Special Tests & Treatment Procedures
In order to enhance the recovery of our patients and return them to function, we may recommend the following procedures to provide information about a diagnosis or to treat your condition.
- Electromyography (EMG) – a test that is used to figure out if the bodies nerves are working properly. They can tell the doctor if nerves are compressed in your wrist, such as carpal tunnel syndrome, figure out if nerves are pinched in your neck, along with many other locations.
- The test listens to the electrical activity of muscles. When muscles are active, they produce an electrical current. This current is usually proportional to the level of the muscle activity. EMGs can be used to detect abnormal electrical activity of muscle that can occur in many diseases and conditions, including muscular dystrophy, inflammation of muscles, pinched nerves, peripheral nerve damage (damage to nerves in the arms and legs), and other conditions.
- WHY DID MY DOCTOR ORDER THE TEST?
An EMG is often performed when patients have unexplained muscle weakness. The EMG helps to figure out if and where a nerve or a muscle is not working properly. The EMG can also be used to detect true weakness, as opposed to weakness from reduced use because of pain or lack of motivation. EMGs can also be used to isolate the level of nerve irritation or injury.
DOES THE TEST HURT AND WHAT DO I NEED TO DO TO PREPARE?
There is some discomfort at the time the needle electrodes are inserted (if needed). The needles are very small, about the size of an acupuncture needle. They may feel like shots (intramuscular injections), although nothing is injected during an EMG. There is no special preparation needed for the test. For upper body EMG it’s preferable to wear a short sleeved or loose fitting top.
- Nerve Conduction Velocity (NCV) – this test is often done at the same time as an EMG. In this test, the nerve is electrically stimulated while a second electrode detects the electrical impulse downstream from the first. The distance between electrodes and the time it takes for electrical impulses to travel between electrodes are used to calculate the speed of impulse transmission (nerve conduction velocity). A decreased speed of transmission indicates nerve disease. The NCV test can be used to detect true nerve disorders (such as neuropathy) or conditions whereby muscles are affected by nerve injury (such as carpal tunnel syndrome).As with EMG, for upper body NCV it’s preferable to wear a short sleeved or loose fitting top.
- Musculoskeletal Ultrasound-Guided Injections – Ultrasound has become an indispensable modality to guide many injections for musculoskeletal disorders. Ultrasound offers many benefits over other forms of image guidance including its lack of ionizing radiation and its ability to identify soft tissue and vascular structures. With this modality, a needle is guided under constant visualization towards the targeted tissue so that therapeutic medication can be placed precisely at the area of injury. The end result is improved pain and function.Examples of ultrasound-guided injections include:
- Shoulder injections (rotator cuff/subacromial bursa, acromioclavicular joint, shoulder/glenohumeral joint, biceps tendon
- Elbow injections (lateral epicondyle, medial epicondyle, elbow joint)
- Wrist and hand injections (thumb/first CMC joint , carpal tunnel, trigger finger, DeQuervain’s tenosynovitis)
- Hip injections (hip joint, bursa/greater trochanter, piriformis, sacroiliac joint)
- Knee injections (knee joint, Baker’s cyst)
- Foot and ankle injections (Achilles tendon, ankle joint, plantar fasciitis, Morton’s neuroma, tarsal tunnel)
ARE THERE ANY SPECIAL PREPARATIONS FOR THE EXAM?
There are no special preparations for a musculoskeletal ultrasound injection examination.
HOW IS THE INJECTION PERFORMED?
You will be instructed to lie or sit on an examining table. A small device called a transducer is placed on the skin surface after a gel is applied to your skin to provide better contact. The gel can feel cool and could leave a dry white powder on your clothes, so you might want to wear easily washable clothing. A paper or cloth gown will be provided if necessary. The room is usually darkened during the examination so the examiner can see a monitor screen more clearly. The stenographer will position the transducer over the body part to be injected while the physician will adminster the injection.
WILL IT HURT?
There will be some discomfort as with any injection procedure, however ultrasound provides guidance so the physician can more accurately place the needle. This reduces the risk of additional pain and discomfort while increasing patient safety.
HOW LONG WILL IT TAKE?
The length of time for the injection varies with the complexity. A general guideline is between 30 and 60 minutes. After the injection you may safely drive home and eat and drink normally.