Femoral Nerve Palsy

Is it possible to have a normal EMG and still have symptoms of femoral nerve palsy?  I am a P.T. with a patient who is 4 months post-op for an ACL repair using PTG graft. She is in her mid-20"s and use to run. She had difficulty with quad exercises in the beginning but at 2 months was progressing fairly well and could do 4# on a straight leg raise and was doing other closed-chain exercises such as step ups and leg press. Then she suddenly started having problems with her leg buckling while walking and now she struggles to do a SLR and cannot fully straighten her knee actively. Her leg routinely buckles now 1-2 times a day especially after walking awhile. Stretching her quad prone causes thigh pain (Femoral traction test) and she "drags her leg" during swing through gait. She had an MRI of her knee and an EMG in mid-December and they were normal. Her Orthopedist prescribed continued PT and a muscle stimulator to strengthen the quad. I plan to talk to him about this but was seeking further information. Can she have this palsy and still have a normal EMG? What should the treatment be if she does have this problem? What type of specialist would you recommend for her to see to get a 2nd opinion? A Neurologist or a Physiatrist? Thank you for your help. Jan

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

In general, in a femoral neuropathy leading to obvious weakness, abnormalities on the EMG would be expected. EMG is operator dependent, meaning that only when an expert in this technique calls it normal should it truly be taken as normal if there is a clinical suspicion for a significant abnormality. Most neuromuscular specialists are well trained in EMG. Femoral neuropathy is uncommon after knee surgery as you may know. In any case, treatment typically involves physical therapy and walking aids if necessary.

A neurologist with specialty in peripheral nerves and muscles, ie neuromuscular specialist, would be best to evaluate for a neuropathy. On the other hand, a physiatrist obviously would be most appropriate in assisting with improving the gait and guiding the physical therapy.

Thank you for using the forum I hope you find this information useful good luck.