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EMG results and what they mean

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Chronic Pain
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Posted 3/14/2014 7:26 PM (GMT 0)
I got a copy of the EMG I had done in November 2012, one month before my surgery.

I called that neuro to explain them to me, but was told he was paid to administer the test, not to consult or interpret them, and I was referred to my surgeon.

I called my surgeon, and his receptionist said "most likely," he will only discuss this with me if I make an appointment (which means driving into Boston and all the sitting and walking and waiting that entails)...when I just know, based on my history with him and what he knows I already understand,....we could accomplish in a 5 minute phone call....

Now, I did not ask the neuro at the time, in November, when I was getting the EMG done, what all of that meant because frankly, I don't remember much of those months leading up to surgery. I was in such pain that I had no sense of time or reality, I just felt pain and loss of control of my limbs, and more pain.

Between the time of that EMG and now, I've had 3 surgeries, so yeah, I've been preoccupied.

Regardless, I'm waiting for a return call, and eventually I'll get this figured out, and I'm dropping a copy off to my PT.

In the meantime, I'm wondering if anyone knows what the following translates to. I understand what it reads, but I want to know what it means as far as function, future, healing, etc.



"Severe dysfunction was present in the left L5 and left S1 root distributions, more L5 than S1, with considerable ongoing active denervation. There was no indication of any regeneration in L5 distribution and very little in the way of regeneration in S1 distribution."


Then I have a few pages of graphs and various values, addressing everything from L1-S1 and listing a variety of muscles and their involvement/response.


Insight? Anyone? Something? (Remember, I already called my docs, so I'm not looking for medical diagnostics or anything like that, just some semblance of what the heck this translates to).





M.
Posted 3/14/2014 8:38 PM (GMT 0)
You have nerve problems at L5/S1, this can be nerve root irritation. When I was having problems in this area my big toe went numb.
Posted 3/14/2014 9:23 PM (GMT 0)
Hi Merrida it looks like you have problems with the nerve on the left side, and more so at L5 than S1, if you Google denervation the medical definition is interruption of the nerve, or loss of nerve supply. In short, you have problems with the nerve root on the left side at L5 and some at S!. The definition of nerve regeneration is :(the reconstruction and renewal of cell structure and function; generally restricted to myelinated nerve fibers.) So it looks like the damaged nerve at L5 and S1 are not regenerating themselves or repairing themselves. Google both of these words and I went to the free dictionary and they have a medical dictionary section. I hope this help you!

Oh yes the neurologist does read those test and writes up the result and sends them to the requesting doctor! I think is might be not telling you everything!

Good Luck to you!

White Beard
Posted 3/14/2014 10:32 PM (GMT 0)
I understand that, about L5/S1, and the left side, as it's been the left side that was affected, (whether it was the left side of my actual spine, where I had the slip and herniations,--had both,--and it was the left leg acting all dodgy that he did the EMG on, and the left leg getting weak and with neuropathy and radiculopathy).

So that part I can deduce from the summary. Now this was before my surgery mind you, one month before.

I feel greatly improved, and I'm able to slowly, (as in, snail's pace slowly) build strength in that left leg. It's the left leg I can't feel or move from the knee down and have foot drop on. And yep, there's pain between the great toe and 2nd toe. So again, got all that.

The subsequent pages of graphs and values indicate a few zeros, some 85%'s, and some 15%'s....several muscles and their various nerves were tested, as I can see.

I'm trying to see,--and maybe the next pages with the value info which identifies specific nerves/muscles,--if I'm looking at permanent damage, and of what, and his summary sounds less than hopeful of my nerves regenerating, (which I thought they would, albeit quite slowly, -- IF they were going to).

My neurosurgeon still has not phoned me back. The neuro that did the EMG in 11/12, whose report I now have, stated clearly his responsibility was to conduct the test, not interpret, so the office flat out refused to even entertain discussing what his conclusions inferred.

Ergo, the call to my surgeon.

I can read the summary and it's pretty obvious the regions and levels he's referring to, and I know from my body as well as the summary where I have problems. What I'm curious to know is what this means.....down the line. I know what it means, in and of itself. But I don't know what it means pertaining to what physical effects, healing ability, indication of permanent damage of a nerve or nerves that CAN never regenerate? That kind of stuff.

Thanks guys. I know my doc will (eventually, whenever that is) explain it to me, but I appreciate you guys offering up some thoughts! :)





M.
Posted 3/15/2014 5:33 AM (GMT 0)
Not to be the bearer of bad news and explaining may take a anatomy instruction but I will as always with you dear anyways,tell it as I see it.

Nerve cells,that of which we are speaking of, contain a body and axions,stringlike things coming off the main body. Damaged Nerve cell bodies are capable of regenerating or repairing when damaged. The axions which actually transmit the signal to other neurons to produce feeling and action do not regenerate or repair,they simply wither and float away.

As of date all the scientific research is in trying to find a means to trigger the thing to rebuild and regenerate towards the right path. They have been able to identify certain chemical substances that trigger the things to grow which is a great thing but if it doesnt grow towards the correct direction the impulses are marred or misinterpreted and you cant have that either.

So alls lost? Not necessarily. Some eventually do head in the right direction and the impulse becomes better meaning you can see less numbness and return of feeling to the effected part.

As Susie said my damage which is a pars defect or small fracture
at S1,L5, effects the big toe and the inside of my rt foot,complete numbness.

Not sure if this helps or how much but if you understand how they work its easier to understand the effect on you when they dont.

So there is your very scaled down,bare minimum instruction on nerve regeneration.
Posted 3/15/2014 8:48 PM (GMT 0)
Vickie,

I do not consider what you relayed as any type of news to be labeled bad. I'm looking for information, flat out,...not looking to only be told stories of sunshine and rainbows.

Even though I've been out of the system for a while, I do have a history with A&P, and I find it quite fascinating. I watched them do surgery on my foot and thought it was pretty cool, so I don't get wigged out.

I knew I had damage, and I know where the area is, and I recognize the dermatome, etc. I'm simply trying to gain some understanding, regardless of what that entails....what that summary translates to, what it implies, what's the impact.

When I was looking for a WalkAide, and got hooked up to the stim, what was interesting was that while the pads were on my peroneal nerve and on my anterior tibs, when stimulated, I actually was everting and plantar flexing? Go figure. So I was wondering if my body "re-wired" those damaged nerves.

Any and all learning is good, regardless of the message. As long as I understand. I also don't consider my surgery a "failure" just because of this, because no matter how I look at it, I'm better now than before. (Not losing control of anything,....know what I mean?)

So I just slap the brace on, and I still work out, and sure, my gate is compromised, but I'm trying to learn. I was curious if, based on that, it inferred no regeneration was possible (if that's the case, okay, I just want to know, either way)...or if it would be slow, (as in, my sensory nerves have become hyper-sensitive, and where the skin was "numb" I can now feel touch).

I still cannot move that darn foot and I'm the poster child for trip-hazards, but I find it fascinating that my skin can feel touch sensations where before it couldn't.

I'm not holding my breath for anything, and above all, I don't want to be told "news" under the condition it's only "good" news. I want to hear it all, regardless.

Hopefully my neuro will call me next week.

I think my primary concern would be in what manner will it, or would it, affect my abilities to work out, and what restrictions I need to utilize, or what to expect in the future (no surprises, if possible, so I'm looking for info now to prepare).

I was curious if this was as good as it gets? If I can expect it will only get worse? If it's possible something or another may spring back to life? If something's going to wither away, I want to know what it will take with it (ie: permanent foot drop?) I can work with whatever I'm told as long as I am told.

Thank you for telling it like it is, as that's what I was asking. I do have a basic understanding, and as I've said, even though I've been out of the loop for a while, A&P is more up my alley than say,....I dunno, computers or something? (That's very much out of my depth!) If it has to do with the body, mine or anyone else's, I want to learn. Either way.





M.


PS: WB -- I'm not sure my doc is withholding info, as he has yet to return my call and explain this to me. And I accept responsibility for not asking questions...I was in too much pain to think about anything. This has been a very rough year. So I'm trying to pick up the pieces now and ask more questions, even if I'm late to the party.
Posted 3/16/2014 12:24 AM (GMT 0)
Regenerations not impossible but more wild I guess. Getting the axon to grow in the right direction so it will be able to send the signal to the correct neuron is the problem that occurs. If it grows back say heading towards a neuron thats responsible for impulses other then it is will cause you to get the feeling or reaction someplace other then where it should be.

The best example of this is deferred pain.

Remember your basis anatomy,touch hot stove neurons sent the signal to brain,hot,pain,burn,3 different neurons send signal to hand to move!!! The signals all have to get from the hand to the brain and back to the hand for that to take place. It does that by a very unique method of the nerve cell feeling,firing,down the little fiber,a chemical action occurs causing the message to jump across to the little fiber of the next nerve cell and so on until it reaches your hand to tell it to move.

That should explain the planter flex as well. Its like a miss fire sending the message to the wrong place.

There is some great studies being done on substances that can aide in better more accurate regeneration. It holds promise in spinal cord injury as long as theres not complete fractures. In paralysis the gap at the break in the cord is far too wide for those jumps therefore the just drop off and the signal never gets to the part of your body the brains telling to move or vice versa.
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