Neurodiagnostic testing, or electrodiagnostic testing, is a method to evaluate the physiologic function and nerves and muscles. It is used to diagnose peripheral nerve injuries such as carpal tunnel syndrome and spinal nerve injuries causing sciatica or radiculopathy.
Dr. Scott holds the highest level training and board certifications needed to complete these studies and has been doing so for over 20 years. EMG/NCS studies, as they are often called, involve the stimulation of multiple nerves and the measurement of physiologic muscle responses. The tests involve tiny surface electrical stimulations and the placement of wired acupuncture type needles into several muscles to measure muscle activity. The electrical stimulation portion of the test is also known as nerve conduction studies or NCS. These are not really painful but feel like a very small shock that may cause muscles to twitch briefly. Needle electromyography, EMG, does not involve any electricity or stimulations but involves the placement of a very small needle just under the skin into the underlying muscle. The needle is small enough that one may not feel it’s placement in many muscles but in some muscles can cause a sharper cramping sensation that is uncomfortable. For this reason Dr. Scott applies a local anesthetic to the skin prior to placing the needles.
While many people are apprehensive regarding what they’ve heard or may expect regarding these procedures they are really not as uncomfortable as one would guess. Dr. Scott takes his time and does his best to make this experience as comfortable as possible.
These procedures are used to diagnose and treat low back pain caused by inflamed, strained, or arthritic joints in the back and neck. The joints line the spine on both sides, lie deep to the paraspinal muscles but closer to the skin than the discs and nerves. Pain is typically local, worsened with standing or with any prolonged position, and worsened with leaning back as opposed to bending forward. Pain is not associated with any numbness or tingling in the arms or legs. Each joint is typically fed by 2 tiny nerves that transmit pain signals from the joints towards the brain.
Facet blocks: A physician, using an x-ray machine, can inject the joints with a very small amount of anesthetic and cortisone to provide pain relief that may last from several weeks to several months. These work best to treat pain following injuries or to treat flares of pain and those of chronic conditions. Chronic pain due to facet joint conditions is typically initially addressed with medial branch blocks.
Medial Branch blocks: This procedure involves the placement of local anesthetic only on the tiny nerves to the facet joints, for the purpose of diagnosing which joint(s) causes the pain. The local anesthetic lasts about 8 hours. If the patient’s pain resolves for this period of time than we have identified the source of pain, the facet joint. The patient may then be a candidate for radiofrequency ablation (AKA facet rhizotomy) procedures, to provide longer-lasting relief of pain from the facet joints.
Radiofrequency ablation procedures provide the most long-lasting treatment available for chronic spinal joint pain. Once the painful joint or joints is/are identified with diagnostic medial branch blocks (see above), then the physician, using X-ray guidance and an equipped needle, is able to create a very small radiofrequency lesion on the pain nerve to the joint(s). This procedure typically takes less than 5 minutes per joint, is completed with local anesthesia, and the benefit lasts 9 months to 2 years.