- Joined
- Oct 2, 2007
- Messages
- 4,182
- Reaction score
- 37
Ok, Ludicolo and I can't be the only ones writing on this forum. 982 reads, but only 17 replies on the last 3 topics? C'mon people! Stir up some debate here! Post your cases! Reply to ours!
My latest intersting case, just seen today:
21 yo male, referred for EMG RUE to R/O Long thoracic nerve palsy for "scapular dyskineses" No winging, but scapular "popping" after W/C injury 3 months ago, not getting better with PT and subacromial steriod injection.
NCV from right Erb's point to Serratus Ant, Supraspinatus, Deltoid, Triceps and Biceps all normal. LAC and MAC sensories normal. Median and ulnar motor and sensories normal.
So I start the needle exam. Deltoid Normal. Triceps shows continuous "Dive bombers" (DBs). Normal MUAPs. Hmmm, unexpected this is.
Biceps normal. Pronator Teres shows DBs, as do the EDC, EIP, FDIM and APB. They also have some PSW's and Fibs. Again, MUAP's normal. Recruitment normal, except FDIM doesn't get full recuitment.
Up to the neck, Supraspinatus, Rhomboid, trapezius and cervical paraspinals all normal. Now this is Work Comp, and they hate when you do additional studies unrelated to the referred R/O, but I figure inquiring minds want to know, so I just won't bill for other limbs. So I go over to the left arm. I already tested the Long Thoracic on the left, for comparison.
Left Tricep, EDC and FDIM all the same as the right side. I go to his left foot and the EDB also shows DBs and some Fibs. Peroneus longus showed some occasional DBs and a few fibs also. At this point I knew enough.
What do you think his physical exam showed? I did a little more PE after the EMG to confirm my Dx. FHx unremarkable. No symptoms of the Dx noticed by the pt.
My latest intersting case, just seen today:
21 yo male, referred for EMG RUE to R/O Long thoracic nerve palsy for "scapular dyskineses" No winging, but scapular "popping" after W/C injury 3 months ago, not getting better with PT and subacromial steriod injection.
NCV from right Erb's point to Serratus Ant, Supraspinatus, Deltoid, Triceps and Biceps all normal. LAC and MAC sensories normal. Median and ulnar motor and sensories normal.
So I start the needle exam. Deltoid Normal. Triceps shows continuous "Dive bombers" (DBs). Normal MUAPs. Hmmm, unexpected this is.
Biceps normal. Pronator Teres shows DBs, as do the EDC, EIP, FDIM and APB. They also have some PSW's and Fibs. Again, MUAP's normal. Recruitment normal, except FDIM doesn't get full recuitment.
Up to the neck, Supraspinatus, Rhomboid, trapezius and cervical paraspinals all normal. Now this is Work Comp, and they hate when you do additional studies unrelated to the referred R/O, but I figure inquiring minds want to know, so I just won't bill for other limbs. So I go over to the left arm. I already tested the Long Thoracic on the left, for comparison.
Left Tricep, EDC and FDIM all the same as the right side. I go to his left foot and the EDB also shows DBs and some Fibs. Peroneus longus showed some occasional DBs and a few fibs also. At this point I knew enough.
What do you think his physical exam showed? I did a little more PE after the EMG to confirm my Dx. FHx unremarkable. No symptoms of the Dx noticed by the pt.