Non-Surgical Orthopedics & Physiatry
Physiatrists, or Physical Medicine and Rehabilitation physicians, are nerve, muscle, bone, and brain experts who treat injury or illness non-surgically to decrease pain and restore function.
Physical medicine and rehabilitation physicians diagnose and treat a vast number of conditions, including: musculoskeletal injuries and pain syndromes such as trochanteric bursitis, injuries such as patellofemoral syndrome or rotator cuff syndrome, and degenerative conditions such as arthritis. They are trained in complex neurologic rehabilitation conditions including stroke, brain injury and spinal cord injury, and often use electromyography (EMG) and nerve conduction studies to evaluate neurologic disorders and diseases such as carpal tunnel syndrome and radiculopathies, or “pinched nerves”.
They perform a comprehensive evaluation of the problem to determine what can be done conservatively to treat the condition. Physiatrists are trained to diagnose the condition by using a patient’s medical history, a physical exam, X-rays, magnetic resonance imaging (MRI), musculoskeletal ultrasound and nerve diagnostic studies.
In developing a treatment plan, Dr. Lehman might order laboratory work or imaging studies, or she may perform diagnostic ultrasound imaging or electromyography and nerve conduction studies. The treatment plan might include physical therapy, therapeutic exercise, specialized training, orthotics, bracing, medications or injections of corticosteroid, hyaluronic acid, or platelet rich plasma.
Physiatrists often involve other specialists in caring for patients including physical therapists, as well as other doctors and specialists, such as orthopedic surgeons, neurologists, pain physicians and rheumatologists.
ELECTROdiagnostic testing (EMG/NCS)
Electrodiagnostic medicine is the study of diseases of nerves and muscles. By conducting an electromyography, or EMG, we can see if your muscles and nerves are working properly. If not, this test helps us determine the extent of your disease and how to treat it most effectively.
What is an EMG?
EMG stands for electromyography. This term is routinely used to describe specialized tests which involve electrical testing of nerves and muscles. The two most commonly performed electrodiagnostic tests are: Nerve Conduction Studies (NCS), Electromyography (EMG).
NERVE CONDUCTION STUDIES: NCSs show how well the body’s electrical signals are traveling to a nerve. This is done by applying small electrical shocks to the nerve and recording how the nerve works. These shocks cause a quick, mild, tingling feeling. The doctor may test several nerves.
NEEDLE EMG: For this part of the test, a small, thin needle is put in several muscles to see if there are any problems. It is used once for each patient and is thrown away after the test. There may be a small amount of pain during this part of the examination. The doctor tests only the muscles necessary to decide what is wrong. During the EMG test the doctor will be able to hear and see how your muscles and nerves are working by the electrical signals made by your muscles. The doctor then uses his medical knowledge to figure out what could be causing your problem.
What is the purpose of the test?
These tests are helpful in finding the causes of numbness, tingling, weakness, cramping, pain, or other loss of function. The doctor who performs and analyzes these tests can tell if your nerves or muscles are not working properly.
Why is an EMG test necessary?
An electrodiagnostic study is the only test of nerve function and it can determine if nerve damage exists. The test results will assist your doctor in establishing a plan of treatment specific to your needs.
What kind of medical training do doctors who do EMGs have?
Doctors who do EMGs go to 4 years of medical school then have 3 or 4 more years of training in a residency program. Most work as neurologists or physical medicine and rehabilitation doctors. Medical training helps the doctor decide which tests to perform based on your symptoms. It teaches doctors what can go wrong with the human body and how to tell the difference between these problems.
Who does the testing?
The American Association of Neuromuscular & Electrodiagnostic Medicine’s policy is that an appropriately trained doctor should do all needle EMG testing. A trained assistant or technologist under a doctor’s supervision can do nerve conduction studies.
What should I do before the test?
On the day of the test, do not apply lotions or oils to the skin. This is to ensure the adhesiveness of the electrodes and proper responses.
Loose fitting clothing is recommended. Since a majority of the test is completed on your extremities, loose fitting clothes allow for better access.
How is the test administered?
Certain areas are cleansed of any dirt and oils on the surface of the skin to ensure the best results. Depending on which area is being tested, you may be asked to lay down or sit upright. Electrodes are placed over specific sites on the extremities and small electric impulses are applied (NCV). The impulse is a part of the test and is harmless. During the latter part of the test, a tiny pin electrode (EMG) is used to measure electrical activity in the muscle.
What are the side effects?
There are no lasting side effects from the tests, but the testing itself can sometimes be uncomfortable. The NCSs involve small electrical shocks to the nerve which may cause a quick tingling of pricking feeling along with an involuntary twitch of the arm or leg.
EMG studies use a thin needle inserted into several muscles. These needles are disposable and a new one is used for each patient. Like any needle, some discomfort may be felt.
How long will the tests take?
The tests typically take 30 to 60 minutes depending on the complexity of the case. It is imperative to arrive 20 minutes early for your appointment in order to ensure adequate test time.