Transcribed EMG Sample Reports For Medical Transcriptionists:
REFERRING PHYSICIAN: John Doe, MD
Nerve conduction studies were performed on the bilateral upper extremities. The left median sensory nerve action potential was within normal limits for latency and amplitude of latency was 3.3 milliseconds, amplitude 23 microvolts, reference range for normal is less than or equal to 3.8 milliseconds and greater than or equal to 20 microvolts. The right median sensory nerve action potential was within normal limits for latency at 3.4 milliseconds, amplitude was slightly diminished at 18 microvolts.
Bilateral ulnar sensory nerve action potentials were within normal limits for latency. The latency of the right ulnar was 2.9 milliseconds, which was 0.5 milliseconds faster than the right median which is at a cutoff for carpal tunnel syndrome or median mononeuropathy at the wrist based on relative latency for the ulnar compared to the median sensory fiber.
The left median motor complex muscle action potential was within normal limits for latency, amplitude, and conduction velocity with latency being 3.4 milliseconds, amplitude being 6 millivolts, and conduction velocity being 50 meters per second. The right median motor complex muscle action potential was within normal limits for latency at 4 milliseconds. The amplitude, however, was diminished at 2.4 millivolts with a conduction velocity borderline slow at 49 meters per second. Reference range for normal, for conduction velocity, is 49-65 meters per second.
Bilateral ulnar motor complex muscle action potentials were within normal limits for latency, amplitude, and conduction velocity including across the elbow, on the right side, which is the more affected side.
Needle examination was performed on the bilateral upper extremities and associated paraspinal muscles and there was slight increased muscle membrane irritability noted in the right abductor pollicis brevis, however, really no significant abnormalities noted throughout the rest the muscles tested on the bilateral upper extremities including paraspinal muscles.
Concerning volitional motor unit activity, there was slight increased amplitudes noted in the right abductor pollicis brevis muscles but otherwise there were no abnormalities noted.
IMPRESSION:
1. Abnormal study.
2. There is electrodiagnostic evidence of a median mononeuropathy affecting both sensory and motor fibers, primarily axonal, and does appear to be primarily affecting at the wrist. Some of these findings may actually be fairly chronic in nature given the reinnervation potentials noted by virtue of the elevated amplitudes. These findings are consistent with carpal tunnel syndrome, moderately severe.
3. There is no electrodiagnostic evidence of an acute radiculopathy, plexopathy or myopathy of the bilateral upper extremities. A new needle, sterile and disposable, was used and discarded.
Thank you very much for this referral.
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REFERRING PHYSICIAN: John Doe, MD
INDICATION FOR STUDY: The patient is a (XX)-year-old female who complains of numbness, tingling and weakness in bilateral hands and fingers. The patient’s symptoms have been intermittent. The patient has had electrodiagnostic testing done and was told that she had carpal tunnel. Her current symptoms are worse on the right than on the left and she notes that the pain actually starts for her in the region of her elbow. She denies any diabetes, thyroid disease or cancer.
SUMMARY:
1. Nerve conduction studies were performed on the bilateral upper extremities.
2. Bilateral median sensory nerve action potentials showed prolongation and diminution. The absolute findings left to right were 6.6 and 5.4 milliseconds for latency, reference for normal is less than or equal to 3.8 milliseconds. The amplitude was 7.4 and 8 microvolts respectively, reference for normal is greater than or equal to 20 microvolts.
3. Bilateral ulnar sensory nerve action potentials were within normal limits for latency and amplitude.
4. Bilateral median motor complex muscle action potentials showed prolongation and diminution. The absolute latency was 7.2 and 6.3 milliseconds left to right, reference range for normal less than or equal to 4.2 milliseconds. Amplitude was 2.8 and 3 millivolts left to right with reference range for normal greater than or equal to 4.4 millivolts.
5. Bilateral ulnar motor complex muscle action potentials were within normal limits for latency, amplitude and conduction velocity. An inching technique was used on the right median motor and did show good recovery of latency from 6.3 milliseconds to 2.5 milliseconds at 5 cm with improvement of amplitude from 3 millivolts to 8 millivolts.
6. Needle examination was performed in the bilateral upper extremities and associated paraspinal muscles. There was no increased muscle membrane irritability or abnormal spontaneous activity, except for complex repetitive discharge in the left paraspinal muscle group. There were some increased amplitudes noted in the abductor pollicis brevis muscles bilaterally.
IMPRESSION:
1. Abnormal study.
2. There is electrodiagnostic evidence of a median mononeuropathy at the wrist bilaterally. Findings are worse on the left than on the right. They affect both sensory and motor fibers and have both demyelinating as well as axonal features. There is no evidence of acute denervation noted; however, there is some evidence of reinnervation potentials noted in the bilateral abductor pollicis brevis muscles. These findings are consistent with a moderately severe carpal tunnel syndrome bilaterally, worse on the left than on the right.
3. There is no electrodiagnostic evidence of an acute radiculopathy, plexopathy or myopathy of the bilateral upper extremities. The complex repetitive discharge in the left paraspinal muscle is suggestive of a remote injury pattern and may be related to possible underlying degenerative disk disease or cervical spondylosis. Further neuro imaging could be obtained if clinically indicated. A new sterile disposable needle was used and discarded.
Thank you very much for this referral.
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