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  1. #21
    Join Date
    Aug 2007
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    374

    Default Re: How Accurate Is an EMG

    POR, I wish I knew what their next move would be. But I have a feeling that this is some form of way to cover their butts.

    I wonder why they continue to tell me that there is no bowel or urinary problems with back injuries. It is like telling people here that if they post on this forum, their computer will dissappear.

    The doctor said he would only order the EMG for my legs since a back injury has nothing to do with urinary problems. If I want that treated, then "go see your primary care physician." He asked me who that was, and I said, "You."

    Pushing him with the info is not getting me anywhere. He is acting like I am not telling him things. Doesn't record it on his notes either. Now he isn't acknowledging that I have been talking about bowel problems. When I mentioned it the last visit, he only addressed urinary problems. What is his game?
    Lue

  2. #22
    Join Date
    Feb 2007
    Posts
    775

    Default Re: How Accurate Is an EMG

    Senility ?

  3. #23
    Join Date
    Nov 2006
    Location
    Ohio
    Posts
    324

    Default Re: EMG

    How am I ever going to talk my husband into getting his emg/ncv done?! I guess I should read up on it and be honest with him?? Ugh! Something is going on he has numbness/tingling down leg he explains it to be like a cell phone on "vibrate" () on his leg causing his big toe to be numb....any ideas what causing this? claim is still at IC level so medical is on hold still.

    Thanks,



    Quote Quoting POR View Post
    Lue:

    Your post implies that you are aware that bowel and bowel problems, and erectile dysfunction in males, is often caused by low back problems, called cauda equina syndrome.

    You may not be aware of the fact that a spine surgeon almost never requests or cares to know what an EMG/NCV test result is. An EMG is pretty much irrelevent to the decision to operate or not as that information is better assessed with a simple physical examination and a review of the imaging studies.

    So - why not ask the DR what is the reason for doing the test and what treatment recommendations will change based on the test result ? In other words, why do the test if it doesn't change treatment ?

    This question is even more relevant if it is your Dr who will be performing the EMG. Drs get big bucks for doing a test that is only occasionally clinically indicated but are performed on as many as they can schedule.
    Beth, Legal Assistant
    Wife and Mother of injured workers

  4. #24
    Join Date
    Aug 2007
    Posts
    374

    Default Re: How Accurate Is an EMG

    POR, That's funny!....He looks 40ish, but he could just be eat up with the dumb a$$.

    On Cauda Equina, is it possible for this not to show up on an EMG? Could this be in part of the false negative test?

    Can Cauda Equina be found only testing the legs or do you have to go higher up on the back? I guess if it can't be detected by any nerve passing that low, then they "ain't a looking for it!" I am sorry for so many questions, but you are the only one answering what I need to know.

    They called earlier wanting me to go to PT before the EMG. Seems we could see if there was a problem before we made it worse. So that is scheduled.

    Maybe I can make a cold compress of wet leaves and chew on a sasfrass root, and then it would all be better!

    Lue

  5. #25
    Join Date
    Dec 2006
    Posts
    2,165

    Default Re: How Accurate Is an EMG

    Lue, here is something to review re cauda equina and EMG testing:

    http://www.emedicine.com/neuro/topic...section~workup

    "Other Tests:


    Needle electromyography (EMG) may show evidence of acute denervation, especially in cauda equina lesions and multilevel lumbar spinal stenosis. EMG studies also could help in predicting prognosis and monitoring recovery. Performing needle EMG of the bilateral external anal sphincter muscles is recommended.
    Nerve conduction studies, especially of the pudendal nerve, may rule out more distal peripheral nerve lesions."

    Google "Cauda Equina and EMG testing" if you want even more scientific literature.

    But POR is right on... a COMPETENT Neurosureon would not CLINICALLY need to base a diagnosis of Cauda Equina Soley on the results of an EMG. The Neuro would make the diagnosis based on his/her Physical Exam and your complaints. The Neuro, however, MIGHT want to double-check and order an EMG as a confirmatory test.

    In the "world of WC", however,(which IS different from the "real world" as most of us know it to be when we go to a "regular doctor" under group/private health insurance) MOST DOCS dealing with WC injuries ARE REQUIRED TO CONFIRM THEIR CLINICAL DIAGNOSIS WITH OBJECTIVE TESTING, Particularly IF your State's WC Laws require using diagniostic criteria per AMA 4th or 5th Guidelines, or similar guidelines based on OBJECTIVE FINDINGS/DIAGNOSTIC CONFIRMATION.
    Last edited by Charles Stevens; 11-06-2007 at 01:23 AM.

  6. #26
    Join Date
    Oct 2007
    Posts
    112

    Default Re: How Accurate Is an EMG

    How much an EMG hurts depends on how dead your nerves are. There is the needle EMG and a probe EMG and both shoot electricity into the nerves. I've had several of them. The last one was for several hours over both arms, hand, legs, feet and finally I told the neurologist to stop. My nerves were not reacting and he thought if he kept stabbing and electrocuting me that somehow he would get a reaction.

    If you do not have nerve damage, it must hurt like Hell. Like my adjuster said, "An EMG cuts out the fakers" because if you are not really injured, you will avoid the test.

    Pam

  7. #27
    Join Date
    Feb 2007
    Posts
    775

    Default Re: How Accurate Is an EMG

    Lue:
    Cauda Equina symptoms will not be measured/assessd via EMG/NCV to the extremities. You can use the same basic methods to evaluate innervation loss to the bladder detrusser and anal sphincter muscles but do you really want to do that ???

    Actually you go to a urologist to have bladder studies done which can tell if there is a nerve problem to the bladder vs a mechanical problem. Ther nerve comes form the low back via the sacral nerve plexus.

    You shouild certainly try PT before anything else becasue the fact of the matter is that most things get better in time despite what your physician does to you !

    Case in point, my own employee has back pain and radiculopathy with loss of strength of the ankle flexors and big toe is numb, minimally improved after two epidurals. MRI showed two level DJD with disc bulge but no large herniation or nerve compression. No need for EMG/NCE, we know what the problem is and no need to talk to a surgeon anytime in the 12 months or so as it will almost certainly get bettter in 12 -18 months on it's own. She comes to work , stands at her computer most of the day and limps around the rest. Life could be better for her but no change is needed because she can work. The research demosntrates this quite well and ALSO that if a similar patient cannot work they are better served with early surgery.

    You have never said, or I missed it, if there was a significant abnormality on MRI and if you can or cannot work.

    PAM - the pain is the same for folks with and without most types of nerve damage and normal controls vs injured patients in that some simply tolerate it better than others.

    Beth - referred pain and tingling may or may not show an abnormality on EMG/NCV. It just depends what is causing it but absent motor loss is likely to be read as non-specific. My questio is why do the test / what will the answer change ?

  8. #28
    Join Date
    Aug 2007
    Posts
    374

    Default Re: How Accurate Is an EMG

    Charley and Pamela, thank you so much for putting the information down.
    Looks like as long as they don't even write it in the file, then no clinical tests have to be done. Therefore, it isn't recognized.

    Pam, I don't want to do the test, but I guess that would be anybody's reacation to having needles stuck in your body. I'll give a full review of the tests.

    I am on DSL, but it is with a private telephone company. It is going down constantly and here lately, I have had more trouble staying on line. Yesterday, I kept getting kicked off of this forum. But when I try to Google much, it says server problem or something like that. I have seen it a million times, but I just click off of it.

    I better get ready for my PT this morning. I am looking so forward to that. This will be so much fun. Sheeeesh!
    Lue

  9. #29
    Join Date
    Aug 2007
    Posts
    374

    Default Re: How Accurate Is an EMG

    Por,
    I would love to call and tell them that I can work. But once I do that, it will be their way, or no way, and if I do not do the work they offer, then I go off on my own.
    I could do office work, but the only part I must deal with is the restroom up the stair's. Most of the time I could get up them, but at times, my back pulls down my rear end, down into my leg and I cannot move. I cannot put a lot of weight on my left ankle yet. It makes for a bad situation. It is when I get off balance. But won't have to worry about the office work, because they will not let me do it.

    The only work they will offer me will be loading and unloading trailers, working on a very fast conveyor that moves fast and pulling heavy boxes from heavy machinery parts, copper bushings, and large garment boxes that I must reach bending all the way over to pulll off and sling up on a set of rollers. You must plant your feet on the floor, grab the packages from the side so you can sling it to the other sides on rollers a lot higher than the conveyor. We are in an older smaller outdated type building. Not like the newer updated large ones.
    No matter what I do, it will involve a lot of weight, balance and strength to maintain the equipment. And lots of steps and bending hundreds of times an hour. Heavy boxes above my head that I cannot see on top of and cannot reach unless I partially crawl up on a shelf below it.

    So.......... I don't know what to do.
    The PT asked me what my goal was, and I cannot answer it. I know that I want to get better, but this company is not that simple.

    Another conceren is my bowel and bladder problem. It came with the fall. So if I just say, "OK WC, you don't have to address it," but what happens in a few months or a year if the nerve dies that actually controls my bowel. What happens when I get a colostomy? What do you do in this situation?
    What happens if I lose the control of my bladder and it gets worse? Is this something I need to know now, or just let it go?

    There doesn't seem to be a good answer to any of this.

    The best answer that I can honestly come up with, is to just shut the door, and sleep as much as I can so I won't have to think about it.
    I am now being told by the PT that I have a chip on my shoulder and do not want to get better. Once someone thinks that, it makes me want to back away and not go back.

    He has no idea how fast and how heavy things are at work. I go to the bathroom, and my bladder will not empty. I will stay there hoping it will happen, and sometimes partially it will. Then it stops and will not start back. Then later on, I can wet my pants.
    Wonder how that is going to work when I am always slinging heavy boxes everywhere?
    Also, it is kind of a rough place to work and most think that a woman should not be there.

    The MRI showed a bulging disc and spinal stenosis at the same level that I had a fractured vertebrae, L2 &3 L4 & 5 from 1989, which is from flipping a vehicle at work. We had lap belts back then and it slings you around like a rag doll. They were ordered by a judge to treat my back from then on, but the IC says that it has been too long ago and it no longer applies. Odd that a judge has less power than an IC.

    I am so tired of trying to figure out what to do.
    Lue
    Last edited by Lue; 11-06-2007 at 09:28 PM. Reason: misspelled

  10. #30
    Join Date
    Oct 2007
    Posts
    112

    Default Re: How Accurate Is an EMG

    POR:

    In every EMG I have had which is 5 needles EMGs, the reaction to electrical stimulation is a flat line. Therefore having no nerve reaction, I would think that although it hurts, I think my EMGs are probably less painful to me than to those who do not have a flat line. Just a guess on my part.

    Pam

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