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If there is not a proper balance of these chemicals in the body, then the nerves may not conduct properly even though they are structurally intact.
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Nerve signals (called “action potentials”) are generated within neurons through a complex series of chemical reactions. Multiple sclerosis also often causes symptoms in the extremities, but because it is a central nervous system (brain and spinal cord) disorder it typically will not be detected by electrodiagnostic tests (which primarily evaluate peripheral nervous systems).ĭisorders like these are uncommon, but if they exist in a patient’s history, they may help to explain why EMG/NCS tests come back normal. Since sensations essentially come from the brain, pathology in the brain often creates abnormal sensations in the body.įor example, a stroke affecting the right postcentral gyrus (a part of the brain that receives sensory information) may leave a person unable to feel his or her left hand.įigure 1: Areas of the postcentral gyrus responsible for sensation of various body parts. Thus, although normal EMG/NCS results do not absolutely preclude a carpal tunnel syndrome diagnosis, they do cast some doubt, and many physicians opt for conservative treatment strategies when EMG/NCS evidence is lacking. That being said, surgical success rates are higher in those with electrodiagnostically established CTS. Indeed, some studies have shown that the majority of patients with a clear clinical diagnosis of CTS respond favorably to surgical intervention. Median nerve dysfunction at the wrist, as measured by EMG/NCS, is one of the signs that contribute to CTS, but if other clinical signs paint a very clear picture, carpal tunnel syndrome can be diagnosed even with normal test results. Carpal Tunnel Syndromeīefore diving into other symptom causes, let me be the first to acknowledge that normal EMG findings do not necessarily mean that a person does not have carpal tunnel syndrome.īy definition, syndromes are conditions with multiple signs and symptoms which “run together” (the original Greek meaning of the word) to create a distinct pattern. Pain and other symptoms are always very real to the person experiencing them, but because they rely on the brain’s interpretation (and sometimes misinterpretation) of stimuli, they do not always line up well with their own causes. Keep this in mind as we discuss some sources of hand symptoms which are not nerve related. My punch really didn’t make contact, but the mere sight of it was enough for his brain to generate the pain which seemed like an appropriate response to the anticipated hit.
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Similarly, when I was a boy, I would sometimes jokingly throw a punch past my younger brother’s shoulder, and when he would grab his arm and say, “That hurt!” I would argue back that “I didn’t even touch you!” As a medical professional I now understand that we were both right. The most classic example is phantom limb pain, where a person feels genuine discomfort in a hand or foot that no longer exists! When peripheral nerves are damaged, however, they send confusing signals to the brain, and the brain in turn produces abnormal feelings like numbness and tingling.īut our brains can even create sensations without any peripheral nerve signals to cue them. When the nerves and the brain are working properly, the things we feel make sense: a fluffy cat feels like a fluffy cat and cold steel feels like cold steel.
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In the first place, it is important to understand that all the things we feel-touch, pain, temperature, and even the “pins and needles” sensation of paresthesia-are products of our own brain interpreting the stimuli it receives. So what is going on with these patients? This is a big question, but in this post, I hope to shed a little light as we explore a few of the possible causes for carpal tunnel-esque symptoms (pain, numbness, and tingling in the hands) which lie outside the realm of peripheral nerve dysfunction. Indeed, of the 338 patient records I examined, 14% of those referred with suspicion of CTS had no evidence of nerve damage found with electrodiagnostic testing. A third possibility is that the test may yield normal results. In most of these patients, EMG/NCS serves to confirm the presence of median nerve pathology and to describe how severe it is, but other disorders like radiculopathy and ulnar nerve compromises can also be found masquerading as carpal tunnel syndrome. Several weeks ago I published a blog describing the kinds of neurologic disorders revealed by electromyography and nerve conduction studies (EMG/NCS) in patients who are suspected of carpal tunnel syndrome (CTS) on clinical grounds.