Thanks Syeda. In a nutshell in Myopathy one gets small polyphasic units recruiting rapidly to a full interference pattern with minimal effort and Neurogenic changes are enlarged and often polyphasic units with reduced interference patterns.
Thanks, this gives me a high degree of confidence that the NCS/EMG study that I am scheduled for will actually yield some valuable information to enable my physician to do an accurate diagnosis.
You are amazing, Dr. freilich. I’ve been watching your videos for the last few months and they’ve helped so much in clarifying concepts and guide further reading. Thank you so much for being amazing.
You all probably dont give a damn but does anybody know a method to log back into an instagram account?? I stupidly forgot the login password. I would love any tips you can give me
Hello, i have a question. I had a biopsy test done and my results were 4,6 mf p mm skin in the lower right leg. They said this would be classified as normal but its not far away from an sfn diagnosys. My emg showed high amplitude potencials in 3 limbs. Up to 1633 uv. I read that a sfn wouldnt rise the amplitude in an emg. Originally i went to the neurologist because of fasciculations and im very concerned about a possible motor neuron desease. So could the reason for the higher amplitude in emg mean that i have a beginning sfn and dont have an mnd?
A good question and it depends on lots of factors e.g which muscle, time since onset, severity, as well as the type of needle used and machine filters (I could go on..). Usually above 3mV tends to be considered enlarged but it's not just about the amplitude.. morphology, width, pattern of recruitment and insertional activity all contribute to this evaluation. Bw Simon
Hi there. My EMG after a year of cervical radiculopathy showed chronic denervation (mild-moderate) in brachioradialis and moderate chronic partial denervation in triceps and to a lesser extent in deltoid. What is the difference between denervation and partial denervation? Also, do larger motor units cause slower contractions and therefore slower movements? I.e. is there a functional difference between a normal muscle and a reinnervated one? Thank you!
Hi again John, there are 2 approaches to doing this, either under the chin or directly into the side of the tongue. It looks weird but is actually very well tolerated (which never ceases to surprise me). I personally prefer the under chin method. Inferring (rightly or wrongly) from your line of questions, it seems that you may be due to have an EMG? If so, good luck with it and very best wishes.
This is new to me so I don’t really understand and am not sure that it’s related to this video directly, but can I ask you about normal emg results but delayed reactions and if this could only be due to being cold or if there are other causes?
Hi Jenna, I'm not sure what you mean but would direct you to the person who did your tests in the first place, as it seems that it might be more complex than a brief RUclips answer. Bw Simon
Why when I got an EMG I didn't feel anything not even the pokes or electricity, is that normal, painful neck, shoulder, back and chest with painful radiation burning on my skin on elbow and progressive loos of arm strength. Thank you.
1.The needles are very thin 2. The tips are super sharp and if you take a look at the videos I made on single fiber emg you can see just how small and sharp they are 3. Unlike blood taking needles they aren't hollow so they dont cure your skin 4. A good EMGer (not a proper word but hey...) can perform distraction techniques much like a skilled magician (doesn't work on everyone and not something your formally taught) 5. I get asked this all the time and quite honestly, if it didn't hurt, don't complain ;) Bw Simon
Dear John, The answer to this depends entirely upon where the disease stage is at and what type of ALS a patient may have. For example, the upper motor neuron predominant form (PLS) which is characterised by spasticity, can be quite challenging as denervation in the muscles is often quite sparse and so difficult to pick up with the EMG. Conversely, lower motor neuron predominant MND can have very florid changes which are easy to detect but can be difficult to distinguish from other neuro-muscular conditions. Hope this makes sense, and best wishes Simon
Hello doctor, i have a question about my abnormal EMG test results. I have right leg and right arm weakness but i can move normally. I’m 25 years old and i have numbness, tingling and twitching all over my body, especially in my legs and feet. My EMG says ( i will try to translate it from my language to english): We register normal motor and sensory speed of conduction of the nerves of lower extremities with reduced amplitude potentials n tibialis left. The needle test of lower leg muscles on both sides shows there is no signs of acute denervation. However, we register high amplitude potentials of prolonged duration with moderate reduction in muscles of lower extremities but with no significant asimmetry. (What does this mean??) Left and Right TIB Anterior shows +1 on amplitude, reduction and pol. akc. Neu. Also the same for Left and Right Gastrocn (med). What does this mean? Doctor didn’t explain anything.
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Thanks Syeda. In a nutshell in Myopathy one gets small polyphasic units recruiting rapidly to a full interference pattern with minimal effort and Neurogenic changes are enlarged and often polyphasic units with reduced interference patterns.
Such a brilliant video, has helped massively for my neurophys exam, thank you!
Thanks, this gives me a high degree of confidence that the NCS/EMG study that I am scheduled for will actually yield some valuable information to enable my physician to do an accurate diagnosis.
Thanks Len and wishing you better soon!
Thanks Dr Simon. You explain so well
You are amazing, Dr. freilich. I’ve been watching your videos for the last few months and they’ve helped so much in clarifying concepts and guide further reading. Thank you so much for being amazing.
I'm a medical biller learning to bill those code...trust me it's harder than u explained
Is it necessary to test both arms to get an accurate reading
Random question? When I had the needle inserted into my leg, but I was unable to push down when they asked , my leg went weak is that normal?
Quite common actually, because it's often uncomfortable to contract the muscle with a pin inside it. Bw Simon
Excellent explanation! Thank you!
You all probably dont give a damn but does anybody know a method to log back into an instagram account??
I stupidly forgot the login password. I would love any tips you can give me
@Luciano Reginald instablaster :)
Great video!
I suffer with lots of twitching will the emg pick it up and diagnose me what it cud be
Hello, i have a question.
I had a biopsy test done and my results were 4,6 mf p mm skin in the lower right leg. They said this would be classified as normal but its not far away from an sfn diagnosys.
My emg showed high amplitude potencials in 3 limbs. Up to 1633 uv.
I read that a sfn wouldnt rise the amplitude in an emg.
Originally i went to the neurologist because of fasciculations and im very concerned about a possible motor neuron desease.
So could the reason for the higher amplitude in emg mean that i have a beginning sfn and dont have an mnd?
1. That's not high. 2. EMG isn't about size per se anyway. Bw Simon
@@DrSimonFreilich thanks a lot.
What about emg results of almost 4mv in the lower legs and fasciculations but without any other noticeble signs?
Perfect explanation, appreciate.
What amplitude are we talking about in the neurogenic changes?
A good question and it depends on lots of factors e.g which muscle, time since onset, severity, as well as the type of needle used and machine filters (I could go on..). Usually above 3mV tends to be considered enlarged but it's not just about the amplitude.. morphology, width, pattern of recruitment and insertional activity all contribute to this evaluation. Bw Simon
Doc. But can't increase amp and duration on your MUAP reading also be an early indication of ALS?
I have muscle twitching going on 7 months now. Whole body. Would this test be any good for me?
Hi there. My EMG after a year of cervical radiculopathy showed chronic denervation (mild-moderate) in brachioradialis and moderate chronic partial denervation in triceps and to a lesser extent in deltoid. What is the difference between denervation and partial denervation? Also, do larger motor units cause slower contractions and therefore slower movements? I.e. is there a functional difference between a normal muscle and a reinnervated one? Thank you!
Hi, too complex for a one liner but residual strength very much depends on baseline and age. Bw Simon
thank you very much your reply is explain me the difference.
thank you sir, do u have any lecture series on ncs emg? I really need that
Dear Dr.how do you test the Tounge with EMG?do you put a needle under the chin?
Hi again John, there are 2 approaches to doing this, either under the chin or directly into the side of the tongue. It looks weird but is actually very well tolerated (which never ceases to surprise me). I personally prefer the under chin method. Inferring (rightly or wrongly) from your line of questions, it seems that you may be due to have an EMG? If so, good luck with it and very best wishes.
This is new to me so I don’t really understand and am not sure that it’s related to this video directly, but can I ask you about normal emg results but delayed reactions and if this could only be due to being cold or if there are other causes?
Hi Jenna, I'm not sure what you mean but would direct you to the person who did your tests in the first place, as it seems that it might be more complex than a brief RUclips answer. Bw Simon
Do the muscles in ALS twitch on rest and stop when they are active or they twitch regardless of the state of muscle (rest/motion) ?
They'll twitch at any time. Bw Simon
Why when I got an EMG I didn't feel anything not even the pokes or electricity, is that normal, painful neck, shoulder, back and chest with painful radiation burning on my skin on elbow and progressive loos of arm strength. Thank you.
1.The needles are very thin 2. The tips are super sharp and if you take a look at the videos I made on single fiber emg you can see just how small and sharp they are 3. Unlike blood taking needles they aren't hollow so they dont cure your skin 4. A good EMGer (not a proper word but hey...) can perform distraction techniques much like a skilled magician (doesn't work on everyone and not something your formally taught) 5. I get asked this all the time and quite honestly, if it didn't hurt, don't complain ;) Bw Simon
sir please if you don't mind please explain me what are the basic difference of findings of EMG between myopathy and neuropathy. THANK YOU
Dear Sir,is it easy to diagnose ALS with EMG
Dear John,
The answer to this depends entirely upon where the disease stage is at and what type of ALS a patient may have. For example, the upper motor neuron predominant form (PLS) which is characterised by spasticity, can be quite challenging as denervation in the muscles is often quite sparse and so difficult to pick up with the EMG. Conversely, lower motor neuron predominant MND can have very florid changes which are easy to detect but can be difficult to distinguish from other neuro-muscular conditions.
Hope this makes sense, and best wishes
Simon
how do you differentiate chronic denervation from reinnervation in EMG findings?
Hi Sudha, important question but it's too complex for a one liner answer... bw Simon
Thank you for usefull video!
Much appreciated!
very helpful, thank you!
Sir is there any fellowship/observership course to get trained under you?
Thanks, it's great to be asked, but unfortunately it's not possible at this time. Bw Simon
is +2 Fibrillation able to heal
Yes. Bw Simon
@@DrSimonFreilich even if it's been 2 years ? But seeing improvement in last 2 months ?
how are you now brother@@csb.2513
Thanks Mohsin, not yet! Bw Simon
very interesting, thank you !
Hello doctor, i have a question about my abnormal EMG test results. I have right leg and right arm weakness but i can move normally. I’m 25 years old and i have numbness, tingling and twitching all over my body, especially in my legs and feet.
My EMG says ( i will try to translate it from my language to english): We register normal motor and sensory speed of conduction of the nerves of lower extremities with reduced amplitude potentials n tibialis left. The needle test of lower leg muscles on both sides shows there is no signs of acute denervation. However, we register high amplitude potentials of prolonged duration with moderate reduction in muscles of lower extremities but with no significant asimmetry. (What does this mean??)
Left and Right TIB Anterior shows +1 on amplitude, reduction and pol. akc. Neu.
Also the same for Left and Right Gastrocn (med).
What does this mean? Doctor didn’t explain anything.
Hi, I'm really sorry but I can't answer personal questions. You will need to ask them directly. Wishing you all the best though, Simon
I have the same issue with you how are you now
How are you now
@@iykegideon8199 i can relate to that. not one side but only ne foot small symptoms
Turn up the volume and hardly hear you
👋
Gr