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What are the MRI test indications if EMG/NCV do not support symptoms?

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Orthopaedic Surgeon
Practicing since : 1998
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Lumbar Spine MRI results: lumbar spondylosis with moderate spinal stenosis at L-3-L-4 & severe spinal stenosis @ L4-L5. Cervical Spine MRI results: asymmetric narrowing of the \left neural foramina is identified at the C2-3, C3-C4 and mainly at C4-C5 level. Findings secondary to degenerative changes in the facet joints. Small soft tissue structure seen in the anterior cervical canal at C6-C7 level representing a bulging disc or small herniated disc. EMG/NCV results: showed electrophysiological evidene of mild bilateral median neuropathy at the wrist (carpal tunnel syndrome). There was also evidence of chronic left lumbar (L4) radiculopathy. There was no evidence of cervical radiculopathy or active denervation the needle EMG examination. In patients with small sensory polyneuropathy NCV is typically normal. Clinical correlation should be applied. The EMG/NCV test was done after the MRIs of the neck & lumbar. EMG/NCV does not support my symptoms. What are the MRIs these test indicating if they do not match the EMG/NCV? My symptoms: Symptoms reported to my primary care physician prior to MRI & EMG/NCV test: 1. Lower back pain (painful pressure on the lower back) (MRI results – provided) 2. Muscle spasms to upper back from back pain stiffness 3. Muscle cramps on lower legs and/or thighs (EMG/NCV test pending: 14 XXXXXXX 2013) 4. Trouble sleeping due to back pain & pain on toes 5. Hands and ankles swelling – with painful joints (+ CCP antibody test results provided)** 6. Aching back from sitting, driving & lifting 7. Performing simple task and normal work functions are difficult and sometime unbearable 8. Grocery shopping difficult – can add to cart but cannot bend to remove groceries from cart checkout – is painful 9. Can only walk short distance from car to store – before pain at hip socket & buttocks starts 10. ADL’s affected - can’t sweep, mop or dust – hired housekeeper 11. Prolonged sitting causes lower back & pain at the ball & socket joint on my hip 12. Shooting leg pain with painful, burning, pins pricking on toes 13. Numbness, muscular weakness, pins and needles & tingling on toes and finger tips 14. Painful to make a tight fist, unable to open cans, bottles or jars 15. Difficulty moving & controlling leg pain, pain starts as shooting leg pain 16. Simply bending forward can trigger severe back pain & muscle spasms’ 17. Sciatic back pain, acute & chronic back pain 18. Twitching right thumb, twitching right eye, 19. Sitting up from lying position in bed is painful – need to roll out of bed 20. Loss of urine post voiding – urine dribbles after tissue wipe 21. Post voiding – when going from sitting position to standing position - Need to immediately sit again to void – happens at least 1-2 times after voiding (reported at Pain Management Clinic) Referral for Evaluation & Treatment • Moderate Positive RA [CCP AB = 47 Units (40-59)], 2nd ESR 12 IU/ml (<14) 1st ESR 13 IU/ml) • Morning joint stiffness - lasts at 2-3 hours before joints feel loose – limited ROM w/shoulders • Painful joints on hands, fingers & ankles • Joint swelling, in the hands – ankles – joints are puffy & contributes to stiffness • Weakness –making a tight fist, holding objects ≥ 5 lbs; walking 20-30 min (triggers back/leg pain) • Redness and warmth - joints feel warm and look red on hands. • Exhausted – unable to sleep throughout the night • Chest pain – on & off • Heavy breathing – while walking – (noticed by others) • Eyes – are sometimes red &/or occasionally painful • Jaw pain – referral appointment for Endodontics (evaluation & treatment) last dose AB’s 2 wks ago Medications: • Flexeral (Cyclobenzapine) 10 mg - ½ to 1 tablet every 8 hours (24 mg q day) • Ibuprofen 800 mg - 1 tablet 3x/day PRN pain • Lidocaine Patch 5% q 12 hrs. (one on lower back & 1 on thoracic area) • Aleve 220 mg 2 tablets BID • Phentermine 37.5 mg QD • Amoxicillin 500 mg TID (last dose 03 XXXXXXX 2014) • Vitamin B12 (2000 mcg QD) As well as 1. Loss of urine post voiding – urine dribbles after tissue wipe 2. Post voiding – when going from sitting position to standing position - Need to immediately sit again to void – happens at least 1-2 times after voiding. Thanks, XXXX age correction 63 years
Posted Sun, 16 Mar 2014 in Bones, Muscles and Joints
 
 
Answered by Dr. Vaibhav Gandhi 15 hours later
Brief Answer: Explained below Detailed Answer: Hello, I have studied your case with diligence. As you have median nerve compression syndrome [carpal tunnel syndrome] in which nerve occlusion is in periphery, it can’t be seen on MRI spine. Due to autoimmune sjogrens syndrome and age there is degeneration of your spine which can be seen on MRI. Due to compression of this nerve root there is tingling numbness in your arm and leg and pain associated on exertion. For these symptoms continue analgesic and neurotropic [methylcobalamine] medication can be started. You can consult physiotherapist for help. Physiotherapy like ultrasound and interferential therapy will give quick relief. I will advise to check your vit B12 and vit D3 level At age of 63 there can be degenerative wear of muscles and ligament and loss of elasticity of muscles, due to deficiency of VIT B12 and carnitine these symptoms can be aggravated .so supplements of these nutrients can relieve pain. Another associated factor can be due to osteoporosis of bones there can be diffuse pain all over body. Check your bone strength with DEXA SCAN and you can start medication according to level of osteoporosis. For your incontinence raised residual post void you need to take tone increasing medication and start perineal muscle strengthening exercises. You can consult urologist or gynaecologist for it. Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries. Wishing you good health. Take care.
Above answer was peer-reviewed by
 
Follow-up: What are the MRI test indications if EMG/NCV do not support symptoms? 3 hours later
For chronic back pain & neck pain I am seeing Consultants in Pain Medicine who want to do injections to my back & neck. Pharmacological therapy includes: Tramadol & Hydrocodone PRN. I get dizzy spells from the medications & can't drive while on these meds. When I don't take the pain returns. The numbness, thingling and burning on my toes & fingertips continues. I have had various falls (2) within the past month and still find it difficult to sit/walk for prolonged periods of time (1-2 hrs). I have been taking 2500 mcg VB12 & Folic Acid too for the sensations in my fingers & toes (2 mos). I am an RN - when I take the pain meds, my concentration is slow & have difficulty reading to understand. Without pain meds - the pain gets worse to back & have difficulty walking due to sciatic pain. Knees also lock up - have bone spurs on both knees. What is the best test to confirm for this type of disability?
 
 
Answered by Dr. Vaibhav Gandhi 11 hours later
Brief Answer: For knee locking you can do MRI knee. Detailed Answer: Hello again, Due to hydrocodone medication which is opioid you can have dizziness and lack of concentration, you may shift to ibuprofen or another non sedative medication. For knee locking you can do MRI knee to see for meniscus injury, as there is locking. Along with methylcobalamine you can start neurotropic medication like pregabalin in night consulting your doctor. Dexa scan will help to know status of your bone density. Physiotherapy will help you. Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries. Wishing you good health. Take care.
Above answer was peer-reviewed by
 
Follow-up: What are the MRI test indications if EMG/NCV do not support symptoms? 7 days later
Since your last recommendation I went to my PCP and he gave me a RX for a 4 legged cane & bilateral splints for TCS. I have fallen 2x because my knee locks & my leg feels numb. I have another appt to see with the pain clinic to do steroid injections to see if that helps. I had mild back pain since 2006-2007 and the back pain has progressed. With my RA & back pain I am constantly working on one problem or another. B12 level was 334 pg/ml (normal range 200-1100) and my MD started me on B12 2500 mg QD but not D3. How much Vit D3 should I take?
 
 
Answered by Dr. Vaibhav Gandhi 2 hours later
Brief Answer: Vit D [cholecalciferol] 60K units orally weekly. Detailed Answer: Hello again Steroid shot will help your to reduce pain. You can take Vit D [cholecalciferol] 60K units orally once in a week. Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries. Wishing you good health. Take care.
Above answer was peer-reviewed by
 
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