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Table of Contents

Introduction
• Team Information
Objectives
Emma Curtis Case Study
• Information
• Medical History
• Physical Exam
    » Lab Results
    » EMG exam
• Action Plan

Authors:

Dovie Weston, MEd, OTR/L, †

Richard E. Oliver, PhD, †

Larry J. Petterborg, PhD, ‡

P. Kevin Rudeen, PhD, *

David D. Cravens, MD, §

Diana J. Baldwin, MA, OTR/L, FAOTA, †

Tarilyn Dobey, MEd, RRT, †

Marilyn Sanford Hargrove, PT, PhD, †

Damascene Kurukulasuriya, MD, §

Stephanie Reid-Arndt, PhD, †

Barry L. Slansky, PhD, CCC-SLP †


† School of Health Professions, University of Missouri-Columbia

‡ School of Physical Therapy, Texas Women's University, Dallas TX

§ School of Medicine, University of Missouri-Columbia

* College of Allied Health, University of Oklahoma, Oklahoma City, OK
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Interdisciplinary Geriatric Assessment:
Mrs. Curtis

Electromyographic Exam


Table 1: Motor nerve conduction
Nerve Latency mS Amplitude mV Velocity m/S Distance cm
R. Median Wrist-APB 11.7 (2.6-4.0) 2.8 (5-16)    
R. Median Elbow-APB 20.1 1.7 26.6 22.5
R. Peroneal Ankle-EDB 16.6 (2.8-5.4) 0.7 (2.5-14)    
R. Peroneal Fib. Head-EDB 33.0   6.83 33.5
R. Ulnar Wrist-ADM 11.9 (2.0-3.1) 2.9 (7-14)    
R. Ulnar Elbow-ADM 17.9 1.8 33.6 20.0


Table 2: F-waves
Nerve Latency mS
Marker 1     Marker 2		 Delta Lat.
M1 - M2
R. Ulnar absent  


Table 3: Sensory nerve conduction
Nerve Latency mS
Take off     Peak		 Amp (uV)
R. Median Wrist-Index absent  
R. Ulnar Wrist-D5 14cm absent  


Table 4: Routine needle EMG exam
Muscle / Root Spontaneous
Fibs   PSW  Fasc		 Othr MUAP Dur MUAP Amp Recruit Pattern
R. Ant Tibialis L4,5 2+     2+     -   -   NI   NI Few-MUPs
R. Ext Hal Long L5,S1 2+     2+     -   -   NI   NI Few-MUPs
R. Gastro-cnemius S1,2 1 1+     1+     -   -   NI   NI Mild decr

Electromyographic Exam Summary

There is conduction block with marked slowing of distal latencies and slowing of conduction velocities in all nerves tested. There is decreased amplitude of the CMAPs (compound motor action potentials) with absent SNAPs (sensory nerve action potentials). EMG reveals positive waves and fibrillations and decreased recruitment in the limited number of muscles tested.

Conclusion: These findings are consistent with an acquired demyelinating peripheral neuropathy. There is significant secondary axonal loss.

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Next: Action Plan

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Last Update: June 17 2008