United Brachial Plexus Network, Inc.

Hi! My 7 month old, is scheduled for a EMG test this month. I understand it will be hard on her. Has anyone had to go through this and have any advice for me? Are they in pain or very sore afterwards? Also, does anyone know if surgery is performed to correct bpi, does it help with shortening? My daughters arm gets shorter every month. Thank you so much for your time everyone. Heather

We chose not to have an EMG done on Maia early on because we found out that they were not reliable. We were also very concerned about the pain and didn't want to put her through a torturous session.

We felt comfortable with trusting assessment by movement scale... meaning that because of how nerves grow, a specialist can easily identify what the general nature of the injury is just by looking at what specific movements have returned. It's the 'ole "hand to mouth without the assistance of gravity" and the other assessments that are used.

I heard from a few people that the test can be a little less traumatic if the cream EMLA is used. This is a numbing cream that is applied one hour before the test.

Good luck,
francine


have you seen this page?

http://ubpn.org/awareness/A2001Rnewparentguide.html

and this:

http://ubpn.org/awareness click on Birth Injury

-francine

[http://www.injurednewborn.com]
[http://www.injurednewborn.com/maia/homepage.html]

I had am emg and a nerve conduction test done yesterday. Obviously I'm not a baby but a fully alert and cognizant adult who knew why this test was necessary and exactly what was going on as the test was conducted.

I do not want to minimize the pain associated with an emg. A lot depends on the amount of innervation within the muscle. The less innervation, the less pain. So in a way if there is pain then it is a good sign, right?

I don't know how one could prepare a child for this, esp. a baby. Give that child as much extra attention as possible during the day of the test and the day following. After the second day, I've found that most of the pain has diminished. Relaxing helps, always with pain, when one tenses up, that intensifies the feeling. So if you are breast feeding a baby, some extra time might be in order. Whatever mechanism you have to soothe your child will help.

Nancy

My son had an EMG done when he was 9 months old. We did use the ELMA cream. We didn't have to ask for it the doctor just put it on. You might need to ask for it first... and I would highly recommend it! Ian had more discomfort with the nerve conduction study but even that was bad. The way that I prepared was... brought his favorite toys, and lots of food distractions. We had an extra bottle and a gerber bitter biscut thing. I think I had a jar of fruit as well but didn't need that. The doctors office we went to was one who worked only on kids so they were also prepared with a TV and sing-a-long videos. Although Ian wasn't big on TV it really helped him since I was singing a long as well. Oh and maybe the most important thing I brought with me was a friend. My husband was out of town so I had a friend go with me for moral support and to help with Ian if I ran out of entertainment ideas.

Ian didn't seem to be in pain afterwards. The doctor said that he might have some tenderness where they inserted the needles but he didn't appear too.

I hope all goes well and that you keep asking questions!

Always,
Kristie
PS My son is now 1 year old.

Hi, Nancy. I hope you don't mind me asking, but I am curious as to why you had an EMG and nerve conduction test. I'm also interested in what the difference is. I guess Nicole hasn't ever had a nerve conduction test, but just intra-operative EMGs. Anyway, I'm wondering what would be the benefit to a test like that other than when considering nerve surgery. Any info. you can share would be great. Thanks. -Tina

Hello, Heather. Welcome to the board. I'm sorry thought that your daughter has a BPI. You will find a lot of info. here and on Francine's site that she listed. We basically followed the same reasoning as Francine wrote. We were comfortable with exams by BP specialists that Nicole needed surgery, so we never had an EMG done. We had heard that they were sometimes painful and sometimes inaccurate. If Nicole's injury was borderline, we prob. would've done a surface EMG, but her injury is severe so we knew she would be having surgery. She has had intra-operative EMGs, which are more accurate. BTW, she did have an MRI done before her primary surgery. However, that test gave us false hope b/c it didn't show the avulsed root and it also doesn't show the tears, stretches, or neuromas. I recommend reading the links that Francine posted. If you would like to share what state you live in, then perhaps someone here can refer you to a good BP Specialist. I'm guessing that you might not have found one yet if your daughter's injured arm is shorter and no one has mentioned the surgical option to you. There is nerve surgery to help repair BPIs (as you'll read about in all the links). However, it's not something that directly helps with the length difference. The best way right now to address the length difference is to do lots of PT -- esp. weight bearing activities and to seek out a good BP Specialist/surgeon for an opinion on surgery. You see, time is of the essence for nerve surgery and if you decide to go that route, the sooner it's done, the better chance for recovery, thereby minimizing further arm size differences as well as helping with much more important things like better positioning and function and better chance to minimize future muscle imbalances.

I have heard that there's surgery to help with the arm length, but that's done much later, if at all. Most parents choose not to make that call b/c many of our children go through enough treatments through the years. That's something most drs. would recommend letting your child decide when she's older.

BTW, we have seen a few BP Specialists and have chosen to have Nicole's surgeries done at TCH (TX Children's Hospital). I suggest checking out their website for a lot of great info. too (http://www.texaschildrenshospital.org). We have also consulted with Dr. Waters at Children's Hospital in Boston and like him as well. I think it's good to seek opinions from 2-3 BP Specialists.

Heather, I don't want to scare you, but please don't delay on looking into a BP Specialist b/c if surgery is indicated, there is a limited window. It is not too late at this point for your daughter, but you don't want to wait too long either.

What kind of therapy are you doing now? Have you found a good PT / OT? Also, I don't know if you know this, but there are early intervention groups that every state has and they provide PT/OT right in your home at no charge. If you don't know about this, I'd be happy to give you more info.

Again, welcome. Ask any ?s you can think of. Did you notice Francine's post about the chat tonight? There will likely be lots of people there too who can give you some info. Enjoy your sweet little girl. What's her name?

-Tina (Nicole's Mom)

Tina,
I had the two tests done because I will be having surgery next month. The mod quad that I had last year gave me a lot of new hand motion as the ulnar nerve was freed up. This surgery will be a decompression of the ulnar nerve at the elbow and the wrist. I am hopeful that I will see further change. So yes, the reason I had the test was indeed because I am considering nerve surgery.
In a nerve conduction, brief electrical shocks are delivered to the nerve in an effort to determine how fast or slowly that nerve is conducting the electrical current. The EMG tests the muscle to see how well the nerve is supplying innervation and if there are any problems with the muscle. So the basic difference is that the EMG is examining muscles and the nerve conduction is testing the nerve that supplies those muscles. That is my take on it, anyway.

Nancy

Hi Heather. My daughter, Alexyss, is going to have her second EMG next Wednesday. She will be 6 months. My daughter was sedated, but it was not that bad. She whinced when she was stuck(about 6 times), but went back to sleep. She was not real sore afterwards, but I gave her aspirin anyways(just to be on the safe side). If the surgery is successful and the nerves rejuvenate then her arm should grow to the size of the other arm. If the surgery is not successful, you might have to go through a second surgery of the muscles or they can do bone surgery at about the age of 6 where they cut the bone in half and turn it around. Her orthopedist told me this just a couple of weeks ago. Get your daughter on her stomach with her arm bent in front of her so that she will be applying pressure to the muscles. Why don't you email me and we can go into more detail about anything. I think the EMG is good because it lets you know where you and your daughter are standing and working with. My email address is: littleones26@yahoo.com

marlin had the emg done at tch when she was 5 months, there was a dispute between what the two drs who evaluated her, one was convinced that she would benefit from surgery and the other wanted to send her home. as it turns out the emg gave us information that indicated that she did require surgery, however what no one really knew was that the nerves were avulsed until the actual surgery. the emg was only moderately annoying and only lasted for about 5 minutes, i thought it was worth the minor discomfort to get a better diagonis. it is very difficult to tell the severity of an injury by a visual . just one person's opinion though

Thanks for the info., Nancy. I didn't realize that you were having surgery. Also, I tend to forget that there is "other" nerve surgery besides the primary. I hope the surgery works out well for you and that you get the results you're hoping to see. Please keep us posted. -Tina