EMG help...

[Taus]

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I'm having trouble locating ncs criteria guidelines for diagnosing and grading focal/entrapment neuropathies in the setting of peripheral polyneuropathy. Any thoughts on a good article or section of a text on this?

 

[Jitter Bug]

Hmm that's a sticky one. I'm not sure there is a good definitive text or mimeograph out there. If there is I'd love to hear about it.

What I do is try to identify two separate patterns. Since the most common polyneuropathies are distal to proximal and symmetric, usually you can identify anything that isn't symmetric and breaks the distal to proximal picture as a separate focal entrapment issue. Clinical correlation becomes more important in this scenario as well.

In order to find two patterns I don't rely on NCS, I rely on sticking a whole pile of muscles with the EMG needle. That needs to be coupled with what I know of the history and exam and imaging that may be consistent with two problems instead of just one.

 

[RUOkie]

Jitterbug had it right. What I do is try to explain the results to the best of my ability. If you can't discern a focal neuropathy because of the severity of systemic disease, say so (and why). Sometimes EMG's are very frustrating when we can't answer the question posed to us.

 

[Taus]

Thank you. So no clear cut criteria exist for grading concomittant focal processes?

I looked through all my saved aanem minimonographs, Preston, Kimora and pubmed.... no luck so far

 

[PMR 4 MSK]

Did you look at the mini monograph on Mononeuritis multiplex? If I remember, it covers some of this.

 

[Taus]

I didn't... will do... thanks