Peripheral Nerve Pain
Nerve entrapment syndromes on mononeuropathy can occur in athletes as a result of swelling in the surrounding soft tissues or anatomical abnormalities. These may affect the suprascapular nerve, the posterior interosseous, ulnar and median nerves in the forearm, the obturator nerve in the groin, the posterior tibial nerve at the tarsal tunnel on the medial aspect of the ankle and the inter-digital nerves between the third and fourth toes known as morton’s neuroma. Diagnosis of nerve injury is made via EMG/NCV testing. The treatment will include reducing the inflammation and source of compression of the nerves, with anti-inflammatory and nerve medications, physical therapy and injection therapy. Occasionally, these nerve entrapments may require surgical decompression.
Peripheral Neuropathy
Peripheral neuropathy is a chronic painful condition that can affect the small and large nerves in the body. There are many different kinds of peripheral neuropathy with many different causes. Peripheral neuropathies can be caused by Diabetes, alcoholism, chronic ankle edema or poor nutrition to the nerves as well as many auto-immune diseases. NCV/EMG testing may help to diagnose the condition and differentiate the nerve pain from radiculopathy. There are many different treatment modalities which focus on returning nutrition back to the nerve.
Physical therapy modality known as microvas has been very effective for helping to alleviate the nerve pain. Nutritional supplementation plays a key role to bring important nutrients to the small nerve fibers. If the pain is localized to a single nerve, injection therapy may be an option.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a condition where the median nerve may be compressed at is passes thorough the carpal tunnel. It is characterized by burning, tingling numbness and pain in the distribution of the median nerve (thumb, index finger, middle finger and lateral palm). Tingling and burning during the night are very common with carpal tunnel syndrome. Patients awaken with the need to shake their hands out. The pain can also radiate into the forearm, elbow and rarely shoulder. It is diagnosed via the EMG/NCV testing. Mild cases can be treated conservatively with anti-inflammatory medications and splinting. If symptoms persist despite bracing, then injection therapy with steroid helps to alleviate the pain and inflammation of the nerve. Very severe persistent cases may need a referral to a hand surgeon.
Electrodiagnostic Testing
What is NCV/EMG testing?Nerve conduction testing (NCV) measures the health of the nerve. It calculates the speed or velocity of the nerve as well as measuring the amplitude. This gives the physician information on whether the nerve myelin sheath has been injured and the extent of the injury. Electromyography, or EMG, tests the electrical activity of muscles, which can often be indicative of nerve damage that originates from the spine verses actual muscle diseases.
What are the risks?There are minimal risks to the patient. The needle portion of the exam may cause possible bruising if on blood thinners, infection or bleeding. Does it hurt?The procedure is mildly uncomfortable. There are low voltage zaps which may startle the patient during the NCV testing that is not painful, but possibly uncomfortable for sensitive patients. The EMG portion of the test uses acupuncture size needles, very, very tiny that are inserted into a few muscles for 1-2 seconds to read the electrical activity of the muscle and to see if the muscle has been damaged. How does it help me?NCV/ EMG is a very helpful study. It helps to differentiate the cause of the nerve pain such as a compression injury like carpal tunnel syndrome. The study can also show if a patient suffers from peripheral neuropathy, or spinal nerve root injury known as radiculopathy. It can also diagnose myopathies and other serious muscle diseases such as myasthenia gravis, amyotrophic lateral sclerosis, and muscular dystrophy.