bilateral EMG's

[Hemisphere]

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question: bilateral EMG's for unilateral symptoms - is this indicated and in what circumstances? full limb vs. limited extremity comparison? any official statements on this issue, eg. AANEM, etc. to show to parties requesting more bilateral studies be performed?
thanks...

 

[RUOkie]

question: bilateral EMG's for unilateral symptoms - is this indicated and in what circumstances? full limb vs. limited extremity comparison? any official statements on this issue, eg. AANEM, etc. to show to parties requesting more bilateral studies be performed?
thanks...

It depends.

When I have an order for a bilateral study (or sometimes "4 limb"), I interpret that as giving me free reign to perform what they ordered. I have done a 4 limb EMG once or twice in my career (I am well over 10K studies)

Like today, I had an order for B UE for CTS. The patient only had sx in the L arm. I did the L arm first, it was normal. I stopped the study and wrote "the RUE was not tested in light of the normal study of the LUE and all symptoms were L sided".

If the L arm showed Severe CTS, or an acute radiculopathy, then i likely would have checked the RUE. If the L arm showed MILD CTS, I probably would have stopped.

Understand?

 

[PMR2008]

It depends.

When I have an order for a bilateral study (or sometimes "4 limb"), I interpret that as giving me free reign to perform what they ordered. I have done a 4 limb EMG once or twice in my career (I am well over 10K studies)

Like today, I had an order for B UE for CTS. The patient only had sx in the L arm. I did the L arm first, it was normal. I stopped the study and wrote "the RUE was not tested in light of the normal study of the LUE and all symptoms were L sided".

If the L arm showed Severe CTS, or an acute radiculopathy, then i likely would have checked the RUE. If the L arm showed MILD CTS, I probably would have stopped.

Understand?

I understand your justification for testing only the side which has symptoms. I don't understand why you would not check the right arm if the left arm showed MILD CTS when atleast 50% of people have bilateral CTS. In my short career I have seen CTS progress from mild to severe within 6-12 months and I have read that the earlier the treatment for CTS is initiated the better the outcomes.

 

[PMR 4 MSK]

Contralateral testing is indicated when unilateral testing raises questions or is inconclusive. Examples:

Median and ulnar are both abnormal on the symptomatic side and you want at least one normal nerve to compare them to.

Polyneuropathy is suggested, such as testing one leg and finding low ampliude peroneal and tibial nerves with mildly low NCV. You may wish to test the peroneal and/or tibial nerve on the other side to see if it is a symmetric PPN, or alternatively something like mononeuritis multiplex.

Brachial plexus studies. Due to high variability b/w people, comparison with the opposite side is usually a good idea and should be expected.

AANEM has it's model guidelines, and addresses issues of bilateral testing

http://www.aanem.org/getmedia/93f75...8d/Recommended_Policy_EDX_Medicine_1.pdf.aspx

 

[RUOkie]

I understand your justification for testing only the side which has symptoms. I don't understand why you would not check the right arm if the left arm showed MILD CTS when atleast 50% of people have bilateral CTS. In my short career I have seen CTS progress from mild to severe within 6-12 months and I have read that the earlier the treatment for CTS is initiated the better the outcomes.

I was basing this on the assumption that the R side had ABSOLUTELY NO symptoms. You wouldn't operate/inject/treat in any way a patient with moderate severity median neuropathy with NO symptoms would you?

Do not treat the test, treat the patient.

 

[Jitter Bug]

I aslo would test the contralateral side if the symptomatic side had a NCS that was only slightly abnormal. If the unaffected side had the same value, I would probably call it "of uncertain clinical significance" but if the unaffected side had a markedly better NCS, then I would call it out for being significant.

The clinical history and results of initial testing can expand a 1 limb study into a 4 limb, or cut down a 4 limb into a 1 limb.

 

[RUOkie]

I aslo would test the contralateral side if the symptomatic side had a NCS that was only slightly abnormal. If the unaffected side had the same value, I would probably call it "of uncertain clinical significance" but if the unaffected side had a markedly better NCS, then I would call it out for being significant.

The clinical history and results of initial testing can expand a 1 limb study into a 4 limb, or cut down a 4 limb into a 1 limb.

I can't argue with this. Different practice styles.