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Now I want to know this

Posted by cindyp on 5/26/00 at 18:18 (020928)

So what is an emg test and what is it supposed to show you when you take it?

Re: Now I want to know this

Dr. Zuckerman on 5/26/00 at 19:05 (020929)

It is test that is used to determine nerve conduction . You are looking for nerve neuropathy, low back nerve problems, tarsal tunnel
So you are testing the connection of the nerves from the back to the feet. This can be a very painful test. I recommend some type of oral sedation before this test.

Re: Now I want to know this

wendyn on 5/27/00 at 00:50 (020937)

This is also known as a nerve conduction velocity test. It is used to measure the strength and speed that electrical impulses travel through both your sensory and motor nerves. It can be used to confirm a compression (as in carpal tunnel syndrome) and the location of the compression. For example, you may have tingling in your hands and this test can help determine if the nerve compression is in your wrists or in your elbow.

My understanding is that there are different machines that doctors can use, and also maybe even different components to this test.

I have never heard of oral sedation for an emg test like Dr Zukerman suggests.

Laurie from this board had a horrendous experience where as a component of this test they inserted needles into her (I am not sure what this was for and I don't know that most people have this done). She said it was very painful. Perhaps this is what Dr Z is talking about (?).

Typically though, most folks (including myself) only have electrodes placed on one end of the nerve (say the inner calf muscle) - with a receptor at the other end of the nerve (like the bottom of the foot.) Then - electrical impulses are generated with something that looks like a tiny booster cable, and the speed and intesity are measured. The little booster cable is only on the outside of your skin and there's no puncturing anything.

As for pain....this is a tough call. I had this done in August and again just on Thursday of this week. This time I had both my feet done and one hand. I cannot say that I had 'pain'. I would describe it at worst as uncomfortable. I think that my hand hurt worse than my foot overall. The zap behind my knee and the one right where I'm sore on the tarsal tunnel area were the worst in my foot. However - I did not have tears or major stress...it was enough pain to give me sweaty palms. Having my legs waxed was worse, but they're two very different sensations. Electrical impulses are not something most of us are accustomed to dealing with. How often do you stick your toe in an electrical socket?

I think that the amount of pain experienced depends on...(in no particular order and only in my opinion)

-Type of machine used
-Skill of the doctor doing the testing (an in experienced doctor may have to do more 'zaps' to pinpoint the right spots)
-Relaxation level of the patient (you need to relax)
-Existing irritation of the nerve (I think it goes with out saying that a highly irritated nerve will not appreciate electrical stimulus.)
-Pain threshold of the patient
-What you're comparing the pain to. I think labor and the nerve pain I had last spring/summer were far worse than the nerve conduction tests. BUT everyone is different.

I discussed this pain perception with the neurologist and the assistant while I was having the test. They said that everyone is different (and in this case the doctor and machine would be staying the same from patient to patient). They said that relaxation level and pain threshold seem to be different for everyone. Sorry guys, they also said that men tend to perceive more pain from the tests than women.



Re: Now I want to know this

Dr. Zuckerman on 5/27/00 at 08:24 (020942)

The oral sedation is usually valium or oral visteril. The part of the testing is the insertion of the needles that is the real killer. The skill of the neurologist is very important. I still remember the first time I ordered my first EMG .I was in my residency program. The head of the department of orthopedics, was a back surgeon and before any surgery he would order EMG's So he told me to tell the patient the it would feel like a little burning. I still remember the pain in the woman's face as I watch this test being done. The insertion of needles is alot of pain. This doesn't have to be done today. There are alot of different types of machine. So always ask questions, especially in the hospital.

Re: Now I want to know this

wendyn on 5/27/00 at 09:34 (020943)

So Dr Z are you saying that the needles are something that were once used a lot and are no longer used now? I can see how oral sedation may good for something like that, but from my experience I can't see how it would be needed for the standard EMG electrodes.

If the needles aren't usually used now - why do you still recommend oral sedation?


Re: Now I want to know this

Dr. Zuckerman on 5/27/00 at 09:43 (020944)

What I am saying is made sure that your testing doesn't involve the needles and if it does find out why you need the needles. I still know of places where they use needles right into the muscle.

Re: Now I want to know this

wendyn on 5/27/00 at 12:46 (020949)

All right. Now, I don't mean to pick at you - and you're the doctor...but why then - did you respond to the intial question of what the test was by saying that it was very painful and required oral sedation? Why put unecessary fear into someone without explaining what you mean and that the standard EMG test is not what you are referring to?

I'm not trying to be difficult - but anyone reading your first post will assume you are answering the question Chris posted and not referring to some other procudure that is rarely used.


Re: Now I want to know this

Dr. Zuckerman on 5/27/00 at 13:03 (020950)

Most neurologists in my area only use the needle insertion testing for lower extremity EMG's I only know one that will do a surface EMG. So I guess what I am saying is that more then likely when an EMG is ordered you are going to get the insertion of needles. The patient will have to make sure which test you are getting. When I oreder EMG it is first a consultation with a neurologist and he will determine if the testing is to be done. So I will have no imput as to whether needles or no needles because the neurologist makes the call. . Most patients will want to skip this part or will have to stop or not complete the testing. I just make it a habit to explain the testing since I am making the referral and I don't want the patients pissed off if they have alot of pain and I could of giving them or talked to them about oral sedation before the testing.

Re: Now I want to know thisRe EMG

Laurie R on 5/27/00 at 14:08 (020954)

Hi,
All I can tell you is what I went through,It hurt so bad (The neendle part was the worst for me).I think I handle pain very well for all I have been through.I wish the Neurologist that did my test would of sedated me ,I am the type of person that believes in do anything to take the pain away give me any shot you want,plus the Neurologist was a jurk big time.See I think my test would of went better if the doctor had a little bit more compassion.The Zaps were ok ,I don't call that pain but again the needles going into the muscles of your foot hurts like hell.

When I went to see my Pod I told him what happened and how painful it was for me and he had compassion for me he felt bad that it hurt me so much and I also told him about the neurologist that he was such a jurk,he said he was sorry,I told my Pod I would never go back to see that doctor.I wanted my Pod to do the test but he said he does not do the testing that Neurologist had to do it.

Any testing you need to have done I would ask all kinds of questions before and ask if it hurts and have them give you something for the pain ahead of time ,I learned the hard way next time I will have them sedate me first. I hope your test goes better than mine did. Laurie R


Re: Now I want to know this

Dr. Zuckerman on 5/26/00 at 19:05 (020929)

It is test that is used to determine nerve conduction . You are looking for nerve neuropathy, low back nerve problems, tarsal tunnel
So you are testing the connection of the nerves from the back to the feet. This can be a very painful test. I recommend some type of oral sedation before this test.

Re: Now I want to know this

wendyn on 5/27/00 at 00:50 (020937)

This is also known as a nerve conduction velocity test. It is used to measure the strength and speed that electrical impulses travel through both your sensory and motor nerves. It can be used to confirm a compression (as in carpal tunnel syndrome) and the location of the compression. For example, you may have tingling in your hands and this test can help determine if the nerve compression is in your wrists or in your elbow.

My understanding is that there are different machines that doctors can use, and also maybe even different components to this test.

I have never heard of oral sedation for an emg test like Dr Zukerman suggests.

Laurie from this board had a horrendous experience where as a component of this test they inserted needles into her (I am not sure what this was for and I don't know that most people have this done). She said it was very painful. Perhaps this is what Dr Z is talking about (?).

Typically though, most folks (including myself) only have electrodes placed on one end of the nerve (say the inner calf muscle) - with a receptor at the other end of the nerve (like the bottom of the foot.) Then - electrical impulses are generated with something that looks like a tiny booster cable, and the speed and intesity are measured. The little booster cable is only on the outside of your skin and there's no puncturing anything.

As for pain....this is a tough call. I had this done in August and again just on Thursday of this week. This time I had both my feet done and one hand. I cannot say that I had 'pain'. I would describe it at worst as uncomfortable. I think that my hand hurt worse than my foot overall. The zap behind my knee and the one right where I'm sore on the tarsal tunnel area were the worst in my foot. However - I did not have tears or major stress...it was enough pain to give me sweaty palms. Having my legs waxed was worse, but they're two very different sensations. Electrical impulses are not something most of us are accustomed to dealing with. How often do you stick your toe in an electrical socket?

I think that the amount of pain experienced depends on...(in no particular order and only in my opinion)

-Type of machine used
-Skill of the doctor doing the testing (an in experienced doctor may have to do more 'zaps' to pinpoint the right spots)
-Relaxation level of the patient (you need to relax)
-Existing irritation of the nerve (I think it goes with out saying that a highly irritated nerve will not appreciate electrical stimulus.)
-Pain threshold of the patient
-What you're comparing the pain to. I think labor and the nerve pain I had last spring/summer were far worse than the nerve conduction tests. BUT everyone is different.

I discussed this pain perception with the neurologist and the assistant while I was having the test. They said that everyone is different (and in this case the doctor and machine would be staying the same from patient to patient). They said that relaxation level and pain threshold seem to be different for everyone. Sorry guys, they also said that men tend to perceive more pain from the tests than women.



Re: Now I want to know this

Dr. Zuckerman on 5/27/00 at 08:24 (020942)

The oral sedation is usually valium or oral visteril. The part of the testing is the insertion of the needles that is the real killer. The skill of the neurologist is very important. I still remember the first time I ordered my first EMG .I was in my residency program. The head of the department of orthopedics, was a back surgeon and before any surgery he would order EMG's So he told me to tell the patient the it would feel like a little burning. I still remember the pain in the woman's face as I watch this test being done. The insertion of needles is alot of pain. This doesn't have to be done today. There are alot of different types of machine. So always ask questions, especially in the hospital.

Re: Now I want to know this

wendyn on 5/27/00 at 09:34 (020943)

So Dr Z are you saying that the needles are something that were once used a lot and are no longer used now? I can see how oral sedation may good for something like that, but from my experience I can't see how it would be needed for the standard EMG electrodes.

If the needles aren't usually used now - why do you still recommend oral sedation?


Re: Now I want to know this

Dr. Zuckerman on 5/27/00 at 09:43 (020944)

What I am saying is made sure that your testing doesn't involve the needles and if it does find out why you need the needles. I still know of places where they use needles right into the muscle.

Re: Now I want to know this

wendyn on 5/27/00 at 12:46 (020949)

All right. Now, I don't mean to pick at you - and you're the doctor...but why then - did you respond to the intial question of what the test was by saying that it was very painful and required oral sedation? Why put unecessary fear into someone without explaining what you mean and that the standard EMG test is not what you are referring to?

I'm not trying to be difficult - but anyone reading your first post will assume you are answering the question Chris posted and not referring to some other procudure that is rarely used.


Re: Now I want to know this

Dr. Zuckerman on 5/27/00 at 13:03 (020950)

Most neurologists in my area only use the needle insertion testing for lower extremity EMG's I only know one that will do a surface EMG. So I guess what I am saying is that more then likely when an EMG is ordered you are going to get the insertion of needles. The patient will have to make sure which test you are getting. When I oreder EMG it is first a consultation with a neurologist and he will determine if the testing is to be done. So I will have no imput as to whether needles or no needles because the neurologist makes the call. . Most patients will want to skip this part or will have to stop or not complete the testing. I just make it a habit to explain the testing since I am making the referral and I don't want the patients pissed off if they have alot of pain and I could of giving them or talked to them about oral sedation before the testing.

Re: Now I want to know thisRe EMG

Laurie R on 5/27/00 at 14:08 (020954)

Hi,
All I can tell you is what I went through,It hurt so bad (The neendle part was the worst for me).I think I handle pain very well for all I have been through.I wish the Neurologist that did my test would of sedated me ,I am the type of person that believes in do anything to take the pain away give me any shot you want,plus the Neurologist was a jurk big time.See I think my test would of went better if the doctor had a little bit more compassion.The Zaps were ok ,I don't call that pain but again the needles going into the muscles of your foot hurts like hell.

When I went to see my Pod I told him what happened and how painful it was for me and he had compassion for me he felt bad that it hurt me so much and I also told him about the neurologist that he was such a jurk,he said he was sorry,I told my Pod I would never go back to see that doctor.I wanted my Pod to do the test but he said he does not do the testing that Neurologist had to do it.

Any testing you need to have done I would ask all kinds of questions before and ask if it hurts and have them give you something for the pain ahead of time ,I learned the hard way next time I will have them sedate me first. I hope your test goes better than mine did. Laurie R