The Effect of Monochromatic Infrared Energy on Sensation in Patients with Diabetic Peripheral Neuropathy

Based on 5.07 monofilament testing there was no statistical difference in lower extremity sensitivity when using monochromatic infrared energy as compared to a placebo. This study is an underpowered, negative trial due to its small sample size and inclusion of the null value. Clinical judgments prove difficult to determine due to sample size.  Level of evidence: 2b Citation/s: Clifft, J. K., Kasser, R. J. (2005). “The effect of monochromatic infrared energy on sensation in patients with diabetic peripheral neuropathy.” Diabetes Care 28(12): 2896-2900. Lead author’s name and fax: Judy Clifft, UTHSC Department of Physical Therapy, 930 Madison Ave., Room 650,…

How Well Do You Know Your Nerves?

Evaluating the neuroanatomy of any patient is an important part of the clinical exam that is vital in making an accurate diagnosis. Just because a patient cannot raise their arm above their shoulder does not inherently mean their ailment is a musculoskeletal shoulder issue. There should be a list of possible diagnosis that need to be ruled out. Let us take for example the above mentioned shoulder patient. What are the possible diagnoses given this limited amount of information? They could have a labral tear, rotator cuff tear, axillary nerve lesion, brachial plexopathy, C5/C6 cervical radiculopathy, or frozen shoulder to…

When the EMG Comes back Normal: What Else Could be Going On?

Several weeks ago I published a blog describing the kinds of neurologic disorders revealed by electromyography and nerve conduction studies (EMG/NCS) in patients who are suspected of carpal tunnel syndrome (CTS) on clinical grounds. In most of these patients, EMG/NCS serves to confirm the presence of median nerve pathology and to describe how severe it is, but other disorders like radiculopathy and ulnar nerve compromises can also be found masquerading as carpal tunnel syndrome. A third possibility is that the test may yield normal results. Indeed, of the 338 patient records I examined, 14% of those referred with suspicion of…

An Electromyographer's Look at Hereditary Neuropathy with Liability to Pressure Palsy

Hereditary neuropathy with liability to pressure palsy (HNPP) or tomaculous neuropathy shares a molecular genetic relationship with Charcot Marie Tooth Disease type I (CMTI) in an autosomal dominant manner1.  Most cases of CMT1A are caused by the duplication of 1.5mb in chromosome 17p11.2, while upwards of 85% of all HNPP cases are a result of the inverse of this mutation1. Mutations within the PMP-22 gene cab also cause HNPP1, 2, 3.  The term “tomaculous” is derived from the focal globular thickening of the myelin sheath that resembles sausages, which are revealed during nerve biopsies1,3. The purpose of this case study…

Taking the Mystery Out of an EMG/NCS Report – Part 2

In Part One of this article, I discussed the basics of nerve conduction studies and waveform analysis. In Part Two, I will cover principles of needle electromyography (EMG), specific diseases and injuries that relate to hand therapy, and how EMG/NCS findings relate to outcomes for certain injuries and surgeries of the upper extremities.   The needle EMG examination is performed “on the fly” requiring in-depth knowledge of nerve and muscle physiology and how they relate to both normal and abnormal electrical activity in the muscle. While the muscle fibers belonging to a single motor unit can be distributed over 5-10 mm or more, the needle records…