EMG Results

Hello,

I want to post my recent EMG study and seek the opinion of the forum. I appreciate your feedback, opinion, and recommendations. My left arm, right leg, and right ulnar were tested. My concern is why would the neurologist not test my entire right arm? Also the explanation was not clear to what the results mean for my health. Does the below sound like something of concern?

Evaluation of the left ulnar motor and the right ulnar motor nerves showed decreased conduction velocity (A Elbow B Elbow, L41, R35 m/s). The left ulnar sensory and the right ulnar sensory nerves showed prolonged distal peak latency (L3.8, R3.8 ms), reduced amplitude (Wrist L4.3, R12.7 uV), reduced amplitude (B Elbow,L5.5, R4.1 uV), reduced amplitude (A Elbow, L4.2, R0.5 uV), and decreased conduction velocity (A Elbow B Elbow, L44, R41 m/s). All remaining nerves were within normal limits. Left vs Right side comparison data for the ulnar sensory nerve indicates abnormal L R amplitude difference (66.1%). All remaining left vs right side differences were within normal limits.

Needles evaluation of the left dorsal interosseous muscle showed slightly increased polyphasic potentials and moderate decreased interference pattern. All remaining muscles showed no evidence of electrical instability. A slight fascination finding in the right calf was found.

Why should the neurologist test your entire right arm? All previous findings there have been normal, haven't they?

A few other comments:

• You left off the conclusions from the person who interpreted the results.
  
• ALS doesn't cause problems with nerve conduction velocity. NCVs for PALS are normal.
  
• Results seem consistent with previous findings of ulnar neuropathy in your left elbow that you've mentioned here before.

Whatever it is that you have appears to have no relevance whatever to ALS. Were you really expecting something different after all this time?

Hi Trfogey,

My concern is the doctor only tested my right arm at the ulnar nerve. This is the only time my right arm has ever been tested. The neurologist suggested bi lateral ulnar issues and detected weakness in my left hand. I can't feel or see this weakness in my left hand. If anything my right feels weak and "stiff"...which is why I thought he would test the right median nerve.

I have no idea what is going on and the doctors do not either. I try to research hoe to interpret EMG results but it is confusing. The neurologist also indicated that the left ulnar is showing signs of progression as far as the numbers on the exam.

Anyway, thanks for the reply. I appreciate your wisdom and insight.

Where are the rest of the results?...the summary at the end?

They commonly only do one side. If they find an abnormality then they may do one or two muscles on the other side. Completely normal procedure, trust your doctor and quit worrying about his ability to perform his job. Sounds like your EMG was thorough.

I'm going to hazard a guess that the explanation part is missing from the OP because it says "This is consistent with ulnar nerve entrapment. The fasciculations noted in the calf are likely a benign fasciculaituon syndrome"

But hey--that's just my guess.

Here's my unsolicited advice. See a specialist for the neuropathy (trapped nerve) and see if it's repairable. There have been people here with what they thought were ALS symptoms--only to have them be trapped nerves.

Should your symptoms persist after treating the neuropathy persist in seeking answers. The truth is that as long as they find something like a trapped nerve, they won't look for anything else until it's repaired.

Damaged nerve, by the way, heals at about the rate of 1/2 inch per month, so don't expect a quick fix.

Good luck

Hello Notme,

You are correct in what the neurologist suggested on the findings. I did not leave that out for any reason other than I assumed people would know that was the outcome of his findings.

I like your suggestion...and will make sure to follow up. My concern is how can a neurologist distinguish between "ulnar entrapment" and ALS? It just seems odd to me that I have issues with both arms at the ulnar nerve? Can ALS present as ulnar entrapment?

Thank you.

How can a neurologist distinguish between an ulnar nerve entrapment and ALS? Are you serious? I had to read that a couple of times because I truly thought I didn't read it correctly. Is there something you left out of that statement? I guess if your neuro was a complete moron, he/she wouldn't be able to distinguish between the two. There are a few conditions that can mimick ALS. An ulnar nerve entrapment (along with the clinical and electrophysiological signs of it) is not one of them. Congratulations on having an inconvient condition that is 100% treatable.

I'm sorry Wright...my last post really did not come out right. I meant to say, is it a safe assumption that I have two issues? First issue being the bi lateral ulnar entrapment AND the second being BFS?

Both issues presented at the same time in Dec 2010...that is what prompted my initial question if somehow the loss of amplitude found in my EMG referencing the ulnar nerves could be a sign of something more serious. The widespread twitching I understand as BFS...it's the EMG findings that worried me.

I have to be honest and transparent with my doctors but once I mention anything related to a vaccine I feel they do not want to comment. That is why I seek out advice on the forum and greatly appreciate the insight.

Thanks.

stvhck said:

My concern is how can a neurologist distinguish between "ulnar entrapment" and ALS? It just seems odd to me that I have issues with both arms at the ulnar nerve? Can ALS present as ulnar entrapment?

Click to expand...

One thing that distinguishes an entrapment from ALS is the NCV study. With a mechanical entrapment, the NCV study will show changes in the NCV -- decreased conduction velocity, reduced amplitude of the electrical pulse -- below the level of the entrapment. The electrical signal travels along the nerve normally until it reaches the entrapment and is abnormal after passing through the entrapment.

NCVs in ALS patients are normal. ALS attacks the motor neurons of the brain and spinal cord, not the peripheral fibers extended by those motor neurons.

As to why you have issues in both elbows, take a look at the spaces you spend most of your time. For example, do you often sit in a chair where your elbows support the weight of your upper body while wedged against the armrests of your chair? Do you sit with your head propped in your hand and the elbow resting on a hard surface?

And, to answer your final question, no, ALS will not present as ulnar entrapment. An ALS patient may have an ulnar entrapment, just like a person with a broken leg could have a pulled hamstring, but the conditions are easily distinguishable.

Trfogey. THANK YOU. Seriously, thank you for taking the time to explain this to me.

My ignorance on the subject caused me to fear the worst. I didn't know the EMG/NVC could show where the issue is located in the nerve (brain/spine versus peripheral fibers).

Thanks,
Steve

Steve,
Please do yourself a favor and look up ulnar nerve intrapment symptoms, it should put your mind at rest. I wasn't going to answer this but
It can be bilateral, like someone else said it is commonly from leaning on your elbows which we all do. It can cause weakness and and wasting in forearms and hands as well. Please put your mind at ease and see someone about repairing it before it gets worse.
Celebrate!