EMG & MRI'S

[KGGUNNS]

Hi Lorrie,

What is involved with exploratory surgery? Do you go under? When they found the severed nerve, did they remove the scar tissue right away, during the exploratory or did you have another surgery scheduled after that? Again when you say each problem nerve caused denervation o different muscles, ..... what exactly does that mean. With me on my MRI my brachial plexus was normal but with the EMG, I had no nerve response at all with the sensory test. The doc said I had severely stretched nerves. Anywho, just curious. Take care.

Thanks, Karen

[Lorrie]

Karen hi,
My mri also showed no avulsions either. Initially I was told it was probably just a stretch so, when after several months certain muscles weren't showing any "life" on the emg the dr scheduled the exploratory. There has only been one surgery. The Dr. told me ahead of time that he was going to go in and have a look around and went thru some possible scenarios of what they would find and what they might do to correct it. While in there they did electrical tests to narrow down where the problem areas were. There were wires attached to my head and then once inside they would stimulate a nerve and be able to tell from the wires on my head whether the message got thru. By doing this they could tell at what point along the nerve the problems were occurring. On the radial nerve the messages were being blocked by scar tissue. If you think of it like a set of Christmas tree lights. If the second light in the string is removed or burnt out then the entire string doesn't work even though the rest of the bulbs are fine. With the lights you keep tryimg a new bulb in each socket until you identify the bad one. Once you have the string lights up. Sometimes there's more than one bulb that is bad. I hope the analogy isn't too corny. I had extreme internal bleeding in my shoulder at the time of my accident. - so apparently there was a lot of scar tissue. On the axillary nerve there was actually a sever so they did a sural(sp?) nerve transfer. I was told ahead of time that this was a possibility. They also tested my subscapular nerve at the time but could only access part of it because of my position on the table. On the part they could access there was no problem but my muscles served by that nerve are still not recovering so later this month he's doing another exploratory in that area he couldn't access. Again there could be scar tissue removal or another transfer needed. I had broke scapula and the nerve travels along it so I won't be surprised if it has been severed or if it got stretched too far and can't recover - like an elastic that looses its elasticity. Either sceario will mean a nerve transfer. I'm hoping for scar tissue. In answer to your other question, the brachial plexus has 5 main sets of nerves as you probably know. Each main set of nerves work different muscles. Axillary nerve for deltoid, subscapular for infraspinatus and supraspinatus etc. So depending on which nerves are damaged different muscles are affected. Different muscles control different actions - bicep flexion at elbow, tricep extension at elbow. In my case the medial and ulnar nerves were just stretched and as a result I have a lot of hand movement and elbow flexion. My bicep started coming back after a few months. After my first emg most muscles showed no innervation but with time more of them are reconnecting with the nerves, so strength is developing. At my latest emg more muscles were innervated, showed "life". The tricep wasn't doing anything at that time but the emg showed it had become innervated and sure enough I'm getting strength in it. I did go under for the surgery. My last one was 6 or 7 hours. This one will be much shorter and may only require a local. My dr has been pretty upfront before the surgeries - he's a strong believer in exploratory because the tests aren't sensitive enough to pinpoint all problems. For me I'm so glad I had it because even if the other muscles controlled by the radial nerve (wrist extenders)don't come back, getting my triceps back has been huge. I have a pretty severe subluxation and today for the first time I was able to contract the muscles in my arm enuf to lift the arm back into the socket. As soon as I relaxed them it fell out again but I'm hoping that with time it will stay in without assistance. Hopes this helps.

Cheers
Lorrie

[KGGUNNS]

Hi Lorrie,

You certainly know your stuff! Thank you for the indepth description of your exploratory surgery. It sounds like you are really coming along in your recovery. I hope thst my specialist will give me the answers or do what is necessry to possibly get the use of my hand and arm back. It is awful not being able to bedn yor elbow or move your fingers to pick up something or be able to tie your shoe laces up. I am learning to do more things with the one hand but I find that my good hand is getting sore and feels strained. I don't want to overuse it.

Should I even suggest to this doc about exploratory and tell him about some of the procedures I have learnt about? Or is that over stepping my boundaries. I just don't want to walk away again not knowing the answers or outcome. Should I be persistant with this guy?

Thanks again for your explanation and thorough help Lorrie.

Karen

[Lorrie]

Karen, I would definately talk to your Dr about different possibilities. Its your body and you have every right to question any dr and to get a second opinion if you don't feel you are being heard or respected. There have been too many people who have passively accepted what their drs have said only to find out that the dr was wrong. My mother-in-law went to her dr and told him she thought she had cancer, tests were done that were inconclusive so the dr told her not to worry. 6 mths later when she was still getting worse she was finally sent to an oncologist. She had cervical cancer. They operated but by then it was too late. She died 4 months later. I realize this has nothing to do with bpi but some drs get the god complex and don't listen to patients. In some cases they simply don't keep up to date. Whatever the case, its your body and with bpi time is really important. How long has it been since your accident? As hard as it is unfortunately no dr can definitively tell you what your recovery will be. I was really pushing for that kind of answer initially but have been told by everyone that each person is different. Having read so many stories on this site it seems to be true:-( Your dr should be able to run through the possibilities with you though. Get pushy if you have to.

Good luck

Lorrie

[KGGUNNS]

Hi Lorrie,

My injury happened 9 1/2 weeks ago, August 31st. I understand that it is real crucial to get things done within the first 6 months post injury. I am going to print all the info you gave me and take it with me to the doctors to have for reference. I will be pushy. My persistance got me in to see this guy a month and half earlier then I was supposed to.

I am sorry about your mother-in-law. Thst is terrible especially when she knew there was something wrong and the doctors didn't listen.

Well again thank you. Are you from England? It was the cheers that made me ask? All my relatives are from England.

Ta Ta for now, Karen

[admin]

Yes, unfortunately impossible for me to get 2nd opinion short of going to another country as all roads lead to Mr Birch from Ireland and he has answered with a no need for exploratory. In fairness to him I do have a spinal injury which showed up on the MRI and he says he has seen my sort of injury before which none of the surgeons in Ireland have. His last paragraph was optimistic tho he said the cases he saw improved enought to get functional shoulder back. That would be great but I amn't holding my breath.
Anyhow, KAren in your case you definitely had a fall which caused your injury and I hope they do exploratory. And Lorrie sorry to hear about your mother in law too. Its true we know our own bodies better than anyone and awful we have to convince a stranger "doctor" of our symptoms in order to get some help. ANyhow..so be it.

[admin]

What type of muscle transfer did you have.
What was your function before vs after.
I was offered a laaisimus dorsi xfer to replace my deltoid. Anybody have one -results ? I know recovery is very painful

I have damage to my C6-C7. The injury occurred 20 yrs ago - I believe from a cortisone shot. Anyway my bicep and shoulder are atrophied.
I had mylograms , EMG , MRI -none are painful just
heat lamp in Mylogram is hot.
I finally found Dr. Kline in LSU medical center and had exploratory surgery of plexus - he was going to do
nerve graft-take sensory nerve from my leg but did not
do it because during surgery it was determined graft would be too long and not work. He took scar tissue from nerve and my nerve conductive studies are better but I have no deltoid muscle to generate.
My forearm and hads are 100%- tricep 50%. No bicep strenth but some muscle-deltoid muscle shot.
Plastic Surgeon Dr. Deunne at John Hopkins suggested
Muscle xfer but Dr. Wolfe in HfSS says if no function of deltoid xfer won't work.
Anyway for Brachial Plexus I would highly reccommend Dr. David Kline in New Orleans.

[stacyandjustin]

need help reading emg result? here are my results.


The right peroneal had a latency of 4.5 msec, amplitude of 7 m/v, conduction velocity of 49 m/sec. The right sural sensory had a conduction velocity of 43 m/sec. The right posterior tibial had a latency of 5.0 msec, amplitude of 14 m/V, conduction velocity of 53 m/sec. The right posterior tibial motor gastroc response had a latency of 25.4 msec. The left posterior tibial motor gastroc response had a latency of 25.8 msec.

Neddle sampling in the right lower extremity included sites proximally and distally over the anterior tibialis, peroneus longus, extensor hallucis longus, medical gastroc, lateral gastroc, vastus medialis, vastus lateralis. The patient had scattered positive waves in the anterior tibialis as well as the extensor hallucis longus and the vastus medialis.

Imperssion: Moderate right L5 irritability without clear cut radicular pattern. Clinical corrlation with anatomic testing is indeed warranted.