Relevance of EMGs in Diagnosing Carpal Tunnel Syndrome
Several Bloggers have discussed having the problem of feeling pain and discomfort that is radiating into their hands - one, Mike, a patient of the Mayo clinic - had neck surgery then experienced pain in the distributions of median nerve.
EMG test presumably failed to confirm carpal tunnel syndrome (reported as "negative"). But surgery was recommended. I presume to decompress the median nerve at the wrist AKA carpal tunnel release.
First, EMG is the standard test and usually confirms or documents carpal tunnel syndrome - but there are exceptions. It may have been performed before changes takes place in the nerve and muscles. It usually takes 3 to 4 weeks or changes to occur. Every Hand Surgeon has cases in which EMG does not confirm what appears to be a strong clinical case of carpal tunnel syndrome.
If I feel strongly that a patient has carpal tunnel then I discuss the situation with the patient and frequently I have done carpal tunnel release- and there is unfortunately a small number of patients that do not see any improvement.
EMG is not a 100% test- a patient has to discuss the options with his or her doctor. The carpal tunnel release surgery is not a major procedure as an abdominal or thoracic procedure. It's straightforward- and can even be done under local - so it may be worth a try in order to relieve "carpal tunnel symptoms". I stress that I think about the indications long and hard and always have a frank discussion with the patient.
I would be interested in the experience of anyone who has had a negative EMG in the presence of strong clinical suspicion of carpal tunnel syndrome- what happened and how it was resolved- and if surgery was done.
Another problem is scaphoid fractures that don't heal- It is thought the natural progression is painful arthritis- initially localized then more extensive- I would like to know the experience of those known to have scaphoid fractures that have healed and whether they have had problems after they refused or rejected surgical definitive treatment.
Related Topics:
Technorati Tags: EMG,, wrist,, pain,, carpaltunnel
EMG test presumably failed to confirm carpal tunnel syndrome (reported as "negative"). But surgery was recommended. I presume to decompress the median nerve at the wrist AKA carpal tunnel release.
First, EMG is the standard test and usually confirms or documents carpal tunnel syndrome - but there are exceptions. It may have been performed before changes takes place in the nerve and muscles. It usually takes 3 to 4 weeks or changes to occur. Every Hand Surgeon has cases in which EMG does not confirm what appears to be a strong clinical case of carpal tunnel syndrome.
If I feel strongly that a patient has carpal tunnel then I discuss the situation with the patient and frequently I have done carpal tunnel release- and there is unfortunately a small number of patients that do not see any improvement.
EMG is not a 100% test- a patient has to discuss the options with his or her doctor. The carpal tunnel release surgery is not a major procedure as an abdominal or thoracic procedure. It's straightforward- and can even be done under local - so it may be worth a try in order to relieve "carpal tunnel symptoms". I stress that I think about the indications long and hard and always have a frank discussion with the patient.
I would be interested in the experience of anyone who has had a negative EMG in the presence of strong clinical suspicion of carpal tunnel syndrome- what happened and how it was resolved- and if surgery was done.
Another problem is scaphoid fractures that don't heal- It is thought the natural progression is painful arthritis- initially localized then more extensive- I would like to know the experience of those known to have scaphoid fractures that have healed and whether they have had problems after they refused or rejected surgical definitive treatment.
Related Topics:
Technorati Tags: EMG,, wrist,, pain,, carpaltunnel
12 Comments:
can someone tell me why my hand is worse after having carpal tunnel release done in january
I have been treating carpal tunnel symptoms for over 15 years in the Financial District of San Francisco. Over the years I have had many patients with all the classic signs and symptoms of CTS...but the EMG was negative. Most of these patients responded to our treatment of neck, shoulder, arm/hand adjustments, cervical/hand traction, massage, ice and exercise...along with ergonomic, home care, and nutritional advice. There is just no explanation why some patients EMG turn up negative...other than maybe the primary problem is in the neck. We don't order a cervical MRI unless a patient does not respond to our treatment. In my opinion, CTS symptoms need to be addressed from the neck to the hand...on both sides. Even if there are no symptoms above the wrist...the source of the problem may still be there.
"Why" is always different in medicine- need as much information as possible even with documented carpal tunnel syndrome. There are differences in how the median nerve is affected-and there may be permanent damage from which the median nerve might not recover- also in the immediate post operation period swelling and inflammation from the operative procedure itself may affect the median nerve causing symptoms which get better.
I had endoscopic carpal tunnel release a week and a half ago. What a difference. No pain, no numbness. Its great! Only problem is I noticed a few days ago my pinky and ring finger going numb off and on to varying degrees of numbness. Last night I wore my brace as I always do and both pinky and ring finger were flat out numb. What is the problem here? Do I have some sort of ulnar nerve damage?
I have tested negative for carpal tunnel syndrome with an EMG test. However, I continue to experience pain, tingling, numbness, and weakness in my hands, wrists, forearms, and elbows. The symptoms appear to be worse after typing for long periods of time. Several hours after working, the muscles in my forearms painfully contract. I have had pain in my neck and right shoulder for a number of years. I have been a programmer for 10 years, often working very long hours. I have seen several doctors and been tested for various diseases including diabetes, rheumatoid arthritis, and lupus. I saw a hand surgeon today, only to be told that they can find nothing neurologically or or skeletally wrong. I do not have the results of my cervical spine MRI yet, but if another Dr. Tells me that there is nothing wrong with me, I don't know what I will do.
To anonymous who had endocopic carpal tunnel release: Yes, ulnar nerve affects pinky and ring finger. Check with doctor. May need EMG.
To Dr. Steve Shoshany: I'm not familiar nor do I have experience with the modalities you describe. I do have some question when you state CTS symptoms are usually the result of nerve root irritation in the neck. NO, carpal tunnel syndrome by definition is compression of median nerve at the wrist within the carpal tunnel- a closed space in the wrist. And symptoms of CTS are usually due to CTS. However, nerve root compression in the spinal cord can affect the nerve roots which contribute to the median nerve and hence affect or produce symptoms in the same areas as CTS. Examination and testing usually EMG and MRI can help sort things out.
Well here it is July 10,2008 and I still can't use my hand after I had carpal tunnel release in Jan...
Next Friday I am having a second nerve block into my neck because the first one DID NOT WORK!!!!
My fingers tingle worse now, the numbness is so unbearable, the PAIN IS SO UNREAL!!!!!!
To top it all off....my entire hand twitches!!! NOW EVERYTHING I "COULD" DO BEFORE I CAN'T NOW!!
Roxanne in Maine
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To Dr. Alex haselkorn M.D,
Yes you are right the classic "carpal tunnel syndrome" by definition is entrappment of the median nerve in the carpal tunnel. But I have seen so many patient like the one that posted most recently that had a surgery and still has symptoms.
My dad actually had a bilateral carpal tunnel surgery that did not help him. It was a Chiropractor that helped him, that is why I became a Chiropractor.
I always look to the cervical spine and elbow joint and of course the wrist.
To overlook the neck is foolish.
A basic understanding of the anatomy should help anyone understand that a compression on a cervical nerve root can mimic carpal tunnel syndrome symptoms.
I always recommend a NCV and EMG to better understand exactly where the compression is and how exaclty to best treat the patient.
www.drshoshany.comIf you are interested in learning more about my treatment for carpal tunnel syndrome watch the video
http://youtube.com/watch?v=pLXEckeuIec it was on New York ABC news.
I believe a patient should exhaust all non surgical options prior to a surgical method
I had carpal tunnel release Nov.07. My hand seems worse now, I recently went to a different hand surgeon since leaving the state that I had my surgery in. I was given another emg and the doc said it only showed mild cts in both hands. He stated he did not do surgery on mild cts. So I asked if I should just live with constant pain and numbness after doing ANY activity with my hands, I am only 32 yrs old. He then stated he would perscribe Celebrex which has not helped. Should my hand that had the carpal tunnel release still show mild cts? I am looking into seeing another doctor now.
I had CTS surgery on both hands in February. It has worked great on all symptoms. However, I have 2 small lumps that appeared shortly after the procedure in the palm of my right hand. I was told it is Dupuytren's disease. Now, 6 months later I am also having a lot of inflamation and soreness at the base of my thumb and it is locking. I'm told it is Trigger thumb. I find it hard to believe that I am having these issues in my right hand so sonn after surgery. Could something have gone wrong in the surgery or recovery to be causing these two issues?
I WOULD LIKE TO KNOW WHY DOCTORS DON'T TELL YOU THAT THERE IS A CHANCE YOU GET REFLEX SYMPATHETIC DYSTROPHY WHEN YOU HAVE CARPAL TUNNEL RELEASE DONE?
MY LIFE IS OVER NOW...I AM GOING TO LOOSE 20 YEARS OR MORE OF WORK NOW BECAUSE THE SURGEON FAILED TO WARN ME! I WAS IN A LOT LESS PAIN BEFORE THE RELEASE WAS DONE! SO ALL OF YOU OUT THERE MAKE SURE YOU ASK WHAT THE RISK IS BEFORE YOU HAVE IT DONE! I AM ONLY 49 YEARS OLD AND NOW I CAN'T USE MY HAND!
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