Impression: 25 May 2015
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Peripheral conduction studies are consistent with bilateral median neuropathies localized at the wrist, right > left, with indications of demyelination and axonal damage.
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Needle EMG of the distal median nerve innervated muscles revealed an increase in insertional activity of both abductor pollicis brevii muscles, indicating re-innervation following a period of denervation. The occasional P-waves present in in both abductor pollicis brevii indicate the chronicity of the nerve entrapment. Normal findings of the pronator teres indicate entrapment distal to the site of the pronator teres. No acute denervation is indicated at this time.
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Peripheral conduction studies of ulnar motor, ulnar sensory, and radial sensory nerves were normal throughout.
Summary of Findings:
Nerve Conduction Studies
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Right median sensory latency to digits 1 and 3 are prolonged at 4.7 ms and 6.1 ms (nl < 3.8 ms) respectively, with normal amplitudes
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Left median sensory latency to digits 1 and 3 are prolonged at 4.2 ms and 4.7 ms (nl < 3.8 ms) respectively, with normal amplitudes
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Stimulation of right median motor nerve across the wrist demonstrated slightly increased latency at 4.8 ms (nl < 4.2 ms) and a decreased amplitude at 3.3 mV (nl > 5 mV)
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Stimulation of left median motor nerve across the wrist demonstrated slightly increased latency at 4.6 ms (nl < 4.2 ms) and a decreased amplitude at 3.4 mV (nl > 5 mV)
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Conduction studies at points proximal to the wrist show normal latencies, amplitudes, and velocities of the median nerve bilaterally
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Conduction studies of bilateral ulnar motor, ulnar sensory, and radial sensory nerves show normal latencies, amplitudes and velocities throughout the upper extremities.
EMG Studies
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Needle EMG of bilateral distal median nerve innervated muscles detected increased insertional activity and positive sharp waves in both abductor pollicis brevii. Normal duration, amplitude, shape, and recruitment were found for the pronator teres muscles bilaterally.
Please correlate these findings clinically.
Thank you for the opportunity to participate in the care and evaluation of your patient
K. James, SPT
Patient History:
Ms. Dolinar has a 2-year history of intermittent tingling in hands R > L that has become more persistent in the past 2 months. The tingling begins at the wrists and travels through her 2nd, 3rd, and 4th digits. This often presents with hands being cool to touch. She notes weakness with grip strength; particularly with work related activities of opening cans and jars. She reports mild discomfort around her neck but has not noticed a correlation between her neck pain and the parasthesias in her hands. PMhx: Unremarkable. Meds: Trivora, Allegra, Adderall. Rx reads: EMG/NCV B UE
Clarifying Examination:
Cervical spine cleared with full ROM in all planes. Full ROM of shoulder, elbow, and wrist bilaterally in upper extremities. A neuro screen revealed symmetrical DTR’s of 2+ in biceps and triceps and 1+ in Brachioradialis. Impaired sensation was found on the palmar aspect of digits 2, 3, and 4 bilaterally. Upper extremity myotomes testing was strong and pain-free throughout. Decreased grip strength was found bilaterally with right > left.
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