NERVE CONDUCTION STUDIES NOW SPECIFIC ON THE DIAGNOSIS OF CHEMOTHERAPY INDUCED PERIPHERAL NEUROPATHY

It is a well known fact that both chemotherapy and radiation for cancer patients causes peripheral neuropathy. However, a new study shows that recording from the dorsal sural nerve (DSN) may be a good method for early detection of oxaliplatin-induced peripheral neuropathy (OXAPN), a drug used widely in cancer treatment.

The researchers found it may be a better predictor than traditional sural nerve recording and should be easy to implement in clinical practice.

Paola Alberti, MD, from the Department of Surgery and Translational Medicine at the University of Milano-Bicocca in Monza, Italy, reported results at the 24th Meeting of the European Neurological Society.

Dr. Alberti explained that while oxaliplatin is a cornerstone drug in the treatment of colorectal cancer, neurotoxicity is the dose-limiting effect of the drug, causing both acute but transient cold-induced paresthesia after infusions as well as potential chronic axonal sensory neuropathy, manifesting as sensory ataxia and neuropathic pain. 

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STRAIGHT TO THE POINT

 

What are the 3 Major Problems of Independent Medical Practices?

  1. Decreased Reimbursements causing difficulty to manage financially the independent medical practice
  2. Pressure to sell to large Hospital organizations
  3. Challenges in comprehensive patient management

 

What is the Current Practice Model of Independent Medical Practices?

current practice model of independent practices

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ELECTRODIAGNOSTIC FEATURES OF TRUE NEUROGENIC THORACIC OUTLET SYNDROME

Blog by: Dr. Dimitrios Kostopoulos

Thoracic outlet syndrome (TOS) is defined as a variety of disorders resulting from compression, injury, or irritation of the nerves and/or blood vessels in the lower neck and upper chest area. Thoracic outlet syndrome is named for the space (the thoracic outlet) between your lower neck and upper chest where this grouping of nerves and blood vessels is found.

Causes for TOS include a cervical rib, old fracture of the clavicle, soft tissue abnormalities (scalenus muscle), tumors or large lymph nodes in the upper chest or underarm area, repetitive stress injuries and others.
The signs and symptoms of TOS include neck, shoulder, and arm pain, numbness or impaired circulation to the affected areas
There are 3 major kinds of TOS: Neurogenic, Venus and Arterial.
True neurogenic thoracic outlet syndrome (TNTOS) is rare, with an estimated incidence of only 1 per 1,000,000.

thoracic-lesions

In April 2014, Tsao et al reported on the electrodiagnostic features of a TNTOS. They reported the electrodiagnostic
(EDX) features of 32 patients with surgically verified true neurogenic thoracic outlet syndrome (TN-TOS).

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CARPAL TUNNEL SYNDROME. A new Treatment Solution

Numbness and tingling in the fingers? Burning sensation or pain that extends from the fingers to even above the elbow? Weakness in your grip?

One of the most common causes of these symptoms is compression (entrapment) of one of the nerves passing through the wrist area called: The Median Nerve. This condition is called: Carpal Tunnel Syndrome or CTS.

This nerve provides sensation to your thumb, index and middle fingers and to half of your fourth finger. As you can see from the picture the median nerve is positioned within a canal in your wrist area (carpal tunnel) and passes below a tough ligament (transverse carpal ligament).

Carpal tunnel syndrome can affect anyone. In the U.S., roughly 1 out of 20 people will suffer from the effects of carpal tunnel syndrome. Women suffer more from CTS than men with a ratio of 3:1 between the ages of 45-60 years. Only 10% of reported cases of CTS are younger than 30 years. Increasing age is a risk factor. CTS is also common in pregnancy.

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Carpal Tunnel Syndrome or Cervical Radiculopathy? EMG Testing can provide the answer.

Carpal Tunnel Syndrome is defined as the entrapment of the median nerve in the carpal canal at the wrist. The condition which affects 1 in 20 people can cause numbness, tingling, burning sensation and pain affecting the fingers receiving sensory innervation by the median nerve.

At the same time, in the hand, the median nerve supplies motor innervation to the 1st and 2nd lumbrical muscles. It also supplies the muscles of the thenar eminence by a recurrent thenar branch. The rest of the intrinsic muscles of the hand are supplied by the ulnar nerve.

Aside from the sensory deficits, severe entrapment of the median nerve at the wrist will cause weakness in the grip with patients complaining of dropping objects while atrophy of the thenar eminence becomes obvious.

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Musculoskeletal Ultrasound Used in the Diagnosis of Carpal Tunnel Syndrome

Over the past 20 years, neuromuscular ultrasound has been introduced into electrodiagnostic laboratories as a complement to nerve conduction studies and electromyography for the diagnosis of a variety of nerve and muscle conditions.

Carpal Tunnel Syndrome (CTS) is the most commonly studied condition with neuromuscular ultrasound, and individuals with CTS have displayed ultrasonographic evidence of focal enlargement of the median nerve at the wrist.



But the most important use of, neuromuscular ultrasound for median nerve entrapement at the wrist is to identify the causes of the median mononeuropathy and structural anomalies that could not be detected with electrodiagnostic studies alone, such as compressive cysts, tumors, bifid median nerves and vessels.

A recent study published at Muscle & Nerve demonstrated that in at least 20% of the CTS cases ultrasonography of the median nerve can identify one of the above causes as the culprit for the condition and therefore intervention can be more appropriate and effective.

 

Nerve Damage in Diabetes and the benefits of EMG/NCS Studies

Diabetes, especially if uncontrolled, can cause damage the nerves of the body. This damage occurs due to decreased blood circulation to the nerve tissue and due to the high blood sugar levels. The condition is called diabetic polyneuropathy since it affects multiple nerves of the body. It usually develops 10-20 years after the initial diagnosis.

Diabetic neuropathy can damage not only peripheral nerves in the extremities (hands and feet) but also cranial nerves and nerves to vessels and organs of the body (autonomic neuropathy).

 

When it comes to the nerves of the hands and feet the condition will cause decreased sensation but also numbness and tingling. Many patients suffer burns in their hands because they cannot feel the hot stove or injuries in their feet because they may not feel a sharp object when they step on it.

Eventually the condition may affect motor nerves and cause weakness on the muscles of the feet and hands.

Electromyography (EMG) and Nerve Conduction Studies (NCS) can be a very useful tool to identify the neuropathic changes and quantify the severity of the condition. EMG/NCS is a very easy test and can be performed in about an hour. The specialist performing the test uses mild electrical impulses on the examined nerve to evaluate the ability of the nerve to conduct the change in potential along the nerve. Also a small pin may be used to evaluate the integrity of the examined muscles.

Long term control of the diabetes along with pharmacotherapy, proper nutrition, exercise and vitamin supplementation may help improve the neuropathic changes and this improvement may be evaluated by EMG/NCS testing. For additional information please visit: www.HandsOnEMG.com or call: 1-855-EMG-TEST

 


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"Hands-On EMG Testing has helped me get back to work. Before I had an EMG done, my doctor was not sure the cause of my problem, and after Dr. Kostopoulos performed an EMG on me, we finally had the answer that we were searching for. Thank you Hands-On for the excellent work!"

Sophia Canberra (New York, NY)

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