Question About EMG Results

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Joe Samuels

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Hello amazing people, I have a question that I have been trying to wait off and hold until I can ask my neurologist who is very busy but it's worrying me to the point where I decided to ask you very knowledgeable people :)

- So a few weeks ago, I had felt some weakness in my left hand along with twitching in that upper left arm. I scheduled for, and had EMG the following week. He tested my reflexes and had me do a couple of tests like pushing on his hand which was very light and he held no resistance so I'm not too sure if he properly tested my strength but oh well. He never said anything about the testing he did on me and it took under 5 minutes total.

- The EMG was done only in my left arm and the neurologist inserted the needle into my arm only about 4/5 times. The needle was put in the shoulder area, bicep/tricep area and my forearm area. Each time, he kept the needle in for about 15 seconds each. The total EMG was done in about 5 minutes. He never gave me the results in paper or email, but he just said that my muscles and nerves looked healthy and sent me off as he was busy. The twitching still persists in my left arm but I'm not as concerned because he said that those results were clean. The weakness still persists in my left hand but now it is accompanied by twitching in my palm, wrist area, and on top of my hand where my fingers and knuckles/joints are.

- Also, I didn't mention ALS to him so I'm wondering if he didn't test my muscles properly or thoroughly enough because he wasn't looking for ALS. He told me he suspected or was looking for carpal tunnel which he said I didn't have after the test. So I'm concerned that if he wasn't testing for ALS, then I'm wondering if he could've missed anything on the EMG because he wasn't looking for it.

- I'm very concerned because for some reason he never tested my hand or wrist area and just tested my arm muscles. I told him that my hand felt weak but he seemed to brush it off and just tested my upper arm muscles as I said that I had twitching in my upper arm but not in my hand at the time. I now have twitching in my wrist/hand/fingers combined with the weakness that started a few weeks ago.

- Should I have another EMG in my left hand?

Thank you guys so much for your time to read and answer posts like these!
 

lgelb

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It does not matter that neither of you mentioned ALS. There are distinct abnormalities that would be seen, even in muscles that you did not have problems with, if it were a possibility. But you are certainly entitled to a report, for which I would ask his office.

Best,
Laurie
 

Joe Samuels

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Thank you so much for your quick reply, you're amazing!
So basically, does this mean that even if my left hand and wrist was not tested, clear EMG results in my left upper arm and left forearm area would be accurate for my hand as well?
 

lgelb

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That is correct. From your description, massage and/or PT might help. Often an unappreciated shoulder or upper back strain can relate to the issues you are having. It is always worth considering how you sit and sleep -- even needing a new mattress or pillow can relate.
 

Joe Samuels

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Hey guys, I have had an EMG yesterday. I didn't get the results in paper, but the neurologist didn't seem concerned about anything and he said he would email the results to my pcp and sent me on my way.
I really wanted to get all four limbs tested, or at least two limbs and paraspinal muscles tested but he only tested my left arm and leg. He stuck the needle in my lower leg twice, then thigh once. Then he stuck the needle twice in my lower arm, then my hand. I have twitching in my bicep area and upper arm but he didn't stick the needle there. I also asked him to test my foot where I have a lot of twitching as well, but he said that there was no need to. I didn't even ask for paraspinals because he already declined my foot request.
Would ALS be detected even if the EMG were done in only about 5 or 6 muscles on the left side of my body in only two limbs? This localized twitching is driving me insane and he didn't even test the muscles where I have a lot of my consistent, constant, localized twitching.
Thanks guys.
 

lgelb

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Moved this -- please post only in this thread.

The answer to your question is yes. Feel free to post the full de-identified report when you get it.
 

Joe Samuels

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Thanks for ur reply!

- I'm also wondering why some people have all 4 limbs tested, and why do some neuros test paraspinals as well, if ALS can be detected in just as simple as two limbs like an arm or leg? 🤔

- I asked my neuro to test my right side as well, but he just said the left was suffice? Is there a logical explanation behind this?

- I've also heard that 8 different muscle groups are needed to rule out ALS, but I didn't want to bother my neuro by asking for too much which now I'm kind of mad at myself for hahah.
He only tested 5 or 6 i believe, I'm wondering why didn't test upper arm or thigh when a lot of twitching happens there as well.

I'll definitely post the EMG when I do get the results!
 

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You are fine, they keep testing when they find abnormalities, and truly they are highly trained and know which muscles to test. Many people with no medical training convince themselves they knew better and insist it wasn't done correctly. I hope you can see how ludicrous it is to go down that rabbit hole.
All the best figuring out what is going on but it's not ALS.
 

Joe Samuels

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Hey, so these are my NCS and EMG results.
I have multiple questions I hope someone here can help answer.
- In my EMG summary chart, my neurologist did not include a column for "fasciculations". (or MUAP/MUP) In order to diagnose ALS don't they have to test for fasciculations?
- This worries me that he did not test correctly because I remember him saying that he was looking for a pinched nerve or carpal tunnel and he never mentioned he was trying to rule out ALS neither did I ever mention to him that I was worried about ALS.
- Also, what does "All examined muscles (as indicated in the following table) showed no evidence of electrical instability. " mean?
- Did he test enough muscles or the correct muscles in order to rule out ALS based on my symptoms?
- My symptoms were weakness, stiffness, and twitching in my left hand, weakness, twitching, stiffness in left forearm, twitching cramping in left bicep, left tricep, and left shoulder/back/chest area.
- He seemed to not take me seriously because of my younger age and because he was quite busy so the EMG was done in about 5 minutes tops.
- I listened to 'lgelb' about what he/she had to say about the fact that it does not matter whether or not I mentioned ALS to the neurologist, but after receiving the results and noticing that the EMG looks incomplete without MUAP/MUPs or a column for FASCICULATIONS, I'm wondering if he did an EMG where he didn't test for ALS, but rather looked for other things.
- I've heard that a forum member 'Wright' was an EMG expert? I'm wondering if he can maybe help answer some of my questions as well?
Thank you guys!


Nerve Conduction Studies
Anti Sensory Summary Table

Stim SiteNRPeak (ms)Norm Peak (ms)O-P Amp (µV)Norm O-P AmpSite1Site2Delta-P (ms)Dist (cm)Vel (m/s)Norm Vel (m/s)
Left Median Anti Sensory (2nd Digit)
Wrist 3.1<3.557.9>10Wrist2nd Digit3.114.045>39
Left Radial Anti Sensory (Base 1st Digit)
Wrist 2.2<2.727.5WristBase 1st Digit2.210.045
Left Ulnar Anti Sensory (5th Digit)
Wrist 3.3<3.735.9>15.0Wrist5th Digit3.314.042>38
Motor Summary Table
Stim SiteNROnset (ms)Norm Onset (ms)O-P Amp (mV)Norm O-P AmpSite1Site2Delta-0 (ms)Dist (cm)Vel (m/s)Norm Vel (m/s)
Left Median Motor (Abd Poll Brev)
Wrist 3.6<4.37.5>5ElbowWrist4.022.556>50
Elbow 7.67.5
Left Ulnar Motor (Abd Dig Minimi)
Wrist 2.7<4.37.1>3B ElbowWrist3.519.054>50
B Elbow 6.26.9A ElbowB Elbow1.510.067>53
A Elbow 7.76.4
EMG
SideMuscleNerveRootIns ActFibsPswAmpDurPolyRecrtInt PatComment
LeftDeltoidAxillaryC5-6NmlNmlNmlNmlNml0NmlNml
LeftBicepsMusculocutC5-6NmlNmlNmlNmlNml0NmlNml
LeftFlexCarpiUlnUlnarC8,T1NmlNmlNmlNmlNml0NmlNml
LeftTricepsRadialC6-7-8NmlNmlNmlNmlNml0NmlNml
LeftPronatorTeresMedianC6-7NmlNmlNmlNmlNml0NmlNml
Results:
All nerve conduction studies (as indicated in the following tables) were within normal limits.
All examined muscles (as indicated in the following table) showed no evidence of electrical instability.
Impression:
The NCS/EMG of the left upper extremity was completely normal.
 

Nikki J

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Amp duration and poly refer to mups. Note they are all normal and 0 which mean fine. There is no special test for fasciculations. They see what they see. If they had seen anything worrisome it would have been noted. Again as you were already told it does not matter why the test was done they see what they see.
that sentence means everything was normal.
those look like standard and appropriate muscles for your reported symptoms. I think they are the same ones I had. Unlike you my emg was not normal. I think you had a very appropriate rule out ALS emg.

if you have questions ask your doctor


Wright has not been here for many years
 

ShiftKicker

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A note that Wright has not been on this forum in 9 years. I would also recommend you speak directly with your neurologist to ask these questions, as they would have reasons for making the decisions they did. The person who examined you would be able to address your questions with more specificity- the folk here could only speculate.
 

Clearwater AL

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Joe, as you posted....

"My symptoms were weakness, stiffness, and twitching in my left hand, weakness, twitching, stiffness in left forearm, twitching cramping in left bicep, left tricep, and left shoulder/back/chest area." "Upper left extremities".

Key sentences...

"All examined muscles (as indicated in the following table) showed no evidence of electrical instability."

"The NCS/EMG of the left upper extremity was completely normal."

'bout says it all.

PS. My speculation. :)
 
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Joe Samuels

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oh my, I'm genuinely sorry, I had no idea that Wright wasn't active on this forum. My apologies 😣

Thank you Clearwater AL, Shiftkicker, and Nikki J for your replies! I have emailed my neurologist yesterday but he still hasn't replied yet as he is busy :)

- Also, a couple more questions, I specifically told my neuro that a lot of the twitching and weakness/stiffness happens in my left hand yet he didn't care to test it? I then assumed that it was the physiology of the muscles and nerves that that they don't test hand for EMG, but then I read in many other EMG's from other people, that hand muscles such as thenar or palm are usually supposed to be tested.

- Also, what if there were fasciculations that were detected on my EMG (which I wouldn't know of bc didn't put because there wasn't a column for it), would that then not clear ALS as a possibility anymor?

- Also, are all EMG's done the same or in the same way as in criteria/machine-wise/method even if they might not be testing for ALS? so for example, even if an EMG was done in the methodology/practice to try and detect carpal tunnel or a pinched nerve (even without the intent to look for ALS), would ALS still show up if it were to be there?
I'm wondering this because my EMG looked slightly different than other EMG's that I've seen that were done to rule out ALS, so I'm just wondering if my EMG was just to test for pinched nerve/carpal tunnel and didn't include the tools/diagnostic methodology that was capable of ruling out ALS.

Thanks guys!
 

Clearwater AL

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Joe, you have spent too much time reading old Threads, you've been a member for over a week
I hope you haven't been trying to find any slight comparison, anything similar, unanswered
questions to compose your Thread.

Wright's last post was May 25 2013, last seen on site July 4 2013. We've got members from
a month ago we have answered all their questions, assured them they do not have ALS... from
their own EMG reports. Told them for their own piece of mind they need to log off the Forum.
Still apparently consumed with Health Anxiety and having ALS going back to old Threads from
Aug 18 2005. 2005!

Please refer your questions to your Neurologist. It's up to you, if you even want to doubt
him/her too... then come back and search more old Threads. Get a second opinion.

When you do see your Neurologist again ask him what he/she meant by this...

"The NCS/EMG of the left upper extremity was completely normal."

Last suggestion... copy and print your post just above and let him/her review that with you.

I hope you get clear of this and move onto a healthy life. :)
 

lgelb

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Congrats! You're good to go as regards ALS. The EMG looks perfectly fine to me, in terms of muscles/regions/measures tested. To your questions, the hallmark of ALS is certain abnormalities in muscles that aren't giving you problems. So not testing every muscle that is, is standard. No one tests all the voluntary muscles because it isn't necessary and the insurance company accordingly would question the amount spent.

No neurologist would contemplate an EMG that "only tested" for X or Y, any more than a doctor would order an X-ray to look for a fracture and be unable to see a tumor.

Fascics alone on the EMG would not be any kind of smoking gun, no. And I have never seen an EMG like that, anyway. If any showed up, there would be something else. Fascics as you know are often benign, so omitting them from the report isn't any kind of major faux pas -- more an artistic choice.

Closing the thread so you can get on with your no-ALS life, while considering PT. All the best.

Best,
Laurie
 
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