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EMG techniques & Accurate results?

Danny Gottlieb gottlieb at foodfarm.org
Wed Mar 30 12:16:26 EST 1994

About a year ago, I had an EMG study of major nerves surface of my body.  This 
was follow-up to paresis and acute/temporary episodes of paralysis in lower 
arms/hands(index/middle fingers), 3 episodes of nocturnal/predawn awakening
of temporary right facial paralysis and chronic tingling/stinging paresis in
my legs and painful ankles.  I'm diabetic with bG control average around 210.
The study also was to confirm an auto accident caused CT-Scan diagnosed 
"cervical spine stenosis and degeneration".
To list variances from normal described in the above EMG study report:
  . "H-reflexes were bilaterally unobtainable with multiple attempts, and
      this is considered abnormal."
  . "A right peroneal motor distal latency was significantly prolonged..."
  . "A left sural distal latency was attempted, but was unobtainable."
  . A right median sensory distal latency was borderline prolongrf ..."
  . A left median motor distal latency was borderline normal at 4.0 msec.."
    . Electrophysiologic findings suggestive of peripheral neuropathy, mild
        mild to moderate in severity."
    Probable superimposed mild bilateral carpal tunnel syndrome, more 
        obvious on the right, questionable on the left."
    . "Slowing bilaterally of the ulnar conduction velocities across the
        elbow, of uncertain clinical significance."
    . A significant EMG abnormality was "occasional sharp wave on the right
        of the opponens ..."
Subsequently, a year later, my symptoms have somewhat worsened.  However, 
no other facial paralysis has been encountered.  Yet, I seem to have facial
neuritis along with unbearable posterior and side of neck pain; especially
attempting any position in nightly attempted sleep.  I haven't had a restful 
nights sleep without constant restless squirming to reduce neck pain.  A
year ++ of prescription Darvocet-N seems to increase the unbearable symtoms.
Last Dec., I discontinued Darvocet-N after reading it would probably not be
affective and switched to Aspirin (buffered)/EC-Aspirin combination.
In any case, my paresis/night-time paralysis (hands/lower arms) and leg 
paresis persist chronically.  So, another EMG study was ordered from a
different "medical site" (a university clinic).
Guess what, although my bodily symptoms have seemed to unbearably worsen, 
the university study concludes "all tests appear normal".  A 180 degree
turn-around in EMG test results!!  Yikes!!  I'm questioning in my mind the
QUALITY and accuracy of the 2 studies, now!  Which one is more correct?
Some variances that I remember in technique:
   Older study:
      . Laid on my stomach for most of the testing.
      . EMG equipment appeared very modern and state of the art.
      . Light to Moderate impingement with site access needle.
      . Doctor obtained print-out of results while I looked on.
      . Report showed no specific reference on conclusion about my cervical
          spine stenosis, osteophytes impingement or degeneration.
   Newer study:
      . Older looking EMG equipment.  Clunky looking grey chassis.  Wiring
         for leads looked well used (frayed?).  (University budget vs.
         modern Doctors office equipment?)
      . Laid on my back and left side for all of EMG study, andnot on my
      . Feet were prewarmed with wet/damp Hot towels because neurol. was
         worried my "...feet were to cold to test...".  Now I'm wondering
         if the residual wetness of my lower legs and feet affected the
         rate of conductivity for confirming "H-reflexes"?
      . An electronic temperature gauge was used to confirm surface temp.
         of my feet prior to EMG testing.  The gauge was left plugged "on"
         in the wall sourced convenience outlet, until the teaching
         professor entered the room and pulled the plug "stating it can
         possibly cause interference!" with EMG testing.
       . Statement by testing resident Doctor that, "...that's probably
          just an artifact.." on testing one site.
       . The Univ. EMG testing only tested the "abnormal" results they
          read from a copy of the older study I furnished to them for
    Meantime, I'm continuing to Suffer, awaiting a follow-up appt. on April 8th

    Re: the background above, I'm seeking discussion in this NG and a gathering
       of a Lists of EMG techniques that "should be" used by the EMG Neurologis
       when undertaking an EMG machine use and forming conclusions.  
       How does a neurologist calibrate the EMG machine?  How much pressure or
       duration of time at a "site" is recommened normal?  Wet warming a "site"
       prior to testing that nerve juncture?
       What does a patient do when they feel the testing appears lacking or
        contrary to other studies, and to symptoms ... in discussion with the 
        follow-up Doctor?  Are EMG machines certified as operating acuurately,
        and have no mechanical/electrical defects or mis-calibation?
If you can answer just a few or all of the questions above, this may also
help others involved in applying EMG testing/study skills, and espec. patients
seeking the best Quality testing/study interpretations available.
gottlieb at foodfarm.org

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