Q: Spasticity, tightness, and CPK

[Tokahfang]

tokah-Mostly., but, What is considered passive movement and which tests does the neuro do to see/diagnose spasticity? Tkanks.

Um, in the most literal sense, "passive" means you lie there relaxed and the doctor moves your limb back and forth. The test to find spasticity is the part of the clinical where they tell you to relax and they move your feet up and down, bend your knees, etc. If there is resistance, they'll go faster or slower a few times, and if it gets worse with speed, it's spasticity.

To "see" spasticity usually only comes up with people who can walk, spasticity changes your gait in very characteristic ways. But even if your gait is completely spastic, they check for it the way I outlined above.

 

[trfogey]

tokah-Mostly., but, What is considered passive movement and which tests does the neuro do to see/diagnose spasticity? Tkanks.

Passive movement is when they move the limb for you. It should move smoothly and evenly, yet without being completely flaccid.

The neuro (or any provider, for that matter) is testing for muscle tone, spasticity, rigidity, etc. when they flex your limbs around -- like right before they do one of the push/pull tests. If and when they feel unusual resistance or uneven movement in the limb then or during the push/pull tests, they'll do more extensive testing.

They also observe how you spontaneously hold and move your limbs around while you're giving answers to things like medical history, listing your symptoms, etc.

Even just getting up out of a chair to shake hands or climbing up on the exam table gives them a chance to observe your movements in some important muscle groups.

 

[olly]

haaa! trfogey,after sitting for just ten minutes i am like a arthritic geriatric trying to get up............not a "young"lady.

 

[Tokahfang]

Nerve conduction studies mostly exclude peripheral nerve problems, and things like carpal tunnel and Guillian-Barre.

"Nerve conduction studies show whether the nerves transmit electrical impulses to the muscles or up the sensory nerves at normal speeds (conduction velocities). Sensory nerves allow the brain to respond to pain, touch, temperature and vibration. Different nerves have different normal conduction velocities. Nerve conduction velocities also tend to decrease as a person gets older. Slower conduction velocities may also be caused by injury or damage to a nerve (such as carpal tunnel syndrome) or group of nerves (such as Guillain-Barré syndrome or post-polio syndrome)."

 

[olly]

as beky mentioned i have the waddling gait with spastic legs.
when i walk i need to use my hips hense waddling which helps with walking but i think is also down to weakness in the thigh muscles.
people with none spasticity can walk with the legs straight and in a relaxed mode,in a straight line and good balance .
my gait ,its very difficult to walk with legs straight,they are stiff and clasp together from the hips to the knees and i sway from one side to the other as my balance is poor...........add the waddle and difficulty lifting the left lower leg/foot you have a freaky gait going on.

 

[trfogey]

meli,

In keeping with Beky's electrical wiring analogy, a nerve conduction study measures two things: is the wire (nerve) complete between two points and how long does it take for the signal to get from one point to the other. The EMG, on the other hand is like sticking a multimeter in the middle of the line to measure the natural activity on the line -- how much juice flows on the line, how much force it moves with, is the flow continuous or irregular/spiky, etc.

Various things cause abnormal readings on each test. With ALS, the NCS/NCV is usually normal (the wires are intact and continuous), while there are a specified set of abnormal readings on the EMG that show the ongoing denervation/renervation found in early ALS, along with the loss of parts of whole muscles' electrical activity when groups of fibers go offline (temporarily or permanently) due to lower motor neuron death (the socket where the wire is plugged in has no juice) and erratic activity from those muscle fibers whose motor neurons are currently under attack by the disease (blinky lights, motors that randomly speed up and slow down, etc.).

 

[meli]

So abnormal EMG (needle) studies point to denervation/re-nervation in (mnd/als) and NCS/NCV point to "blank" in (what sort of diseases or conditions)?

"Nerve conduction studies mostly exclude peripheral nerve problems, and things like carpal tunnel and Guillian-Barre."

But what if a EMG(needle) is normal and NCS shows something abnormal, motor nerve or sensory nerve NCS? Where does that point, myopathies, neuropathys, other things...?

 

[Tokahfang]

I think neuropathy and nerve impingements like carpal tunnel are the most common problems found via a NCS.

 

[trfogey]

So abnormal EMG (needle) studies point to denervation/re-nervation in (mnd/als) and NCS/NCV point to "blank" in (what sort of diseases or conditions)?

"Nerve conduction studies mostly exclude peripheral nerve problems, and things like carpal tunnel and Guillian-Barre."

But what if a EMG(needle) is normal and NCS shows something abnormal, motor nerve or sensory nerve NCS? Where does that point, myopathies, neuropathys, other things...?

From the NCV entry in the MedlinePlus Medical Encyclopedia:

"Most often, abnormal results are due to some sort of nerve damage or destruction, including:

* Axonopathy (damage to the long portion of the nerve cell)
* Conduction block (the impulse is blocked somewhere along the nerve pathway)
* Demyelination (damage and loss of the fatty insulation surrounding the nerve cell)

The nerve damage or destruction may be due to many different conditions, including:

* Alcoholic neuropathy
* Diabetic neuropathy
* Nerve effects of uremia (from kidney failure)
* Traumatic injury to a nerve
* Guillain-Barre syndrome
* Diphtheria
* Carpal tunnel syndrome
* Brachial plexopathy
* Charcot-Marie-Tooth disease (hereditary)
* Chronic inflammatory polyneuropathy
* Common peroneal nerve dysfunction
* Distal median nerve dysfunction
* Femoral nerve dysfunction
* Friedreich's ataxia
* General paresis
* Mononeuritis multiplex
* Primary amyloidosis
* Radial nerve dysfunction
* Sciatic nerve dysfunction
* Secondary systemic amyloidosis
* Sensorimotor polyneuropathy
* Tibial nerve dysfunction
* Ulnar nerve dysfunction

Any peripheral neuropathy can cause abnormal results, as can damage to the spinal cord and disk herniation (herniated nucleus pulposus) with nerve root compression."