DATE OF STUDY: MM/DD/YYYY
REFERRING PHYSICIAN: John Doe, MD
PROCEDURE PERFORMED: EMG nerve conduction study.
HISTORY: The patient is a (XX)-year-old female with progressive weakness and difficulty walking. She has been symptomatic with problems in her lower extremities. Since approximately this summer, she had had back pain for which she had undergone epidural steroid injections and actually had excellent relief of her back pain following her second injection. It was subsequent to this time that she noticed difficulties with her lower extremities, and in the last 4 weeks, she has required a walker to get around. EMG nerve conduction studies were ordered for bilateral lower extremities to evaluate for the possibility of radiculopathy versus a peripheral polyneuropathy.
PROCEDURE DETAILS:
1. Nerve conduction studies were performed on the bilateral lower extremities.
2. Bilateral sural sensory nerve action potentials, although did not have dramatically large amplitudes, were within normal limits both for amplitude and latencies and were reproducible.
3. Bilateral peroneal motor complex muscle action potentials were within normal limits for latency, amplitude and conduction velocity; however, both the amplitude on the right as well as conduction velocity on the right were on the lower limits of normal with amplitude being 2 millivolts, conduction velocity being 40 meters per second, which is at the lower limit of normal.
4. Bilateral peroneal F-waves were within normal limits. It was slower on the left than on the right, however, slightly.
5. Additional testing was done on the right upper extremity including the right ulnar sensory nerve action potential, which was within normal limits for latency at 3 msec, but was slightly diminished for amplitude at 9 microvolts. Reference range for normal is greater than or equal to 10 microvolts. The right ulnar complex motor action potential was within normal limits for latency, amplitude and conduction velocity.
6. Needle examination was performed in the bilateral lower extremities and showed no increased muscle membrane irritability. Abnormal spontaneous activity throughout the muscles tested. Concerning the volitional motor unit activity, there was slight decreased interference pattern, which was really pretty much throughout, and we think this is related to effort. The recruitment was okay and she did not have a full interference pattern.
IMPRESSION:
1. There is no electrodiagnostic evidence of an acute radiculopathy, plexopathy or myopathy of the bilateral lower extremities.
2. Nerve conduction studies for the lower extremities are actually within normal limits; however, the conduction velocities are noted to be at the lower limits of normal, especially on the right side. On the right upper extremity, the right ulnar sensory nerve action potential shows very slightly diminished amplitude. These subtle findings really do not support any peripheral polyneuropathy. The suggestion of sensory axonopathy is possible; however, the fact that it is isolated to the ulnar, sensory nerve action potential is really of uncertain clinical significance. A new sterile disposable needle was used and discarded.
Thank you very much for this referral. If you have any questions, please do not hesitate to contact me.
