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negative on emg

Posted by alan k on 1/03/00 at 00:00 (014353)

I tested normal for nerve conduction on both feet for tarsal and tibial nerves (I looked over the shoulder of the tester as they wrote up the report for the doctor).

I have read that it is not a definitive test (I think wendyn posted that), while I have tinnels sign and now tingling and warmth in my feet.

I was wondering if anyone has any advice about what I should do next.

I was thinking of taking advantage of the situation to push for an MRI. But I am also worried that the hmo gatekeepers will use the normal emg as an excuse to stall on further treatment for tts (not that I have any idea of what treatment there is).

thanks,
alan k


Re: negative on emg

wendyn on 1/04/00 at 00:00 (014360)

Hi Alan, sorry to hear that the test wasn't helpful. From everything I've been able to find so far, it seems that the test is useful at confirming TTS but not in ruling it out. One reference said that 50% of people with TTS will have normal NCV tests. Another said its very rare to find someone with TTS that will have a positive test. A couple references have indicated that the tests will only be positive after a certain point. Essentially they said that you can have tingling and pain, but until there is actual damage to the nerve from the compression - the test will remain negative. From all the conflicting information out there, I guess you can conclude that no one really knows for sure......?

Although my tests showed 'latencies' in two nerves in each foot - they are re-testing mine again (after a 6 month wait) to see if there is any change. I suppose that any change (for better or worse) would help confirm that the problem is with those specific nerves. (As you may recall, the confusion surrounding my test ocurred because they doctor forgot that I have two feet that hurt, and not just one. He was such a dufas...I can't imagine spending another hour or two with him. I think this time they will also be doing the tests on my wrists, so I'll get to spend extra quality time with him....would you believe that he had the nerve to suggest that I might consider 'reducing my activity'? At that point I wasn't walking more than what is required to get through life, slowly..I told him that if I reduced my activity any more I wouldn't be getting out of bed..but I really digress....)

I understand that an MRI can identify problems within the Tarsal Tunnel that could cause compression (tumors etc) but it can't actually confirm a diagnosis. I would hope that they'd be willing to look at one for you....

I know you've seen a podiatrist, have you talked to an orthapedic surgeon, specifically one that specializes in feet and ankles? This may be your next best bet.

You can probably continue to self-treat as though it's TTS - its not going to make you worse. If nothing else, you may be treating them more carefully than you would if it was something else.

Let me know what happens.......(isn't this FRUSTRATING!????!!!!)



Re: negative on emg

alan k on 1/04/00 at 00:00 (014362)

thanks wendy.

I hate to repeatedly beleager you, but you mentioned to treat for tts, but I am not aware of anything to do to treat it except rest and icing. Is there anything else I can do? Brevity is fine, and are you sure you should be posting what with your cts?


alan k


Re: negative on emg

wendyn on 1/04/00 at 00:00 (014370)

Thanks for looking out for my wrists, I guess I'm just falling apart all over. Turning 30 was very bad for me! Can't wait to see what 40 brings....maybe I'll get up and my head will just fall off...

I have to type a lot at work, so the ocassional post here and there isn't going to make a difference. I type about 60 wpm so it's not like it takes long. Today is actually the first time my hands have hurt in a while, and remember - I'm still in denial about the CTS anyway...

If you have TTS your options would be along the lines as follows

Rest (lots and lots and lots and lots of rest)
Elevation (this really does help)
Ice (this helps with pain and swelling)
Compression (with support hose, would not recommend unless you do under doctor supervision - I have not tried, but have seen suggested)
Anti-inflammitories (worth a shot, worked for me for a while)
Cortisone (I decided against, but many recommend giving it a try)
Acupuncture
Orthotics (If you have structural problems, may be very important)
The Birks (only thing that has really helped me a lot)
Physio (this was suggested by my doctor, don't know if really helped me or not - they treated more for Posterior Tibial Tendonitis, which is a tendon that runs through the Tunnel. If it becomes irritated it can compress the nerve)


That's all that comes to mind, but I suppose it gives you a start. Probably there are more things that you don't want to try, than ones you would one to try. Surgery is the final option.

I am trying to get up the guts to try the acupuncture now...talked to a doctor yesterday. She is a medical doctor as well as a registered acupuncturist. Was in the market for a handsome young man as per John H advise on how much it helps when the care provider is nice to look at (all my other doctors are nice looking men, but they're not terribly helpful) but I will take this one because I think she's the most qualified and she comes highly recommended.



Re: negative on emg

wendyn on 1/04/00 at 00:00 (014360)

Hi Alan, sorry to hear that the test wasn't helpful. From everything I've been able to find so far, it seems that the test is useful at confirming TTS but not in ruling it out. One reference said that 50% of people with TTS will have normal NCV tests. Another said its very rare to find someone with TTS that will have a positive test. A couple references have indicated that the tests will only be positive after a certain point. Essentially they said that you can have tingling and pain, but until there is actual damage to the nerve from the compression - the test will remain negative. From all the conflicting information out there, I guess you can conclude that no one really knows for sure......?

Although my tests showed 'latencies' in two nerves in each foot - they are re-testing mine again (after a 6 month wait) to see if there is any change. I suppose that any change (for better or worse) would help confirm that the problem is with those specific nerves. (As you may recall, the confusion surrounding my test ocurred because they doctor forgot that I have two feet that hurt, and not just one. He was such a dufas...I can't imagine spending another hour or two with him. I think this time they will also be doing the tests on my wrists, so I'll get to spend extra quality time with him....would you believe that he had the nerve to suggest that I might consider 'reducing my activity'? At that point I wasn't walking more than what is required to get through life, slowly..I told him that if I reduced my activity any more I wouldn't be getting out of bed..but I really digress....)

I understand that an MRI can identify problems within the Tarsal Tunnel that could cause compression (tumors etc) but it can't actually confirm a diagnosis. I would hope that they'd be willing to look at one for you....

I know you've seen a podiatrist, have you talked to an orthapedic surgeon, specifically one that specializes in feet and ankles? This may be your next best bet.

You can probably continue to self-treat as though it's TTS - its not going to make you worse. If nothing else, you may be treating them more carefully than you would if it was something else.

Let me know what happens.......(isn't this FRUSTRATING!????!!!!)



Re: negative on emg

alan k on 1/04/00 at 00:00 (014362)

thanks wendy.

I hate to repeatedly beleager you, but you mentioned to treat for tts, but I am not aware of anything to do to treat it except rest and icing. Is there anything else I can do? Brevity is fine, and are you sure you should be posting what with your cts?


alan k


Re: negative on emg

wendyn on 1/04/00 at 00:00 (014370)

Thanks for looking out for my wrists, I guess I'm just falling apart all over. Turning 30 was very bad for me! Can't wait to see what 40 brings....maybe I'll get up and my head will just fall off...

I have to type a lot at work, so the ocassional post here and there isn't going to make a difference. I type about 60 wpm so it's not like it takes long. Today is actually the first time my hands have hurt in a while, and remember - I'm still in denial about the CTS anyway...

If you have TTS your options would be along the lines as follows

Rest (lots and lots and lots and lots of rest)
Elevation (this really does help)
Ice (this helps with pain and swelling)
Compression (with support hose, would not recommend unless you do under doctor supervision - I have not tried, but have seen suggested)
Anti-inflammitories (worth a shot, worked for me for a while)
Cortisone (I decided against, but many recommend giving it a try)
Acupuncture
Orthotics (If you have structural problems, may be very important)
The Birks (only thing that has really helped me a lot)
Physio (this was suggested by my doctor, don't know if really helped me or not - they treated more for Posterior Tibial Tendonitis, which is a tendon that runs through the Tunnel. If it becomes irritated it can compress the nerve)


That's all that comes to mind, but I suppose it gives you a start. Probably there are more things that you don't want to try, than ones you would one to try. Surgery is the final option.

I am trying to get up the guts to try the acupuncture now...talked to a doctor yesterday. She is a medical doctor as well as a registered acupuncturist. Was in the market for a handsome young man as per John H advise on how much it helps when the care provider is nice to look at (all my other doctors are nice looking men, but they're not terribly helpful) but I will take this one because I think she's the most qualified and she comes highly recommended.