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Thread Title: EMG/NCS and MRI
Created On Friday November 07, 2008 2:46 PM

rosellavera
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Friday November 07, 2008 2:46 PM

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How often can a patient undergo these studies per year? Once, twice?

Thank you,

Rose

rider001
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Friday November 07, 2008 4:46 PM

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Once to confirm or deny diagnosis, when a P&S report is forth coming, and if a pt's symtoms have significantly increased. But to answer your question: As often as the carrier is willing pay for them.

gaiassoul1@yahoo.com
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Friday November 07, 2008 4:56 PM

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depends on the diagnosis, depends on intervening trauma, depends on rationale....there are no timeframes carved in stone here.

rosellavera
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Friday November 07, 2008 7:58 PM

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EMG/NCS 6 months ago. Normal studies. These studies were conducted by a PQME. DOI 2005. I/W has not worked since. Under FMC, PTP wants another EMG/NCS. UR timely denies. FMC per PQME (elbow injury) over the counter medication and periodic follow ups with PTP. Why would PTP want to do further electrodiagnostic studies if the ones done 6 months ago were normal?

stewshe@comcast.net
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Sunday November 09, 2008 2:35 PM

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rosellavera,

If there has been a change in symptoms suggestive of "nerve" problems, then that would be a reason to repeat the studies.

Perhaps ulnar nerve problems suggesting possibly a surgery with the EMG/NCS being needed to confirm or refute the possible diagnosis?

From the fact a study was "normal" yesterday, it does not follow the same studies have to be the same today. There are many possibilities.

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rider001
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Monday November 10, 2008 9:27 AM

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The results of EMG studies often vary depending on the machine used and the test administrator. I have seen on too many occaisions postive results on one machine and negative results on another. I would question any PTP who did not at least try repeating studies before making a final determination.

Doc Newton
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Monday December 01, 2008 7:35 AM

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The fact pattern given here is rather sparse so I may be going out on a limb a bit.

Elbow injuries can secondarily involve the ulnar nerve which gives characteristic symptoms of numbness and dysesthesias into the 5th and 4th digits. If this is the case here, a negative EMG/NCV would not exclusively rule out ulnar neuropathy. Reasons?

1- First EMG/NCV study was technically suboptimal.

2- First EMG/NCV study was incomplete and failed to include measurement of the
"across elbow segment" as well as the "below elbow segment"

3- Condition progressed, notwithstanding time away from the job, the so-called
"tardy ulnar neuropathy" described in the neurological literature.

This is one of those cases where a blanket "yes" or "no" cannot be given. I would be interested in the rationale of the PTP who rightfully bears the burden of explaining the need for testing. I have seen all too many cases where a new PTP comes on the scene and orders a barrage of repeat testing for no good reason. On the other hand I have seen cases where a diligent and thorough new PTP reassesses a case and establishes a diagnosis previously missed.

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Fredric H. Newton, MD
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