Help understanding EMG results

[cabinboy]

Hi,

First, thank you all for all that you do - it is very much appreciated by posters and lurkers alike.

In early December, I began feeling a strange sensation in my feet when I went running - almost a lightness, with occasional pulse/throbbing feeling in both feet. I eventually had to stop running in late December, and after being scared by Google, made an appointment to see my primary care physician in late January. I also began experiencing twitching, mostly in my calves. My PCP thought I had peripheral neuropathy, and sent me to a neurologist, who conducted an NCS and EMG. The NCS was normal, her summary of the EMG is below (I've also attached a photo of the results).

As tabulated on a separate sheet, multiple muscles of the bilateral lower extremities are tested.
On the left side, several muscles of L45, L5S1, and S12 innervation showed some evidence of chronic denervation and reinnervation, without any evidence of active ongoing denervation found in any muscle tested including the lumbar paraspinals. On the right side, several muscles of L45 and L5S1 innervation showed some evidence of chronic denervation and reinnervation, without any evidence of active ongoing denervation found in any muscle tested including the lumbar paraspinals. There were no fasciculations seen in any muscle tested.

Her conclusion is as follows:

This electrodiagnostic study shows evidence of:
1) A chronic Left sided L5S1 radiculopathy without evidence of active denervation found.
2) A right sided, mild, chronic L5 radiculopathy without evidence of active denervation found.
3) A right sided peroneal neuropathy, most likely at the fibular head

My PCP thinks I have a herniated lumbar disc, and I am having an MRI done on Wednesday. I am somewhat concerned, since I keep experiencing fasciculations in both of my calves every time I sit down (which the neurologist did not pick up on the test). I also experience them in other parts of my body, including the arms (one of which is beginning to feel weak). I am also concerned about what could cause chronic denervation and reinnervation other than ALS (Google is useless in this regard). I'm strongly considering seeing a second neurologist, one who specializes in ALS, to confirm the results, but wanted to see what you all thought.

thank you so much for your time.

Sorry - I should also add that I am a 45 year old male. In my initial appointment with my PCP, he found I had brisk reflexes, but did not observe any weakness or balance problems.

 

[KarenNWendyn]

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The EMG does not show an ALS pattern because the insertional activity, psw, and fibrillations are all negative. Therefore no acute denervation. The 5th column and columns to the right of it show the chronic changes. Radiculopathy (pinched nerve roots) and other peripheral nerve injuries can cause those findings. A slipped disc would be a common cause of radiculopathy, but bone spurs can contribute.

Twitching is common, nonspecific, and meaningless in the absence of muscle function failure which you have not described. Pain and throbbing and “feeling weak” point away from ALS.

The good news is you don’t need to be here.

 

[cabinboy]

Thank you so much for the quick reply! It is very much appreciated (and for succinctly explaining the test results, which neither of my doctors have done for me so far).

I will keep everyone on these boards in my thoughts - you do great work explaining a very difficult subject to the public. I have found the information here to be invaluable.

 

[cabinboy]

An update - got the MRI on Wednesday, which showed a collapsed intervertebral disc at L5-S1, with minimal bulging and mild facet changes (as well as mild facet hypertrophy at L3-L4, and minimal facet hypertrophy at L4-L5). The overall impression was mild degenerative changes (interestingly prior abdominal MRI and CT scans in 2018 indicated severe degenerative disc disease at L5-S1).

My doctor wants me to go back to the neurologist for a full clinical examination. Obviously, this has raised by anxiety level considerably, since we thought it was a herniation, but it's not. I'm hoping for the best, but worried about what this could be.

Once again, thank you all for your help and all you do for worried people like myself.

 

[lgelb]

MRIs can show structural changes but not the effect that they are having, which is more than EMG numbers. Disc disease can improve with time and get worse with trauma, overuse like bad lifting mechanics, etc.

I would ask about PT, which is very commonly prescribed in conditions like yours.

 

[cabinboy]

Thanks again for your thoughtful response - I try not to panic (and have read much of what you post), but was concerned that degenerative disc disease alone wouldn't explain the chronic denervation readings from the EMG (that it could only be caused by a slipped disc) - but it sounds like they are consistent, and that my back may be healing itself (the MRI was taken 6 weeks after I stopped running, and my persistent back pain disappeared).

I will hope for decent news from the neurologist.

 

[cabinboy]

Sorry to post again, and if the mods want to delete this I completely understand, but I am concerned that my MRI does not support the neurologists original diagnosis of radiculopathy - specifically, does anyone know if a collapsed intervertebral disc cause the chronic denervation observed in my EMG? I understand that there was no acute denervation observed (and that's a good thing), but am concerned that there may be no other explanation for the chronic denervation if a slipped disc is ruled out (I assume the MRI would have noted a pinched nerve if that was observed). Sorry, but I am out of my element here, and my PCP has not been very helpful in answering my questions.

 

[KarenNWendyn]

ALS is not a diagnosis of exclusion. In other words, just because your MRI doesn’t completely explain the chronic denervation doesn’t mean ALS is the only thing left and therefore it’s ALS. Sometimes things don’t always show up on an MRI. Tests aren’t perfect. It does tend to argue against a surgically correctable lesion, but that doesn’t mean ALS is what’s left. Whether a collapsed disc may explain the EMG is a question for the neurologist. The bottom line is that your EMG is not consistent with ALS.

 

[cabinboy]

Thanks Karen. Just very concerned that ALS may be the only other explanation for the chronic denervation once a herniation was ruled out (understanding that I don't have active denervation - just not sure if that is something the neurologist missed on the EMG).

 

[lgelb]

There are hundreds of causes for chronic denervation. Ruling out a herniated disc doesn't rule in ALS. At all. And no, MRI doesn't catch every slightly pinched nerve. It doesn't see individual nerves, just, in this case, structures that could be pinching them. So again, I would ask about PT.

 

[cabinboy]

Thank you so much - that is very helpful (and comforting). I will definitely ask about PT when I see the neurologist on Friday. And, again, sorry for all the questions and anxiety - this is all very foreign to me, and my doctors have thus far not been very forthcoming about what these test results mean, and there is confusing information on the internet about what can cause chronic denervation. So far, this message board is the only thing that has kept me from losing my mind over this - so thank you again for the information.