My Nerve Conduction Results (Neuropraxia? Axonotmesis?)

[ofthesun]

About 2 weeks ago, I was exercising and applied pressure to something in my left brachial plexus just proximal to my shoulder. During and after this incident, I experienced sensory and motor disruption initiating along my left arm, beginning at my left thumb and spreading up throughout the forearm all the way up to and including my shoulder.

In the 2 weeks since, I've had paraesthesia affecting all of the left arm. This remains most significant at the base of my thumb. Some sensation seems to have returned. However, in addition, I currently have, at most, half the strength in my left arm/hand/wrist compared to my right. X-rays have shown no non-neural injury.

I just came back from a physiatrist for a nerve conduction study. He took a quick glance and stated exclusively that the results were 'within normal range'. However, it was less than a thorough examination, and at one point, he even told me that "lat (m/s)" on the printout stood for "lateral", not "latency".

Furthermore, this situation is somewhat disheartening to me, as, in addition to med student, I'm an avid drummer/guitarist, and the full strength and dexterity of my hands/wrists is quite necessary for both. Currently, I am functioning at a significantly reduced capacity, and it's been pretty difficult to handle as a result.

Based on that, I still have questions about the nature of the injury and prognosis, and I was hoping one of the fellow students a little farther along than me in their education might be able to lend some assistance.

Testing was done in my wrists and fingers. Again, it is the left side that was injured.

My Observations:
- Latency is higher in left limb by 8%, 69%, 0%, 27%, and 20%.
- Left median motor amplitude is 45% of right; left area is 41% of right.
- Left ulnar motor amplitude is 66% higher than right; left area is 58% higher than right (?).


Any help interpreting the data above a bit more thoroughly would be greatly appreciated.

I’m still hoping it’s purely simple neuropraxia with a couple more week recovery window. However, the latency and amplitude differences, as well as minimal improvement thus far, make me wonder if it might be more severe with a much longer (and possibly incomplete) recovery, like, additionally, a partial axonotmesis.

Thanks in advance,
Mike

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[minstral]

why not talk with YOUR neurologist or otehr departmental folks?

 

[PainDr]

you need an emg...and a neurologist.

 

[ofthesun]

you need an emg...and a neurologist.

Unfortunately, I live in Canada, so it's not a simple matter to get any such thing. That's the one thing I like about the US. If you want something, you go get it. Here? Referrals. Don't get one? Can't go.

Physiatrist wouldn't refer to a neurologist, so I have no way of seeing one. Maybe in September once school starts again ... Or maybe I can see another family doc and ask for a referral there... Arg.

 

[Stinky Tofu]

I agree that you should talk to your PCP or Physiatrist about your concerns and hopefully you can get the Physiatrist to explain the results to you in more detail.

In general, decreased amplitudes are more consistent with axonotmesis and prolonged latencies with neuropraxia, but EDX testing can often be complicated by a number of things.

With regards to brachial plexus injuries, in general, EMG is not typically done for at least 3 weeks after the onset of injury. The rationale is so sufficient Wallerian degeneration of the distal parts of the injured nerve can occur. Sensory NCS is also typically a much more sensitive indicator of injury to the brachial plexus than the motor nerve response. The CMAP is usually not affected unless the injury is severe.

If you are specifically looking for a Neurologist, make sure you are referred to one that has done a fellowship in NCS/EMG. If they haven't done a fellowship, they might actually have less experience than the Physiatrist does.