AANEM Connect

1) I prefer to be interactive, and therefore, please pose me with questions you would want to ask the patient?

2) What tests if any, you would like to do first apart from the exam?

3) You would like to know my exam findings, but prior to that, what in his history, you would enquire of this patient?

Does anyone know of tendon transfers or other treatments to help with thumb opposition after complete denervation of the abductor pollicus brevis (not motor units seen in APB on EMG) after T1 radiculopathy due to sarcoma resection in T1 vertebra? 

Based on my review of multiple text books, Fibs/PSWs are thought to occur in inflammatory myopathies due to fiber splitting, resulting in essentially denervation of that segment that no longer has access to the neuromuscular junction.

I have often quoted this as the reason for finding abnormal spontaneous activity in muscles that have been injured by direct muscle trauma (either a single severe event or mild repetitive). 
 
A former trainee of mine asked me for a reference for this and i can't find anything about direct muscle trauma. I think i'm right but would prefer if i could quote it.
 

A patient I performed an UE EMG was diagnosed with an UE DVT two days after the exam. I could not identify DVT listed as a risk factor or identify with a (brief) internet search of a DVT as a complication of an EMG. Has anyone had DVT associated to an EMG?

70 year old healthy looking male with a 5 day history of insidious onset of (just below mid inguinal ligament) with mild diffuse discomfort over the left anterior thigh, intermittent, most aware when sitting and not during gym hour. No motor weakness or sensory loss. DTR: 1+ knees. SLR -ve. Exercises regularly 4/wk cardio + weights. Vitals: 160 lbs, 5'8". No medical issues. No prior surgeries of the spine, or iguinal region, or hernia. No unusual activities. Sleep is unaffected.

What are the possible clinical diagnosis? Please do not order tests.

Currently using Biomedix 6' x 30" vertical & tilt powered bed on rolling/lockable wheels) but am relocating to a smaller lab. Online search hasn't turned up any smaller (eg 5' long w/ leg extension) platforms having power & mobility features above. Any suggestions are welcome. Thanks!

In performing an EMG on a 63 year old man, I obtained an absent left peroneal motor response from the extensor digitorum brevis, with a normal response on the right. The tibial motor studies were normal and symmetric and the surals were absent bilaterally (which I interpreted as being age-related). The man had no sensory loss or weakness in his left leg. Does an absent left peroneal motor response, without clinical findings, have any significance?

I was wondering if you could help me understand and localize a lesion so as to explain the findings below in a 42 year old woman who is 1 year s/p a MVC with an associated pelvic ring FX and right foot drop. On physical examination she has a clear inability to dorsiflex the right foot against gravity and similarly can’t evert this foot either. When she tried these maneuvers, I can, however, feel some muscle contraction. She is also numb on the dorsum of her foot, but there is a clear well healed scar 7 cm in length just medial to the lateral malleolus extending from just inferior to the lateral malleolus vertically.  Her sensation along the lateral margin of her foot is relatively intact but decreased compared to the other side. The patient has no difficulty extending her knee and I cannot overcome her ankle plantar flexion.  Hip flexion is normal as is hip extension and leg external/internal rotation.

On needle EMG of the right lower limb, there are PSW/Fibs easily observed in the following muscles with motor units, but displaying a somewhat neurogenic recruitment pattern: gastrocnemius, tibialis anterior, peroneus longus, flexor digitorum longus, short and long head of the biceps femoris, semimembranosus. There were fewer motor units recruited in the fibular compared to tibial innervated muscles. The following muscles revealed no abnormalities at rest with normal recruitment: gluteus maximus, tensor fascia lata, vastus medialis, and adductor longus. At this point, the patient declined any further needle examination.

Of note, the patient had considerable instrumentation of her L/S spine following the trauma and would not permit any needle assessment of her back.

The sural SNAP on the affected limb had a latency of 3.9 ms with an amplitude of 7 uV and the superficial fibular sensory response was absent. The tibialis anterior CMAP revealed a below fibular head magnitude of 2 mV with an above fibular head amplitude of 1.6 mV. The patient now requested termination of any further needle insertions or nerve stimulation.

Some of my colleagues use the terms “demyelinating” or “demyelination” to explain localized conduction slowing associated with conditions such as carpal tunnel syndrome. For example, their interpretation may state that there is a median mononeuropathy at the wrist characterized by demyelination but no axonal loss. Is it appropriate to include this description?