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  • EMG before ESI?

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    Old 06-19-2011, 12:41 PM   #1
    seeyahome
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    Cool EMG before ESI?

    Pain management MD ordered 2 rounds of epidural steroidal injections, neurologist ordered EMG. No one said whether I should schedule EMG before the ESIs... will the steroid injections affect the results of the EMG? Should I schedule the EMG first?

     
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    Old 06-20-2011, 08:05 AM   #2
    feelbad
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    Re: EMG before ESI?

    just for YOU to have the very BEST chance at actually showing possible velocity flow impact that can come from certain types of inflammation with the spinal areas too, if this were me, i would obtain that EMG first. while it 'may not' impact the test, it also could and you really want 'you' as normal as possible within that c spine level when you obtain this type of test. an ESI, if it does its job right, will bring down potential sources of overall inflammation and esp possible swelling that also can impact nerve flow too, so there 'could be' a slim chance that there could be some level of impact vs non impact if ya didn't? so just to be on the safer side, i would have the EMG/NCV before ANY ESIs are done. but thats just me.

    what ARE your actual symptoms that the EMG is being ordered for? unfortunetly, and this IS specifically the nature of THIS particular test, unless you are "actively" having a level of either constant or intermittant numbess or loss of fine motor function in the arm/hand/fingers anywhere at THAT time of the testing, that EMG wont show you anything more really than you know now. this test will ONLY pick up on anything that just IS actively impinging or compressing nerve to the point the velocity levels or natural 'flow' becomes impacted during testing. it simply IS geared to show ONLY impairment within nerve impulses to brain and back and to muscle to brain and back, or 'held' overall velocity just present within any given nerve. it is more or less that overall 'time' it takes for those signals(when evoked by the tester) to get thru and do their specific jobs that gets tested for. and just how well that overall flow velocity is all on its own too.

    if you are merely suffering pain from ongoing inflammation at the nerves or nerve root level, nothing will actually show up as 'abnormal'. i was told this right before my very initial EMG(i have now had three since 01) where my main symptoms were a very intermittant level of tingling, off and on(more rare) numbness ONLY at one actual finger tip and also severe neck and shoulder blade pain as well. and i came out with a 'totally normal' EMG. but i HAD been told by that tech that unless the tinlges or numbing IS active during the time of that testing being done, it WOULD more than likely be a totally 'normal result, and it was but ONLY becasue my tingling/numbness decided NOT to show itself at all during my test, just a ton of pain in my neck. and i WAS pretty peeved at that since my ongoing pain and radicu crap was just THAT bad. just a no show when it NEEDED to show, ya know what i mean?

    but, a few years later, when i had actual damage post op spinal cord surgery with alot of fine motor losses and some fingers/areas in my L arm totally numb, THAT one was just insane with losses of total velocitys and much lower responses in other nerve/muscle and areas tested along my hand and arm as well. so it all really depends upon YOUR radiculopathic symptoms and any real levels of impingement actually even 'being there' during the testing itself that would even determine YOUR particular results.

    BUT simply having a 'normal' EMG/NCV does NOT mean you are not suffering with pain from other sources or even on and off tingling or numbness symptoms from alot of possible c spine issues. it just simply means that nothing has impinged or compressed the nerves yet(a VERY GOOD thing for YOU actually), or at least not while you were being tested.

    so depending upon your specific symptoms and when or if they 'decide' to display themselves at test time, very much will impact your EMG results. good luck with this. i still would hold off on those ESIs tho, ya never know if even the more softer tissues within the spinal could be swollen and inflammed enough to actually impact nerve. and the ESIs job IS to try and reduce inflammation and any potential swelling up there too. marcia
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    Old 07-18-2011, 03:25 PM   #3
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    Re: EMG before ESI?

    Thanks, senior veteran, for your response. Unfortunately, I've had L4 L5 disc extrusion, which was surgically removed in April 2009, then 9 months later, the pain came back in left leg/buttock/groin, along with numbness in calf/shin and foot. I had a 2nd surgery done in April 2011, and the pain/numbness is still there...only now I have intermittent rediculopathy in R thigh, not constant, but enough to get my attention. The latest MRI showed exiting nerve root contact at the L5 level, bilateral.

    Then, to make things even more interesting, I had a cervical MRI, which showed pathology at c5, c6, c7, with moderate to severe foraminal narrowing, as well as ventral cord being abutted by bulging disc and osteophytic protrusions, along with uncovertebral joint hypertrophy. (c5,c6). So far there is no frank cord compression seen. The exiting c6, c7 nerve roots are possibly being impinged by severe foraminal narrowing. Lots of areas between c3 and c7 where the thecal sac abuts the central cord, but without significant canal stenosis.

    Sooo... how that effects me: pain in neck (back and sides), between shoulder blades, bilateral shoulder pain, bilateral upper arm pain, electric shock pain from upper arms bilat to fingertips (thumb, index and middle)--kind of feels like someone is hitting my funny bone in the elbow with a hammer! That is intermittent, as long as I don't move my head/neck the wrong way. The arm thing started with a lessening of grip strength, which got worse over months, and it was limited to Left arm; also a feeling of heaviness in L arm. Numbness in fingertips (thumb, index, middle). Feels like my hand is fat and I have a glove on that is too small. Now, over the past 2 weeks, I've noticed the same subtle loss of grip strength in my right hand, but no numbness yet. The foraminal stenosis at c5, c6 is severe, same thing with the c6, c7. Likely will have cervical surgery to open up those foramen this fall. (That will make 2 lumbar surgeries and 1 cervical surgery in 2 years 0 ugh!)

    So I'm on private disability benefits now, and between a rock and a hard place... social security disability is difficult to get approved for degenerative joint disease, I have been told; I'm hoping that the surgeries, which haven't been really successful, will help me get approved once my private disability runs out. The rock and a hard place comes in with unemployment insurance . . . I would definitely meet criteria as far as wages, since I've only been out of work for 2 quarters; however I wouldn't meet the criteria for being
    able to work. (I can't keyboard for more than half an hour or so, unsafe to drive because of the weakened grip, and because of my lumbar issues, can't stand/walk for more than about 20-30 minutes without having pain exacerbated. Also, hard to turn my head to see if there is anyone about to t-bone me!!)

    If you have any suggestions re: disability pointers when it comes to having to apply for social security disability, I'd appreciate it. There is no way, with the constant pain, that I can go back to work, but can't get unemployment because of that very fact ~ I'm not "able". I spoke with someone at the state about this, and he said back injuries are the most common diagnosis they see, and he also said that it's just WRONG that pain to the point of distraction and requiring opiates isn't enough to qualify a person for disability. I mean, when your pain, at some point in the body, is at least a 4 and sometimes up to 7/10, you'd think that would be considered a disability!!

    Thanks for corresponding, and I truly would appreciate any suggestions you might have.

     
    Old 07-18-2011, 06:47 PM   #4
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    Re: EMG before ESI?

    WHY WAIT to get those foraminotomies done? Whatever problems are caused by radiculopathy will only get worse, and could become permanent.

    I had a C5 foraminotomy done a few years ago. I was ready to break out of the hospital a few hours later, but they let me go. Pretty much no recovery period or pain. Perhaps worse with multiple levels, but it's still a minor operation.

     
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    Old 07-19-2011, 02:09 AM   #5
    seeyahome
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    Re: EMG before ESI?

    August 31 is the first appt I could get, and they want to find out if the ESIs will help. Also, the EMG is to r/o a hemiplegia migraine, partially. (Had 48 hours of slurred speech which resolved spontaneously; CVA ruled out). Had 3episodes of bowel incontinence about 6 weeks ago, and that can be r/t cervical problems. The neurosurgeon wants to have all the tests back, and probably will need another cervical MRI done, to see what's changed . . . something has, because up until 2 weeks ago, my left arm/shoulder/hand was the only side affected. Where I live, we can wait up to 2 or 3 months to get in to see a specialist, and with my insurance, they require all these preliminary, conservative treatments be done before they'll pay for surgery. I do know that the ESIs will not do anything for the numbness, possibly the pain. Last April I had another lumbar surgery, and 2 months before that a hysterectomy, so I also think the MD wants my body to have a bit of time to recover from those surgeries. I know the nerve impingements can't be let go for too long, or there can be permanent damage. Also, the left leg pain/numbness could be caused from either the lumbar issue OR the cervical issue. So there are lots of things to r/o. Thanks for support!!

     
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