Interesting EMG

[nvrsumr]

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Had an interesting case today. Ulnar innervated OP. Patient with CV drop across elbow. Florrid spontaneous activity in the FCU, FIDH, OP. Clean APB, EI, and PQ. Subsequent low stim of the ulnar nerve at the wrist and recorded over OP-got a nice CMAP.

Obviously she did not read the anatomy book. Have had ulnar innervated thenar musculature before but not just OP. Pretty cool.

 

[spondy14]

do you check the OP regurlarly?

 

[nvrsumr]

Anecdotally, I find the OP is less painful for my patients than the APB.

 

[SSdoc33]

if you are in the OP vs. the APB? you must be pretty good with that needle. i know that i wouldnt be able to reliably tell the difference when I'm in. We are talking about millimeters here.

 

[nvrsumr]

In this case I was assuming the OP would be clean(ulnar mononeuropathy) so it ended up being a blinded test of needling a denervated and likely atrophied OP(FDIH severely atrophied).

I palpate while having the patient touch thumb tip to pinky. Have patient relax and then insert needle from as far dorsal as possible to avoid the sensitive skin of the palm. If need to confirm have patient minimally oppose thumb while recording.

Best of luck.