Help interpret EMG

[hopingnot]

Hi all,

I have been having right hand weakness for some time. Initial diagnosis ulnar nerve compression (underwent decompression). Also have cervical cord narrowing and sclerosis. No sensory symptoms. Recent EMG/NCV was worse than the one in jan that showed ulnar nerve compression. Thoughts on EMG/NCV below?
NCV & EMG Findings:
Evaluation of the right median motor nerve showed prolonged distal onset latency (4.8 ms) and reduced amplitude (Elbow, 3.7 mV). The right Ulnar ADM* motor nerve showed reduced amplitude (A Elbow, 3.8 mV). All remaining nerves (as indicated in the following tables) were within normal limits.

All F Wave latencies were within normal limits.

A new disposable concentric needle electrode was used and discarded; evaluation of selected extremity and paraspinal muscles showed increased insertional activity with fibrillations and positive waves in the R TIB ANT, R FDI, R EIP, R FCR, and R TRI, with fasciculations in the R VAST LAT, R THOR PSP, R EIP, R FPL, R FCR, R FRI; high amplitude, broad duration units with reduced recruitment were noted in all RUE muscles save the DELT, and in the R TIB ANT; high amplitude, otherwise normal units of unclear significance were noted in the R TFL.

Thoughts? Is this concerning for ALS? Discussing with neurologist soon. How do I differentiate from cervical spondylotic myelopathy?

Thanks

 

[Nikki J]

Was there not a summary / interpretation? Do you have a diagnosis of cervical myelopathy? Can you share your mri reports?

It sounds like spine vs MND is your current differential but your exam and mri would be deciding factors especially the mri Just seeing the emg I would be concerned yes but part of the diagnosis process is ruling out other issues with imaging and labs and correlating everything with your clinical presentation. I hope you hear from your neurologist soon. Waiting is very hard

 

[hopingnot]

Thanks. Impression was This is an abnormal study. There is electrodiagnostic evidence most consistent with an anterior horn cell disease; multilevel radicular disease, or motor predominant or exclusive axonal neuropathy is on the differential localization for these findings

Relevant MRI info below.

C2-3: Normal thecal sac dimensions and neuroforamina with no significant facet disease.C3-4: Mild disc bulge and facet arthrosis. Mild bilateral neural foraminal stenosis.C4-5: Mild disc bulge and facet arthrosis. Mild canal narrowing and mild bilateral neural foraminal stenosis.C5-6: Disc bulge with superimposed left central disc extrusion, increased compared to prior. Mild bilateral facet arthrosis. Moderate canal narrowing. Moderate left and mild right neuroforaminal narrowing.C6-7: Disc bulge with superimposed central disc extrusion with cranial migration. Mild bilateral facet arthrosis. Severe canal narrowing and cord compression. Mild bilateral neural foraminal narrowing.