Thanks for the interesting question. I can't give you a specific percentage as there are lots of variables at play. However, this specific stimulation point is often technically challenging because the tibial nerve at this point is deeply situated (unlike the ankle) and so the current may not adequately 'reach' it as there is lots soft tissues in the way. There are a number of ways to overcome this which can include changing the size of the stimulator, the material it's made from, pressure applied in and the characteristics of the stimulating impulse. All of which can make adequately testing that segment with adequate stimulation pretty uncomfortable. This is also coupled with the fact that it's fairly rare that this region yields sufficiently important extra information that cannot anyway be identified from the ankle stimulation point and EMG of Tibial innervated muscles (as well as studies of other nerves). Hence, I'm not a fan of routinely doing it as part of everyday practice and reserve it for specific situations. So in summary, this segment is recognised as being tricky but there are ways to overcome this, when sufficiently important to do so. Bw Simon
Microwave auditory effect. There's neuro patients misdiagnosed psychosis when they are being abused by someone causing them T.I.s to have Microwave auditory effect. Some T.I.s images and test results come back with abnormalities that are only compared to what's text book.. T.I.s need specialist My nerve conduction test came back with a result that the tech thought was a machine error thinking something must be wrong with the equipment. And then called it normal.. lol Patients who are victims of crimes are being medically neglected..
Hi Dr Simon, I'm Dr Djenane Malek Saber From Algiers, i work with Medicatech Neurology on neurophysiology equipement. i wish to thank you for all your very interisting video. keep going on.
I got completely confused halfway through😭 So if I only have amplitude change of -70% on the left leg and -90% on the right, summarized as "significant axonal changes", which diagnosis does it suggest? I've been to 4 neurologists and 3 of them looked at me like crazy and barely even knew what emg was... One prescribed tioctic acid and B vitamin supplements, and for the first month it helped with my confusion\foggy\drunky state, but 2 months on these pills and my muscles still hurt after a minute of biking, they feel very stiff and weak, I get tired doing minimal efforts and if I push myself physically, like on a bike, it hurts like being electrocuted on the inside... And the doctor who prescribed the pills basically said she doesn't know the reason, while I'm getting worse... I live in small town in a backward country and my only hope is internet at this point 😭
Thank you so much for your earlier correspondence! ❤😻 My Dr.s office are now going to do new Nerve testing on my feet. Their consensus seems to be the Neuromas and Plantar Fascitiis with the injections and Physical therapy are resolved/improved leaving the Neuropathy and Muscle loss (I believe it is actually atrophy due to the pain). Do you think the Neuropathy could have been caused by having been stepped on by a 2000# Draft Horse while I was wearing sandles? Nothing broken, yet that seems to be when my issues started. For some reason the Dr.s seem to discount that, to me, significant event. Will the Nerve testing affirm or negate CMT if My Insurance will not pay for the Blood/Gene tests? What can I watch for? I can't tell you how much I appreciate your Channel as it has given me hope again!!!! Thank you! 😻❤
Great video doctor! I have a question about my recent test. It was written 'both sural and superficial peroneal snaps are not stimulable'. Is this really bad. Thanks in advance for your help!
I have severe femoral neuropathy and this happened after my total knee replacement surgery. Who should I see that can explain my test. My orthopedic surgeon cannot.
Hi, I'd suggest you see a Peripheral Nerve Surgeon to see what can be done. Femoral neuropathy is incredibly disabling, much more so than Sciatic nerve lesions. Wishing you all the best, Simon
I’m having trouble finding information regarding the opposite and am hoping you can shed some light? What if the standard is 4.4 as normal on NCV and mine was 2? The physiologist basically said “wow” and that “was very fast”. Could this attribute to a condition such as overactive nerves, not under active/damaged?
Great question! Basically there's no recognised entity of nerve responses being too big or too fast. Standard nerve tests look at the physical attributes of conductivity rather than function of how nerves biologically behave. There are some conditions where they do actually fire off too much but you need access to highly specialised equipment for that and it mainly exists in the realms of research. Hope that helps, bw Simon
Hi, very interesting videos. I have a question regarding electrical conduction test. I had a test on my left lower leg.The test of the tibial nerve was conducted measuring the signal at the abductor hallucis muscle, invoked at ankle and knee. The test was successful from the ankle, but, despite repeated attempts, the technician was unable to detect a signal when the pulse was from the knee. The technician called in the consultant, and again the test was attempted a number of times unsuccessfully. How often is there a problem with this test?
Thanks, they vary depending on circumstances but I try and use a Sony a6000 whenever possible for best quality. This was shot in combination with a Sigma 30 1.4 lens at f2 and the sound was recorded externally using a Tascam with Rode Lav mic and synced in post. Bw Simon
Woukd neuropathy due to B12 deficiency be visible on this test? I have been waiting over a year for an appointment and I can barely move my arms anymore
hi dr.simon thank you so much for your grateful learning videos please I need some inportant notes about clinical neurophysiology in pdf or text form ...i need it as soon as possible if you help ne
Thank you for this video. Im told after have the EMT and nerve conductor test that I have Carpal Tunnel in both hands but my right hand has severe nerve damage and need surgery ASAP. I will be seeing the hand surgeon on 11/15. I'm wondering since it's so bad with my right hand will the surgery help? Thank you for your time!
+Kimberly Tyson Hi Kimberley, it depends on how bad it is. The evidence is that the best surgical outcomes occur when the degree of compression is still moderate. As it becomes increasingly severe, the probability of complete resolution begins to reduce. However, even when very advanced, there is usually a reduction in pain / discomfort. I think it's always worthwhile having a discussion with your surgeon as to what they expect the outcome to be. That way you will have good idea of the outcome in advance of the procedure. Good luck and best wishes!
Dr Simon Freilich I meet with the surgeon yesterday and he said I may get some relief but there's no guarantee since its so severe but it will keep it from getting worse. The good thing is I won't have to be cut there going to do the other method. Thank you for taking your time to reply.
Hello greetings from Nepal My wife had a norve problem from 7 months, I visited to many neuro physician and they tested norve conduction test and suggest to take some medicine and do physiotherapy But she still have problems in her hand Now her fingers are not able to up and down easily but can up down by force So what will be the best solution for her recovery?
Thank you so much for your earlier correspondence! ❤😻 My Dr.s office are now going to do new Nerve testing on my feet. Their consensus seems to be the Neuromas and Plantar Fascitiis with the injections and Physical therapy are resolved/improved leaving the Neuropathy and Muscle loss (I believe it is actually atrophy due to the pain). Do you think the Neuropathy could have been caused by having been stepped on by a 2000# Draft Horse while I was wearing sandles? Nothing broken, yet that seems to be when my issues started. For some reason the Dr.s seem to discount that, to me, significant event. Will the Nerve testing affirm or negate CMT if My Insurance will not pay for the Blood/Gene tests? What can I watch for? I can't tell you how much I appreciate your Channel as it has given me hope again!!!! Thank you! 😻❤
Thank you so much for your earlier correspondence! ❤😻 My Dr.s office are now going to do new Nerve testing on my feet. Their consensus seems to be the Neuromas and Plantar Fascitiis with the injections and Physical therapy are resolved/improved leaving the Neuropathy and Muscle loss (I believe it is actually atrophy due to the pain). Do you think the Neuropathy could have been caused by having been stepped on by a 2000# Draft Horse while I was wearing sandles? Nothing broken, yet that seems to be when my issues started. For some reason the Dr.s seem to discount that, to me, significant event. Will the Nerve testing affirm or negate CMT if My Insurance will not pay for the Blood/Gene tests? What can I watch for? I can't tell you how much I appreciate your Channel as it has given me hope again!!!! Thank you! 😻❤
Thanks Cat, delighted to have been of some assistance. Its difficult to comment, but nerves can be crushed and if this was so, then NCS could pick it up. They would also be able to confirm or refute the possibility of CMT and if they suggest it, then I'm sure your insurance would reconsider. A completely different alternative possibility, if NCS are normal, is complex regional pain syndrome,. This can follow trauma of this sort and cause painful symptoms. Best wishes and good luck! Simon
