PN not found on EMG or other tests?

    
      Re: PN not found on EMG or other tests?
    


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Posted by CCF Neurology MD(B) on March 20, 1998 at 14:31:12:

In Reply to: PN not found on EMG or other tests? posted by Alan  on March 13, 1998 at 08:28:30:

:    I am a 35 year old male who has had on/off burning pain down the sides of both legs (from hip to ankel and into my behind), numbness and skin sensitivity for 4 yrs.  My question:  Would tests such as EMG's, MRI's, and Evoked Potentials be definitive tests to show Peripheral Nerve prbs---Nerve damage or entrapment?
     I have had 3 EMG's, and MRI and the Evoke, yet all have come back normal.  My Dr. suggests going to Vascular Surgeon.  Could burning, etc. come from veins?  My burn is worse while sitting, and gets better while standing.  A heating pad on my butt helps lessen pain.  Any type of stretching also seems to egg on burning.
     Also, if you would indulge me one more question.  Would nerve entrapment, possibly caused by TRIGGER POINTS, show up on the above tests?  Could trigger points tighten muscles so much that when they are tried to be stretched (or sat on) they push against veins/nerves and cause pain?
  Thank you and God Bless!
=Dear Alan, Based on the history you have provided, it would appear that you have involvement of only the small diameter nerves (i.e. nerves responsible for the sensation of pain and temp).  Test such as EMG and EP are specific in testing only large diameter nerves.  MRI of the spine may show compression of the cord or nerves exiting from the spinal cord through foramen.  However, I would expect other changes on your neurological examination to occur including weakness, senory changes, reflex changes and/or bowel/bladder changes.  Besides the aforementioned tests, I would recommend that you undergo a labratory work-up for a peripheral neuropathy which would include metabollic, inflamatory, endocrine, anemia and neoplastic.  This would be important since many of these causes of neuropathy are treatable.  While vascular may be a consideration, I would expect the symptons to worsen with standing and walking.  In addition to the changes of sensation with increase activity, I would also expect weakness to occur in the lower extremities which will improve with rest.  I doubt you have Fibromylagia (fibromyalgia) which is assumed to be a connective tissue disease with multiple tender points(>11)(i.e. tender points-areas on the skin, when pressed can cause muscle pain), on upper and lower extremities with muscle pain (not a burning as much).   Hope this helps.  "This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options of your specif medical condition."