper and lower body EMGs were clean and I was sent on my way. Over the next few months, I continued to struggle. I was placed on Zanaflex by the 2nd neuro. Meanwhile my GP got me an MRI of my shoulder, which had been bothering me for months. It revealed a rotator cuff tear. I was referred to an orthopedic surgeon, who found clinical weakness and scapular winging on her clinical exam.

She referred me BACK to neurology. The doctor who said I was fine in December did yet another EMG, this time finding abnormalities. He said "very unlikely" to be ALS but probably a myopathy.

I had a muscle biopsy 2 weeks ago. Waiting for results. So many EMGs sounds incredible, but that's my journey.

Paul

 

[Wonderer]

Okay Paul, now I understand why there was a third neuro involved. I did not know that winged scapula was connected to neuromuscular disease, I had winged scapula all my life, my son has it too, he is 8 years old.

 

[Wonderer]

Would like to add that I am unsure of what spacticity means, I do have really tight and stiff muscles ( even when thwy are relaxed) in periods, but the neuros say that it is not spacticity. I have a lot of clonus when I sit and let my toes touch the floor (right foot), but not when the doctors flex the foot. I have brisk reflexes, but not to the degree that it is considered hyperreflexia (no babinsky or something like that).