Movement vs. EMG - Incongruency?

[motormonk]

Hi again,

I have another question... Oh, and here is a link to my previous post where I wrote about my condition: http://ubpn.org/messageboard/thread ... 4&tstart=0

Well, after my last EMG it looks like C5 has still some distance to cover till it reaches my axillary nerve and innervates my deltoid. But, at my PT center we have been seeing what is supposed to be some isolated deltoid movement since the second month post-injury. It did not recover as fast as some other muscle groups but we were still convinced I had some control over my deltoid (especially the anterior wall).

So, how come I can extend and raise my arm forwards to approximately 45 degrees without my deltoid? I can also lift my arm and point the ceiling with my hand when lying on my back (anterior deltoid) and I can lift my arm towards my back when I am lying face down (posterior deltoid?).

I am quite confident about the quality of EMG and I completely trust my doctor. I just need to know if there are known inconsistencies with the EMG tests. And when I asked about the movement the doctor said secondary muscles probably hypertrophied and took over some of the movement; maybe some supraspinatus, some pectoral. But still, my physical therapist can't think of any muscles other than my deltoid that can produce the movement in that trajectory.



So, can I have movement in my deltoid despite the silent reading in an EMG?

Or, what muscle groups could move my arm forwards without the tiniest help from the deltoid?

Any ideas?

[bensmom]

We are fairly new to this, so I don't have definitive answers, but I can't give you our experience. My husband has had a number of instances where movements seemed like they were his deltoid, but his PT told him it was other muscles "cheating", though his involved movement out to the side while lying on his back so I can't help you there. While at Mayo this week though, they did tell us taht EMG's are not absolute, there is some room for interpretation and in fact I posted this question back in November after DH's second EMG, I'll try to find it and bump it up. Also, one of the doctor's at Mayo also told us that results from the EMG lag behind what is actually going on with the nerves/muscles by about three weeks. She explained why this is so, but for the life of me I can't remember. I don't know if that helps or not. Good luck

[Aurelia]

Am afraid, its not your deltoid, as I have/had similar movement without the deltoid. Basically its your pecs lefting your arm up to the 45degrees and lying on your back other muscles like the lats/trapezius (not sure which) seem to take over the task, but that was in my case. When I lift the arm up in front of me, it brushes against my chest, and is right against my body, and I have been told its my pecs,I guess if you are moving it up away from your body you might be on to something.

[motormonk]

I also think part of the movement is by pecs, latissmus dorsi, supraspinatus, trapezius, etc. taking over.

But my arm doesn't brush against my chest like you describe. The movement is clean and perpendicular to my torso. I can also hold it towards my left/front, diagonally, to some extent. But it does not move away from my torso in a clean lateral trajectory, to the side.

Moves forward cleanly, moves diagonally relatively less, moves to the side even less.

[Aurelia]

It sounds to me like some deltoid movement, I can't quite get mine to 45degrees using pecs and it leans sideways then towards my chest, mind you I have no biceps either.

[ptrefam]

For Dustin when they thought he was getting deltoid they had him shrug his shoulders. Also for posterior they had him lay and try to use the shoulders to push down. Anterior would then be try to pull up the shoulders. Not sure if you are able to fire them or make these movements. But this should give an idea.
For Dustin they also say that he is using the rotator cuff to assist with these movements. They said that for some people this will happen and others not.
Sue

[motormonk]

Hi all,

Here is an update...

I've taken the EMG back to my surgeon (head of my 'flail arm project' : )) as the final chapter of my check.

He just disregarded the "no activity" part about the deltoid and told me the movement I have is impossible without at least some deltoid intervention. He clinically checked my arm again and was so certain. His reasoning was probably the EMG needles overshot the innervation points of my currently supposedly too thin deltoid tissue.

He told me the outlook is the opposite of what is suggested in the EMG: Being, I still have no rotator cuff (specifically infraspinatus, supra is quite good) but I have some deltoid movement. And he also told me he had also prioritized deltoid in his mind since he could fix infraspinatus with lattismus dorsi transfer even if it stayed inactive after the primary healing timeframe.

So... everything is back to the mystical shades of creepy gray since everybody has different opinions that cancel each other out.

The only solidish fact is I should be expecting the overall level of prognosis around 1 year. After that there will be only minimal progression.

Funny thing is the prof I went for the EMG was also a reliable expert. *Sigh*