By Cory Bilton
Back in December 2014, I woke one morning with significant numbness and tingling in my left arm. After initially visiting an orthopedist, I was referred to a neurologist to perform a nerve conduction study and electromyography (“EMG”). I knew the doctor was looking to see if the nerve signals were travelling down my arm correctly. But I really had little to no idea what a nerve conduction study or EMG involved. It sounded innocent enough. Diagnostic testing would hopefully give me some insight about what was causing these symptoms in my arm.
What I didn’t realize was just how uncomfortable it is to have a nerve conduction study and EMG performed. Allow me to explain what these tests are like for the patient…
Nerve Conduction Study
My visit to the neurologist started off with a nerve conduction study. A nerve conduction study measures the speed of electrical signals travelling through specific nerves. I was brought into an examination room with a bed and a cart with a computer and electronic equipment on it. The technician asked me a bunch of questions about my symptoms. I explained to her that I was experiencing constant numbness and tingling, along with shooting pain up and down my arm. She told me that the test she was going to perform would involve a series of small electrical shocks to measure how well my nerves were conducting signals.
Before the test began, I thought I could easily handle some small electric shocks. In reality though, I didn’t really know what to expect, because I don’t experience electrical shocks very often. The shocks are relatively small. Each individual shock is manageable. It feels sort of like being snapped with a rubber band. Each shock caused a muscle in my hand or arm to contract sharply. Maybe out of sympathy, other muscles in both my arms and my legs started to contract with each individual shock as well. Just before each shock, the technician warned me, “A little shock” and sometimes “Stronger now.”
As I was shocked over and over again, I grew increasingly uncomfortable. I started to dread the verbal warning, since it was the cue that I was about to be popped. Over the course of 10-15 minutes, I receive a few dozen shocks. The anticipation preceding each shock became worse. I almost told the technician, “Stop warning me! I know you are about to shock me.” I was relieved when she told me she was finished.
But the testing was not yet over.
As I would soon learn, EMGs are also unpleasant. The neurologist himself performed the EMG. An EMG is a test that involves inserting a needle directly into a muscle. The needle is an electrode that measures the electrical activity within the muscle itself. The neurologist is testing the electrical activity within the muscle while it is both resting and flexing. I don’t particularly enjoy getting poked with needles. I consider myself a normal person in this respect. This was easily my least favorite needle experience of all time.
Here is how the test went, step by step. The doctor told me to relax. Then he inserted a needle, probably similar to an acupuncture needle, into a muscle. He then tapped on the computer and a static hiss emanated from the speakers. Then he would tell me to move my arm or hand in a specific way that would cause the muscle with the needle in it to flex. For example, “push your pinky finger against my hand.” The hiss from the computer would get louder and more violent. After a few seconds, he would tell me to relax and he removed the needle. Then he would move on to the next muscle and start again. He managed to find about ten or twelve different locations in my left arm and hand to test.
If you don’t like needles, enduring an EMG is going to be difficult. You’ll want to go to your “happy place” mentally. Being asked to flex a muscle while it has a needle in it is uncomfortable. The pain isn’t intense, but it stings. The fact that you are hearing the static hiss intensify as you flex your muscle, needle protruding, is psychologically disturbing. After the test was done, my left arm was bleeding from two of the puncture sites.
The fairy tale ending to this story would be that the nerve conduction study and EMG discovered the root of my left arm problems. But the truth is not as satisfying. This is the first line of my test results: “This is an unusually abnormal study with EMG abnormalities in ulnar hand muscles but without conduction block.” After discussing the results with the neurologist and then again with the orthopedist a couple weeks later, it appears the test is saying the source of the problem is not in my arm. So it rules out some things, but opens up other possible problems. Neither doctor could tell me much more than that. It is frustrating to have clearly manifested symptoms, but no answer as to what’s wrong. There is more treatment to come.
Please review my disclaimer.