Quality Control during EMG Studies?

gottlieb at foodfarm.org gottlieb at foodfarm.org
Tue May 3 13:21:45 EST 1994


In July, '93, I had an extensive EMG study from neck through to foot (mostly
right side w/Cervical EMG & Lumbar EMG studies).  Among "slow" or normal
measurements, the following "abnormal" determinations were made:
.
 + H-reflexes were bilaterally unobtainable with multiple attempts..."
 + Right peroneal motor distal latency was significantly prolonged..."
 + Left sural distal latency was attempted, but was unobtainable."
 + Right median sensory distal latency was borderline prolonged..."
 + Left median motor distal latency was borderline normal at 4.0ms."
 + Slowing bilaterally of the ulnar conduction velocities across the elbow."
 + Occasional sharp wave on the right in the opponens..."
 + ...some chronic S1 changes could not be completely ruled out."
.
    The Neurologist completed his study and report before the CT-Scan, taken
later, showed:
 Impression:
  + "..evidence of spondylosis at the imaged levels from C3-4 through C5-6.
  + "At C3-4, osseous ridging results in mild bilateral nerve root canal
       stenosis."
  + "At C4-5, osseous ridging and discal bulging mildly impinges upon the
       anterior thecal sac and results in moderate bilateral nerve root canal
       stenosis."
  + "At C5-6 osseous ridging results in mild to moderate impingement upon the
       anterior thecal sac and results in moderate bilateral nerve root canal
(Oops! scratch out-VOID the last 2 lines!)
  + "At C5-6 osseous ridging results in mild to moderate impingement upon the
       anterior thecal sac, moderately severe right nerve root canal stenosis
       and severe left nerve root canal stenosis."
.
   My complaints of excrutiating PAIN on sides and posterior neck (esp. during
attempted sleeps and upon awakening.  Paralysis or exceptionally evident
neuritis of my right hand (paralyzed index & middle finger mostly at night)
and
of my right facial features (esp. around and lower to ear -
sternocleidomastoid
muscles), stinging pain in trapezius muscles, and about 5" oval erethro-rash
on
both sides of my neck/lower jaw to below ear evolved over 2 years and persists
with PAIN also.  Strength in both arms minimized.  Clumseyness (e.g. dropping
dishes and object to be held initially upon grasping?) seems to persist right
hand.  Facial malaise 24 hours and extreme upon sleep awakenings.
Medicines I'm taking for past 3 years:
    Prinivil - for hypertension and cardiac aortic insufficiency.
    Synthroid - 0.05mg 1 per day for thyroid insufficiency.
                                     (Oops! the Prinivil is 10mg per day)
    Dibenzyline - 10mg per every 3rd day for "neurogenic bladder control
                  deficiency" (w/o, inability to activate sphincter valve).
Age 56, lifetime of agricultural work (35 vegetables) and food processing
research and processing with oftentimes strenuous 8-12hr physical involvement.
Have 2 grown children (Son-26, Daughter-29, both always healthy).
.
Orthopedic Surgeon that ordered above EMG study and then CT-Scan declined to
perform osteophytosos and/or cervical corrective surgery stating, "...multiple
level involvement impossible to operate on..." and sent me for 8 shot cervical
neck "selective blocks" and then confirming Discogram"; and says, "...probably
surgery would just make it worse!"
.
Subsequently, my PAIN complaints (to my endocrinologist{I'm insulin diabetic})
are increasing.  Subsequently in March '94, I underwent an EMG study at a
University Clinic and the intern concluded verbally that all areas studied
were "Normal!"
Yikes! ...and Yikes!, again!!
What could cause the 180 degree turn-around or opposite conclusion?  Am I
miraculously cured...I think, NOT!  I've pondered why the Univ. EMG study
probably came up short on correlating impression:
 + Univ. used damp/wet towels to warm up my feet before EMG testing.  Then,
    I wondering of wetness remaining on feet skin enhanced electrical conduct-
    ion?
 + Univ. had much older "grey" looking EMG equipment.
 + Univ. EMG had 2 leads (like grounding wires) wrapped around r-hand fingers.
 + Univ. mentor for EMG intern technologist came in room and pulled plug on
    infra-red temperature monitor that intern had used to measure temp of my
    feet, stating "...could interfer with EMG readings!"
 + Intern blurted out during one position testing to mentoring Doctor,
    "...oh! that's probably just an artifact!"
 + Univ. tested only those deficit areas indicated (listed above) in the 1993
    report, and not near as complete a study as the 1993 Neurologist had
    completed.
.
Questions:
  Can warming the feet with hot damp/wet clothes eliminate abnormal H-reflex
readouts?
  Is there newer equipment today that performs EMG testing more accurately?
  The 1993 study used a concentric needle electrode; whereas, the Univ.study
felt more Painful.  Is there a difference in readout due to variance in type
of electrodes used?
  Do EMG machines need a transformer, or an extra convenience power line
trans-
former to stabilize electrical machine for accurate readouts?
  Do EMG machines need to be "calibrated" to zero, or for sensitivity?  If so,
how often is this done and how often normally required?
  When a patient gets two extremely varying EMG reports from 2 different
Sites,
how does a patient deal with this?  What would you do to make confirm correct
"error free! (is there such a thing?) diagnosis is finally made?
.
Any specific answers helping toward solutions of my health crisis would be
appreciated.  I share the above descriptions for the betterment of All!

A brief List of Quality Control variables needed to be understood &
monitored during an EMG study would be appreciated in (r)eply.
----
gottlieb at foodfarm.org



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