Mercy Medical non-surgical orthopedics doctor, Nicholas Anastacio talks about using EMG to find the source of nerve pain.
Interview conducted by Ivanhoe Broadcast News in 2023.
We’re switching to EMG, and that stands for? Can it be scary?
Anastasio: Electromyography. It can be quite intimidating test, but the good news is patients generally find it’s not as scary or uncomfortable as they fear. It’s a test used to diagnose nerve issues. If you have a pinched nerve in your neck or your back or carpal tunnel or some unexplained weakness or numbness in your arms or legs, it’s a test that we can use to diagnose the problem and figure out where it’s coming from and how severe it is so that we can direct your treatment appropriately.
I think that nerve problems are the most aggravating, painful no matter where they are. How much relief do patients get once you go through the diagnostic of the EMG? Can you actually treat it during that time, too?
Anastasio: It depends on the diagnosis, but certainly many of the diagnoses that we discover on nerve testing are treatable. For example, carpal tunnel can be treated with carpal tunnel surgery, wear bracing or shots. Pinch nerves in your neck or back have lots of treatment options, so you’re absolutely right. Nerve pain is one of the most uncomfortable things we can experience. Oftentimes it’s unrelenting, not responding to medications, and the reason is until you relieve the nerve compression, it’s generally not going to go away. The key to a good nerve test is figuring out where the source of the nerve irritation is so that we can address the root of the problem.
When you talk about the nerve compression, tell us what’s actually happening.
Anastasio: There are many different conditions, but, for example let’s say you have a herniated disc in your back and that disk sticks out and it takes up space and pinches one of the nerves that’s traveling by, the nerve doesn’t like that. It can damage the nerve and it causes irritation. Then the patient experiences numbness or tingling or pain down the distribution of that nerve.
What are the dangers of say waiting and not getting the nerve treated? Does it do further damage?
Anastasio: Absolutely. Anytime a nerve is being compressed, it can tolerate it to some degree. But depending on the length of compression or the severity of the compression, eventually the nerve is going to deteriorate. What happens is you accumulate nerve damage, and sometimes that can become permanent. The nerve test allows us to identify these things quickly and get the right treatment.
This is one of those things, it seems like hearing aids are the same way. So what would you tell people about that?
Anastasio: If patients have any concerning symptoms, unexplained numbness, or tingling, or pain, I recommend they see their doctor right away. Generally, the primary care physician or seeing an orthopedic specialist like myself can identify the problem, and if it’s appropriate to receive a nerve test, then we can get them scheduled tight away
How less scary is it than people anticipate you’re talking needles and electrons?
Anastasio: There is always some discomfort with the test. But like anything, the anticipation tends to be the worst part. What we’re doing is actually checking your nerves much like an electrician checks the circuit in your home. We have to get signals to go down the nerve, and it involves little tiny shocks, like static electricity feeling or patients often equate it to what a TENS unit feels like. Not painful, but a little surprising. Then the second part of the test, we do have to check your muscles with a special needle that records the electrical signals in your muscles. It’s not shocking you, it just feels like the stick of a needle. They’re very tiny needles smaller than the little butterfly needles we use for a blood draw. If you can do a blood draw, you can certainly tolerate the EMG needle. A lot of patients equate it to maybe like acupuncture.
This it seems like the diagnosis can go from minor sciatic nerve all the way up to very certain diseases. What is the difference that you’ll see between those two? Like if somebody has myasthenia gravis in your diagnosis.
Anastasio: There’s a vast array of neurological conditions that we can diagnose on EMG from simple things like carpal tunnel all the way to very scary things like ALS. Obviously, those treatment regimens vary depending on what the problem is. But a lot of those conditions are responsive to medications. The EMG is an important way to identify these things because oftentimes pictures like MRIs don’t really tell you a whole lot about how the nerve is functioning. You can think of the nerve test like it is actually in the nerves and checking them versus just looking at them in a picture like an MRI.
Going to break down the wall to get to it and Robin’s particular.
Anastasio: Robin’s case, she had hand numbness and pain for many years. I think it’s 30 or 40 years that she had been dealing with. We did the nerve conduction test and confirmed that she had carpal tunnel on both sides. But fortunately, there was still very good nerve function to salvage, and so I referred her to one of my partners who does a carpal tunnel release and she had complete relief or symptoms, was very happy almost immediately after the surgery.
Whatever’s going on in life in this case, repetitive typing on computers, for example, creates a specific injury.
Anastasio: Some of these things are no-fault of anybody’s. They can just happen because of bad luck life or your anatomy. Oftentimes that’s the case with carpal tunnel. It’s a big nerve in a small space. Certainly we see some risk factors like overuse or using power tools, but a lot of times it can just crop up on its own. Similar with a pinched nerve in your neck or back, it can happen from sleeping funny, coughing, sneezing. It doesn’t necessarily have to be an injury.
When she came in and you’ve diagnosed her, what did you see?
Anastasio: We saw on the nerve test that she was having dysfunction with her nerve across the wrist, which is the median nerve which gets pinched in carpal tunnel. But there’s still a lot of nerve function left going through her hand. She hadn’t completely ruined the nerve over 30 or 40 years. It still was alive and intact, and that allowed us the ability to justify a carpal tunnel release which takes the pressure off the nerve and relieves the symptoms. It’s a very small surgery with a very quick recovery.
It’s amazing because you’re talking about 30 or 40 years, what people are willing to put up with, they fear to go to the doctor, what have you. You will see that all the time.
Anastasio: The power of denial is pretty strong actually. People sometimes will tolerate things for quite awhile or have a fairly high pain tolerance. But eventually things come to a head where people just can’t tolerate any longer and need to get the test done.
Anything that you feel in your body that is outrageous or you know shouldn’t be there, not just any twinge, but you should be checking it out?
Anastasio: Yes, it’s never a good idea to just brush things aside. It’s simple enough to go see your doctor, and if it’s nothing to worry about, then they can tell you it’s nothing to worry about, but it’s always good to check and it certainly never hurts.
In Robin’s case, what kind of improvement did you see?
Anastasio: Her pain was resolved, her numbness and tingling were resolved, the strength in her hands is improving, and she’s basically back to living without numb hands.
END OF INTERVIEW
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Dan Collins
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