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Member 196060 · 05-28-2009, 08:33 AM

Wait...I found another $0.02.

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Originally Posted by Hilly12

You are of course right that most medical procedures are uncomfortable. But don't compare EMGs to blood-darwing. For blood drawing the needle is inserted only once (provided you know how to do it), for EMG the needles are inserted 10, 20 or even 40 times. For blood drawing the needle is just inserted a few millimeters and withdrawn, for EMG it is inserted deep and moved around. Besides, the patient has to contract the muscle, which is the part when most patients cry out with pain.

There is your qualifying statement. Procedures are quick and can be relatively painless if someone is well trained and proficient. Patients are coached during the procedure on how to contract the muscle in order to minimize discomfort. 40 EMG sticks? Really? Can’t tell if you’re exaggerating or serious.

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And as to falling asleep, I saw that once. But it was an old very sick man who was under heavy sedation and who was almost unconscious when he was wheeled into the room. So many people on whom EMGs are done in a hospital get so many drugs that most of the time they are under sedation. You can't compare them to those who come on an outpatient basis. They are wide awake and none of them will fall asleep.

The patients (plural) who fell asleep on me were all outpatients. Not necessarily doped up on pain meds either. I suspect that PMR 4 MSK’s patient was an outpatient as well.

I had a patient yesterday who thought the NCS part “tickled”.

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I have one more question to all of you:

You actually ask several.

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Have any studies been done as to the percentage of EMD/NCS that were necessary? I mean, what would you say, how many of the tests you have done led to treatment or a change in treatment?

None that I am aware of. However there are many examples (I gave you two earlier, and others have chimed in) where an EMG has confirmed a diagnosis, ruled out other potential causes of a problem, better localized a disease process, aids in prognosis of recovery or progression, and helps guide treatment. The classic EMG board question is that of a patient with polymyositis on steroids who is getting weaker. Is his myositis progressing or is he developing a steroid myopathy? His muscle enzyme levels are still elevated. What do you do next, doctor?

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Most patients that were tested here were supposed to have polyneuropathy. Many were diabetic, so their sugar level was monitored anyway and the additional knowledge that they really had polyneuropathy didn't probably change anything in their treatment.

If their sugars are stable, and they have signs/symptoms of worsening neuropathy, can you truly chalk it up to diabetes? There are hundreds of different causes for neuropathy. EMG can define extent and pathophysiology of the neuropathy, which can help guide further appropriate diagnostic testing. And treatment.

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Would you agree with me that perhaps 70% or 80% of the EMD/NCS are unnecessary?

No. And to come up with an arbitrary statistic like that is very dangerous and misleading.

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Should doctors be advised to think twice before sending a patient to a neurologist to have these tests done? Shouldn't they ask themselves what would change if they didn't do the test? If the answer is 'nothing' shouldn't they refrain from having the patient undergo this 'uncomfortable' test?

Agree with you here, except doctors should think before sending patients to a neurologist or physiatrist to have these tests done.

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I get the impression that too many doctors just send their patients here because they think the test, though uncomfortable, is harmless?
Is it really that harmless? Lasting pain, numbness, inflammation, does occur. Has anyone ever done studies on the long term effects of these procedures?

I refer you to the following review article: Al–Shekhlee A, et al. Iatrogenic complications and risks of nerve conduction studies and needle electromyography. Muscle Nerve 27;2003:517-26. You will find that risks and complications are quite minimal. Nevertheless they do exist, and we need to be aware of them. All procedures have risks and possible complications.

Doctors have been performing NCS/EMGs for decades. It is a proven, safe, well tolerated procedure. Move on.

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I wonder how many polyneuropathies have been induced by these procedures, especially when a great many electric 'shocks' were applied and a great many needles were inserted?

You, my friend, have just stepped over into irrationality. You demonstrate a clear lack of understanding of neuropathophysiology that I cannot overcome (nor should I) on an internet forum for health care professionals. You say you are training to be a medical assistant. You are in health care, but by no stretch of the imagination are you a health care professional. You need to step back, overcome your own personal fears and biases, and approach things more objectively.

And the risk of nerve injury following venipuncture is higher than that following EMG. There have been no reported cases of nerve injury following EMG. There are several following venipuncture. Do a search.