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Pronator Syndrome and MGA
Did a case of a 68yom with vague acute forearm pain from shovelling snow perhaps. EMG showed distal median motor latency of 3.6 msec, and amp of 10.3 mv, the proximal stim showed amp of 4.6 mv, velocity 52 m/s, and I repeated it a couple times. Median transcarpal was normal. Ulnar studies were normal. EMG showed spontaneous activty in the Opponens Pol, the PQ, and the FPL. Pronator Teres and all other upper limb muscles were normal. Thus a proximal median neuropathy (pronator syndrome) was suspected.
But I also wondered what would the median waveforms would look like with the MGA? I stimulated the ulnar nerve at the wrist and recorded at the ADM a CMAP of 4.6 mv. I did not do the needle EMG until after the NCVs, thus I was surprised to see any spontaneous activity as shown because his clinical presentation was more consistent with lateral epicondylitis, not pronator syndrome. Maybe any anomolus anatomy is nothing of concern....
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