Second EMG results - thoughts very much appreciated

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mxuruguay

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Dear all,

Thanks for the wonderful support as always. I posted back in July about my ongoing problems - thread is here but closed:

Long story short, weakness in the right arm and widespread fasciculations. EMG confirmed denervation in the right arm at C7-C8-T1 roots and isolated fasciculations in the legs, and i was given a Cervical Radiculopathy diagnosis, directed to phisioterapy and asked to repeat studies in a few months. I should note all of this happened in South America (Uruguay), but since i have dual residency in Sweden i traveled back to Europe in September. Here i got a referral for a neurologist because i wanted a second opinion and got a second EMG this week. Here are the results (unfortunately in Sweden they dont come in the nice table you are used to in the US but hopefully it still understandable):

EMG
Cranial
nerve innervated musculature Normal finding for M trapezius bilaterally.

Cervical region
M flexor digitorum profundus (ulnar innervated) dx: Slightly increased insertion activity, otherwise no spontaneous activity, occasional enlarged motor unit potentials, but no clear neurogenic picture.
For M biceps brachii, occasional fasciculations are seen, otherwise normal findings.
Normal findings for m interosseus dorsalis I bilaterally, M deltoideus dx, M extensor digitorum dx.

Thoracic region
Normal findings for paraspinal muscles corresponding to level T9 on the left side.

Lumbosacral region
M tibialis anterior : Single fasciculations, on the right side slightly increased insertion activity is seen, single polyphasic motor unit potentials, however no convincing neurogenic picture. On the left side normal motor unit potentials.
M vastus lateralis : Bilaterally, occasionally enlarged motor unit potentials, occasional fasciculations are seen on the left side, otherwise normal findings.

ASSESSMENT
Neurographically, no conduction blockages are seen. Electromyographically, a large amount of fasciculations is easily seen, especially in the lower extremities, otherwise no spontaneous activity, no recent signs of denervation. Single enlarged motor unit potentials are seen im vastus lateralis bilaterally and in flexor digitorum profundus dx, single polyphasic motor unit potentials im tibialis anterior dx, however no convincing neurogenic picture in these muscles. No myopathic picture.

QUESTION
Im a bit confused here about the results. What does "enlarged motor unit potentials" and "single polyphasic motor unit potentials" mean? The doctor seems unimpressed by all the fasciculations but does not they come with increased MUPS. Also, the legs results is a change from my first EMG so im seen a pattern of progression so im a bit worried. Can anybody comment on these results?

Much appreciated as always
 

mxuruguay

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Just a clarification. I havent seen my neurologist again yet -- i only saw the neurophysiologist EMG report on my medical records online, which is what I posted (translated from swedish). Im sure the neurologist will have comments on the EMG but I just wanted to be prepared for that so i basically wanted to know what "enlarged motor unit potentials" and "single polyphasic motor unit potentials" meant.

Many thanks!!!!
 

Nikki J

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Your doctor will explain it in the context of your symptoms and clinical exam findings.

they are commenting on a waveform. Those findings are very non specific and also seem to come and go as your body heals and changes. Large mups are often found in perfectly healthy people who are somewhat muscular
 

mxuruguay

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Thansk Nikki for the reply, much appreciated. I gather you agree then that the results are unimpressive and not indicative of MND?
 

Nikki J

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