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Martin Diamond, M.D.
Good afternoon
first time posting although have followed for many years with interest and valuable education. Would like to present a case which has left me quite puzzled.
This is a 63 year old lady seen for EMG 3/22 for arm and hand pain and numbness. Findings st that time showed left CTS, but also had multiple muscles with 1-2+ fibs and PWs in C-6,7 bilaterlly (PT, FCR, ECRL, APB and C-PS) without clinical symptoms. Had left CTS surgery with good outcome. Returned 3/29/2023 with right digit 2,3 pain and numbness. No cervicall pajn but intermittent right shoulder and upper arm pain. Nerve conductions, including right axillary, MC and radial to triceps all normal, both motor and sensory. However, Emg today showed diffuse 1-2+ rest activity in all muscles, including bilat C-PS bilaterally. No neck pain, normal MMT, nl stretch reflexes, nl sensation (light touch and pin), no myotonia or fascics. No family history of NMDZ, negative drug including excessive caffeine history.
Appreciate thoughts on etiology, differential diagnosis and further testing. Thanks in advance for all your input.
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