ALS Community
EMG testing - how reliable?
About This Community:

This patient support community is for discussions relating to Amyotrophic Lateral Sclerosis (ALS).

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

EMG testing - how reliable?

Haven't gotten any responses yet, so I thought I would re-post...many thanks:

Hi,

Thanks so much for taking the time to address my question/concern.

As previously posted, due to an onset of twitching in early August (after beginning an anti anxiety medication and during a period of very high stress), I had both a neurology consultation and TWO rounds of EMG testing. The EMG testing was done in the middle of and at the end of September. The needle insertions were done on my left arm (four spots), left leg (four spots), upper back (two spots), neck, and jaw. All results were normal - there were no fasciculations, fibrillation potentials, positive waves, etc.

Now, just over a month later, and unable to fully accept the results of the testing, I am having the sensation of my left upper arm feeling slightly sore and/or fatigued. It does not keep me from doing any of my daily activities, which include push up exercises, and other exercises of the like.

On to my questions:

1 - how reliable is EMG testing in detecting muscle denervation (ALS is my fear, in particular)?

2 - if the EMG on the left arm was completely clean, can I rest assured that whatever soreness and/or fatigue I am feeling in that arm now is either perceived, or due to some other cause?

Thank you again for taking the time to answer this.

Oh, lastly, I am female, 34 years old
Tags: ALS, EMG
Related Discussions
3 Comments Post a Comment
Blank
Avatar_f_tn
anyone? is there anyone who can provide any insight?

doctors?! are you there?
Blank
Avatar_m_tn
I am not a doctor, but a long-term patient. I suffered injuries due to an automobile accident 5 years ago. I presented with similar symptoms as you describe, but additionally had extreme pain. I've gone through every scan and test imaginable, have had multiple nerve blocks, radiofrequency ablations, chiropractic,massage therapy, physical therapy, accupuncture, spinal cord stimulation, electro-neuromuscular stimulation, TENS (transcutaneous electrical nerve stimulator), NSAIDS (non-steroidal anti-inflammatory drugs such as ibuprofen and naproxin), steroid injections, neuropathic medications (Neurontin/gabapentin and Lyrica/pregabalin), flexiril (muscle relaxant), Celebrex, Desiprimine (a tricyclic anti-depressent, used to treat neuropathic pain). You name a conservative treatment (excepting opiods, ie: vicodin/hydrocodon, percoset/oxycodon, et. al.), I've done it. Everything has been a "band-aid." Nothing has been curative. Surgery (discectomy and laminectomy--due to spinal stenosis from the anterior discs and posterior osteophytes) will likely only be offered when I am almost totally unable to walk.

I can tell you two things for certain:

1. EMGs ARE NOT reliable. They do not necessarily detect anomalies in electrical nerve activity. I was experiencing fasciculations during my exam, yet the EMG did not detect anything. It ONLY detected hyperactivity in an area where there was no apparent symptoms. Through a collaboration of more than 15 doctors, I've been diagnosed with cervical, thoracic (including a compression fracture), and lumbo-sacral radiculopathy accompanied by peripheral neuropathy. Though different doctors have different opinions on each area, this has been accepted by consensus. Each spinal area shows some disk bulging, with extrusion (the fluid has leaked beyond the walls of the disk) in c5-6 and c6-7 (cervical area). For this, surgery will be imminent, but still a last resort...5 years later!

2. I'd bet the entire cost of my medical care (over $400,000) that you do NOT have ALS. I'd bet almost as much that you DO NOT have multiple sclerosis, which is somewhat more common than ALS.

The most likely cause for your twitching is nerve impingement (pinched nerve) due to disc compression (lol, due to my L5-S1 impingement, I can't even stand having my cell phone on "vibrate" mode in my front pocket, because I often mistake the tingling in my quadraceps for my cell phone ringing--always have to check just in case!). It is inevitable in everybody (to different degrees--people who practice yoga and have near-perfect posture will experience a slower degeneration). In your case, I'd make an educated guess and say that you have slight impingment in c4 root nerve (between c4 and c5 vertebrae) or c5 nerve root (between c5 and c6). The c4-c7 root nerves innervate the brachial plexus nerve group, which controls the shoulder/shoulder blades and arms/hands.

Think of your disc as similar to a water balloon. A water balloon will deflate over a long period of time, as it is not completely air tight. Hence, when the discs dry out and compress, they lose their "cushion," provide less protection against the vertebrae, and can cause nerve impingement. Sometimes, movement or even being in a certain position can affect the nerve, which may or may not also cause pain. During an episode, try to lift your arm and place it on top of your head. This should make the twitching stop and reduce any other symptoms...if not already during the movement (because the repositioning should alleviate pressure on the affected nerve).

Slowly, you will probably notice exacerbation (worsening) of your condition. Barring blunt-force trauma, this process will likely take place over many years. But, beware (but not paranoid)...even a very powerful sneeze (blunt-force) can cause a bulging disk to rupture.

My best advice is to see another doctor to get a second opinion. I understand the time and expense involved. I've spent more time doing online research (only use credible sources--NEVER a company that is promoting services!), and am confident that my level of knowledge is much greater than general practitioners and even more than most of the pain management doctors that I've seen (as I've had to re-direct their courses of treatment because a particular doctor is too stubborn). Neurologists and orthopedic (specifically spine, and preferably cervical spine) doctors are your best bet. When it is time for my surgery, I am having it done at Johns Hopkins Medical Center in Baltimore, MD because you can't get a better combination of specialties--they are nationally ranked #1 in neurology/neurosurgery and #5 in orthopedics. For a multi-level disc (vertebrae) infusion, I cannot consider cost a factor over safety. If I get better, I can restore a high degree of functionality and have the ability to pay my bills.

I hope that this general information is somewhat helpful allays some of your fears. Please consider what I've said. Don't accept it as professional advice; rather, use it to empower yourself by doing research or asking the right questions. Good luck with your condition! Relatively speaking, I am thankful because there is somebody out there worse off than me. I constantly redefine my limitations and push myself to the limits, so I know what I'm able to do and keep my long-term goals in sight. Enjoy life to the fullest and don't ever give up! Carpe diem!
Blank
Avatar_m_tn
I am not a doctor, but a long-term patient. I suffered injuries due to an automobile accident 5 years ago. I presented with similar symptoms as you describe, but additionally had extreme pain. I've gone through every scan and test imaginable, have had multiple nerve blocks, radiofrequency ablations, chiropractic,massage therapy, physical therapy, accupuncture, spinal cord stimulation, electro-neuromuscular stimulation, TENS (transcutaneous electrical nerve stimulator), NSAIDS (non-steroidal anti-inflammatory drugs such as ibuprofen and naproxin), steroid injections, neuropathic medications (Neurontin/gabapentin and Lyrica/pregabalin), flexiril (muscle relaxant), Celebrex, Desiprimine (a tricyclic anti-depressent, used to treat neuropathic pain). You name a conservative treatment (excepting opiods, ie: vicodin/hydrocodon, percoset/oxycodon, et. al.), I've done it. Everything has been a "band-aid." Nothing has been curative. Surgery (discectomy and laminectomy--due to spinal stenosis from the anterior discs and posterior osteophytes) will likely only be offered when I am almost totally unable to walk.

I can tell you two things for certain:

1. EMGs ARE NOT reliable. They do not necessarily detect anomalies in electrical nerve activity. I was experiencing fasciculations during my exam, yet the EMG did not detect anything. It ONLY detected hyperactivity in an area where there was no apparent symptoms. Through a collaboration of more than 15 doctors, I've been diagnosed with cervical, thoracic (including a compression fracture), and lumbo-sacral radiculopathy accompanied by peripheral neuropathy. Though different doctors have different opinions on each area, this has been accepted by consensus. Each spinal area shows some disk bulging, with extrusion (the fluid has leaked beyond the walls of the disk) in c5-6 and c6-7 (cervical area). For this, surgery will be imminent, but still a last resort...5 years later!

2. I'd bet the entire cost of my medical care (over $400,000) that you do NOT have ALS. I'd bet almost as much that you DO NOT have multiple sclerosis, which is somewhat more common than ALS.

The most likely cause for your twitching is nerve impingement (pinched nerve) due to disc compression (lol, due to my L5-S1 impingement, I can't even stand having my cell phone on "vibrate" mode in my front pocket, because I often mistake the tingling in my quadraceps for my cell phone ringing--always have to check just in case!). It is inevitable in everybody (to different degrees--people who practice yoga and have near-perfect posture will experience a slower degeneration). In your case, I'd make an educated guess and say that you have slight impingment in c4 root nerve (between c4 and c5 vertebrae) or c5 nerve root (between c5 and c6). The c4-c7 root nerves innervate the brachial plexus nerve group, which controls the shoulder/shoulder blades and arms/hands.

Think of your disc as similar to a water balloon. A water balloon will deflate over a long period of time, as it is not completely air tight. Hence, when the discs dry out and compress, they lose their "cushion," provide less protection against the vertebrae, and can cause nerve impingement. Sometimes, movement or even being in a certain position can affect the nerve, which may or may not also cause pain. During an episode, try to lift your arm and place it on top of your head. This should make the twitching stop and reduce any other symptoms...if not already during the movement (because the repositioning should alleviate pressure on the affected nerve).

Slowly, you will probably notice exacerbation (worsening) of your condition. Barring blunt-force trauma, this process will likely take place over many years. But, beware (but not paranoid)...even a very powerful sneeze (blunt-force) can cause a bulging disk to rupture.

My best advice is to see another doctor to get a second opinion. I understand the time and expense involved. I've spent more time doing online research (only use credible sources--NEVER a company that is promoting services!), and am confident that my level of knowledge is much greater than general practitioners and even more than most of the pain management doctors that I've seen (as I've had to re-direct their courses of treatment because a particular doctor is too stubborn). Neurologists and orthopedic (specifically spine, and preferably cervical spine) doctors are your best bet. When it is time for my surgery, I am having it done at Johns Hopkins Medical Center in Baltimore, MD because you can't get a better combination of specialties--they are nationally ranked #1 in neurology/neurosurgery and #5 in orthopedics. For a multi-level disc (vertebrae) infusion, I cannot consider cost a factor over safety. If I get better, I can restore a high degree of functionality and have the ability to pay my bills.

I hope that this general information is somewhat helpful allays some of your fears. Please consider what I've said. Don't accept it as professional advice; rather, use it to empower yourself by doing research or asking the right questions. Good luck with your condition! Relatively speaking, I am thankful because there is somebody out there worse off than me. I constantly redefine my limitations and push myself to the limits, so I know what I'm able to do and keep my long-term goals in sight. Enjoy life to the fullest and don't ever give up! Carpe diem!
Blank
Post a Comment
To
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
ALS Community Resources
RSS Expert Activity
469720_tn?1388149949
Blank
Abdominal Aortic Aneurysm-treatable... Blank
Oct 04 by Lee Kirksey, MDBlank
242532_tn?1269553979
Blank
The 3 Essentials to Ending Emotiona...
Sep 18 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank