Mge, nerve conduction test...anyone have one?
I've been having symptoms of a compressed nerve - pain going from elbow to hand & hand numbness. This came on along with a flare up of lymphadema, with swelling mainly in my elbow joint. I'm seeing a clt & the swelling has much decreased, but the pain continues.
I've been referred for a mge test to pinpoint the source, or to determine if this might be neuropathy. I see the test involves inserting a needle, or needles, into the arm muscles. Scary, as I feel that I finally got a handle on this lymphedema in my arm, afraid that this might set it off again.
Anyone have experience with this test or a similar one? Any ideas or advice on approaching this - I hate to have it, but feel I have no choice, I need to do it. I will make an appointment with my clt just after I have it so she can access...other than that?
Comments
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Amanda, I have had a couple of electromyograms for ulnar nerve problems, but it was many years ago (I ended up having ulnar nerve transposition surgeries twice).. It has been a long time, but I remember the needles as being very fine and much like the ones used for acupuncture. They conduct electricity to the needles and then trace the nerve reaction. I'll be honest that the test is not fun, but not horribly painful either.
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melissa, thanks so much, that really helps ease my mind!
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I'm with Melissa... I've had 2 EMG's - one several years ago that just involved an arm and leg. Less than 2 years ago? I had one for those same areas plus my back and neck. The first one smarted in each area though only for a split second. I never felt a thing with the 2nd one. I have polyneuropathy now though did not then so don't know if that makes a difference? I also think there was something about the doc who did the second one.... Best to you!
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Amanda, I had a couple EMGs a few years ago in the muscles around my eyes and in my arms, and the tests were ok. I didn’t feel the needles being inserted. The test itself was similar to a mild snap of an elastic band against the skin. All the best to you!
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livin & shar, thanks so much for your replies
. I'm having the test tomorrow & seeing my lymphadema therapist on Thursday, so feel reassured about it.
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Hi amanda6, thanks for posting about this - I had a similar situation come up recently, and it has been hard to pinpoint what is going on.
For me, I recently started having nerve pain in my upper inner arm, and buzzing and numbness in my thumb and index finger. I have had multiple surgeries and radiation treatments to my axilla, so I thought it could be some kind of late effect from that. However, this new problem has been a bit different, and it coincided with a lymphedema flare in my upper arm. I mentioned this to my MO, who said that lymphedema can definitely cause that kind of issue, because the extra swelling presses on everything. I thought that was very interesting, because I have never heard of that before, but to me it did seem that the nerve pain and the lymphedema flare were somehow related. I see my lymphedema therapist soon, and I plan to discuss it with her also. I hope that getting the swelling down a bit will improve things.
Anyway, I've never had any nerve conduction test, so I have no advice on that in particular, but please keep us posted on how you're doing and what you find out. I'm wondering if we might be having a similar problem, and if it's mostly caused by lymphedema. I hope you get some answers and relief soon!
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Interesting button, it does sound like we have something similar going on! This has been puzzling - I had lymphadema flare up during chemo almost 11 years ago, saw a clt who took care of it & never had a problem again until last spring. I took precautions with that arm but never wore a compression sleeve. The swelling started as very mild, them progressed & the elbow swelled & pain started in Sept. My feeling is that the lymphadema swelling caused the nerve involvement, my doctors -primary & orthopedic surgeon feel that the sleeve caused it - that seemed a stretch to me, but I did read something just today that said that small women ( I'm that) sometimes can't tolerate 20/30 compression & that the lower compression works better for them - the higher compression causes swelling! Strange...Anyway I just ordered a 15/20 tonight & will run that by my clt. My elbow swelling did coincide with getting a sleeve & gauntlet.
The nerve compression test should give some answers. My clt thinks it's likely that the arm pain ( my forearm ) is just lyphadema pain, common among her patients, & the hand numbness could be neuropathy - a long term after effect - so we'll see I guess:)
The orthopedic guy prescribed neurotin which I take once or twice/ day along with 500 mg Tylenol - it works great, no more pain! I didn't mean to write a book here, but I thank you for your reply, & sorry that you are going through this as well! I will definitely update as I learn more...so much of what we learn about the mysterious lymphadema is anecdotal, gleaned from the experiences of others
! Thanks & take care...
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quick update: I had the nerve conduction test this morning - easy, painless & have not seen any change in my lymphadema arm. The neurologist gave me the results immediately which was nice. Everything was normal, just an irritated ulnar nerve, she thought it was likely caused by the lymphedema fluid pressing on it - almost all my swelling is in my elbow. So she thinks the pain & numbness will subside when the swelling goes down. Good news, now if I can get the lymphadema to cooperate!
Button, I forgot to add that the orthopedic surgeon suggested taking a vitamin b complex to help with the pain.
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I'm glad it went well for you! Ironic you mention the likelihood of lymph fluid irritating things. I just finished P.T. for tennis elbow. Even during that treatment and since I would get this knotty kind of swelling on the inside of my elbow that comes and goes. I am now in lymphedema therapy and showed it to my L.T. yesterday and mentioned this ongoing what feels like nerve pain running down my upper arm - also comes and goes. She believes both are related to lymph fluid and the elbow inflamed lymph nodes as well. She also thinks I will be good to go after 3 more sessions??? My cording is improving though we'll see about these lymph areas..... The outpatient part of her organization is closing in 2 weeks or so, so that will be the end of our times. I'll wait and see where things are at that point... I hope you get more relief!!!
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Livin, that is so similar to what I have...I have swelling just above my elbow & a firmish bump that comes & goes just below my elbow on the top of my forearm - nerve pain comes & goes as you said as well. I've had about 7 clt appointments, 3 more to go. The swelling has improved- the pain, numbness as well - still has a little way to go though.
It seems that this - nerve irritation - could be a fairly common side effect of lymphadema - my therapist said the elbow is a commonly involved area. Hope all goes well with you, that your swelling & pain resolve quickly! Take care, let us know how you're doing, & best wishes
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amanda.... My LT said something like that about the elbow as well though she also told me I'm at low risk for lymphedema b/c I'm lean (I'm not thin - truly not though lean fits...) - she said lean people tend to get cording and heavier people tend to develop lymphedema though some of your pics (people plural) show thin or lean people so obviously thin-lean people get lymphedema too. I did have very bad tennis elbow so it all got mixed up. My tennis elbow is much better (93%) and I can clearly tell the pain is now different than that though some of the pain from the tennis elbow time I now realize is more lymph node/fluid related.
So how can this not be lymphedema if she agrees my nodes in my elbow are inflamed and fluid is not flowing as it should? She agreed the nerve type pain in my bicep area is likely lymph node/cording related as well. My arm as a whole is not swollen though the area in one of my node elbow areas, like yours is. She could see that. My arm was soooo painful last night when sleeping which is now not unusual. I've found Aspercreme is quite helpful.... So I'm concerned she thinks I'll be good to go in a few more sessions...? They are closing the outpatient part of the business though she thinks I also will be better by then. I've had 2 sessions so far - tomorrow the 3rd... I'm new to this so also thinking she could be right for this time around.... I really like her and she seems to know a lot and what she's doing....
Thanks for your comments! Best wishes to you as well!
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Livin, lymphadema is such a puzzle to me...it seems that most info on it is anecdotal, & what works for one person may not work the same for the next, it's all very frustrating! I had a mild bit of it, in my hand & elbow 10 years ago while going through chemo. I saw a clt, she massaged it & I was never bothered by it again until April/ May when I started using 5 lb arm weights without a compression sleeve - or so I think. I have it only in my elbow.
I'm pretty much only bothered by it at night too. I started taking neurotin & a Tylenol at bedtime & that works really well. I think your therapist would be able to tell if the swelling is lymphadema related - it feels " boggy" is how all the doctors I've seen describe it - it does feel heavy.
It's good you have a therapist to go too - yeah, I'm nervous at my facility possibly closing again with covid getting bad ( they were closed 6 weeks in the Spring ). Hoping all goes well & you get it under good control - my therapist always reminds me that the lymphatic system is very slow moving & patience is required:)!
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Really interested about the nerve test, what results would show, and what the treatment if Dxd would be. For a long time I've had issues with numbness/tingling. Noticed it most when driving long distances. This came on before cancer ( or at least before it was detected) and definitely before lymphedema. It got worse overtime especially with lymphedema. I suspect cancer treatment and surgery made it worse. Several have posted their frustrations with lymphedema, lack of knowledge, lack of concern, lack of treatment, lack of a cure. I add my frustrations to that. I've been told there is no cure, and that I need to be vigalent about managing it. I've been told that Medicare does not cover much of lymphedema treatment and that I should keep my private. Regular exercise, stretching and hydration help.
A few years ago I saw PT for it (before lymphedema). One of the exercises he suggested were "flys". When going to the gym in the before covid days I was doing this as part of the Strive Circuit Weights. I could do this exercise with a tension/theraband at home , but don't. No excuses, I just don't. I am finding that the gym did energize me to streatch, do weights much more than I do at home. I did like the treadmill and stationary bike, but enjoy the outdoors so much, I tend to get lots of hiking/walking, and now x-country. Looking forward to getting back to the gym and adding swimming as a regular part of the program. . Acupuncture also helps. Demo of fly , ,
2009 ER+ left breast. 52 yrs. Lumpectomy, Sentinel node removal, negative. Radiation 6 weeks, tamoxifen 5 years. Dense lumpy left breast, normal right.
2016 ER+ left breast. Probably a new cancer, but unknown. 4 rounds TC Aug-Oct 2016, Bi-lateral (my choice) Nov 2016, no reconstruction. 2 sentinel nodes remove, negative. Anastrozole 1 mg starting May 2017. Joint issues noticed immediately. Stopped Anastrozole after 3-4 months due to joint stiffness in. After several months of no AIs, fingers were feeling better. Started tamoxifen March 2018.
6/18/2019 Noticed Swelling in R-arm, opposite side from where lymph nodes removed. Urgent Care, suspected clot. None found, but lots of fluid, referred to my DR. Who referred my to lymphedema therapist (without seeing or talking to me). Fortunately therapist recognized that something was very wrong since it was on the opposite side. After a variety of imaging and biopsy, DX'd 9/2019 as a new cancer in R-axilla, ER+ Ibrance and Arimidex
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Bluegirl, my nerve conduction test showed no nerve damage- likely the ulnar nerve is just irritated by the lymphedema swelling...told when the swelling went down the pain would likely lessen. Interestingly the neurologist said she saw some old nerve damage in my hand, likely from my cancer treatment 10 years ago. I do remember a lot of pain in my hand back then.
The elbow swelling has gone down by a fair amount & the pain is mostly gone in my elbow, but it has taken up residence in my wrist & hand now:(! It's frustrating, trying to balance the 2 - all the docs I've seen feel the compression sleeve causes the nerve irritation, but that's kind of the front line of defense in lymphadema. I've been trying to wear the sleeve less & keep a good eye on my arm swelling. Also I just bought a 15/20 sleeve & will try that out - maybe it can contain the swelling & be less irritating to the nerve?? Really it's crazy, and driving me crazy! I am pretty thin & wonder if this general lack of " padding" makes me more vulnerable to this nerve stuff.
I do a modified version of the fly that my therapist showed me - thanks for posting. The tingling you mention was the first sign of lymphadema for me.I use an elliptical everyday but go off & on with the arm portion through the session, not sure if this is right. Swimming would be so wonderful, wish the pools were open here! Take care:)
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Hi amanda6, thanks for updating us on how you are doing. I still think we are having some similar problems - my nerve problem (which is mostly my right index finger, but also sometimes my thumb and occasionally my middle finger) are also still having trouble, although things may have improved ever so slightly. This is what I have been doing to try and help things:
I got in with my LE therapist who measured my arm and did find measurably more swelling in my right arm - my upper arm in particular was fully 2cm bigger than it is supposed to be! So my MO and my LE therapist both think the new nerve pain is indirectly because of my prior surgery and radiation, yes, but more directly from the lymphedema flare that is currently in my upper arm.
My LE therapist suggested that we do some wrapping, which we have been doing about once a week for the last few weeks, and I have found that to be helpful and even gentler than than wearing the regular day compression sleeve. Sure, it's bulky, but I find that it helps me feel better. I have also gotten and been wearing the Solaris tribute night sleeve. It is also gentler than the regular day sleeve, but still provides compression. I also find this really helps. My arm measurements have gone down since doing these two things, and the nerve pain has decreased.
Your point about your regular day compression sleeve pressing on the nerve and causing pain is interesting to me, because I think my regular day sleeve was also doing that on my upper inner arm, even though the sleeve supposedly fit. I finally broke down and went on a new compression sleeve quest and found another brand that isn't so constrictive where the silicone band is. This alone has lessened my nerve pain I think, and I plan to buy a few more sleeves by this brand. I discussed it with my LE therapist, and she said that absolutely some brands are a better fit for some people than others, just because of the way our different bodies fit into those predetermined sleeve size charts.
I also got a LE pump that ends at the shoulder, but I have to "fail" at this pump before my insurance will cover the flexi touch. I still hope this pump will help in the meantime though. I only got it in the mail today so I have not tried it yet.
So to recap, I got wrapped, I got a different brand of day sleeve after some experimentation, I got a night sleeve, and I will soon try a pump.
It's so much work managing LE but I want to do the best I can with it because nerve pain is really unpleasant and is impacting my hobbies and things that are important to me. I really don't want it to get worse. Anyway, that is my very long essay about this. Thanks again for posting about your experience with this - it has really helped me to make sense of what is going on with me too.
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Thanks button, it's really helpful to see how you're handling this - it does sound like we are both having nerve problems along with our flares. I find that wearing a gauntlet ( I don't normally wear one with my sleeve but bought one in case I developed hand swelling) really helps with the hand pain. Also I've used a little Capazan (sp?) pain cream on my hand,that helps too.
I have the Solaris night sleeve on my list of things to try, glad to hear you like it. I have my husband wrap my arm every couple days, leave it on overnight. As long as it's not too tight, I'm ok with it. My swelling is not too bad at all at this point, if this was as good as it got & I just maintained, I'd be fine with it - not perfect, but not bad. I've tried a few sleeves, I like the juzo soft the most by far, very comfortable. Also like that it has a good size range - I wear a 1 maximum - small enough in the wrist but larger in the upper arm - other brands tend to be too large in the wrist for me & I don't want to have to go custom.
I am waiting insurance approval on the flexitouch - really hope I get it! Hope your pump works well for you & that your nerve issues clear up. Please keep posting your progress & I will as well...Take care:).
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I had a R mastectomy 4 years ago and things were fine until this past spring when my R arm started feeling kind of weird. To make a long story short, I currently use a Mediven Harmony sleeve and glove in the day and in the night I wear a Sigvaris Medaform and Medaglove. My oncologist also referred me to neurology because I felt like I was feeling less sensation in my R hand and forearm.
I got the nerve conduction test and EMG which was mostly normal, but there was something a little weird so I got an MRI to see the nerves between my neck and R arm. Then I got a second MRI of just my neck because the first MRI showed a glimpse of a pinched nerve in my neck. The neurologist referred me to physical therapy so I have my first PT appointment next week.
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Navy - did you get a referal for a lymphedema therapist as well? Also see post about "Mueller wrist brace". One person posted on another thread that her DR said that some people experience carpal tunnell like problems. She reports that they have helped a lot. I just bought some today. She uses them while sleeping, I think I will use when on computer, and reading as well.
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Hi BlueGirl,
I do not have a lymphedema therapist at this time because we were not exactly sure if the issue was actually lymphedema or not. My oncologist had me start wearing the sleeves just in case but she told me she is not a lymphedema expert and is pretty much just guessing so my plan is to ask the physical therapist at my initial appointment on Thursday if they know if a lymphedema specialist is available (I get my health care through the VA), and if one is, I will ask my oncologist to refer me to that person as well. If there is not a lymphedema specialist available at the VA, I can ask if I can get referred to one outside of the VA.
I am pretty sure I do not have carpal tunnel because when I saw the neurologist, they had me do the test where you put the backs of your hands together and bend your wrists, and nothing happened (as in it was not painful and did not cause any tingling or other weird feelings). Also, I am a software engineer and I have never felt pain or weirdness from typing and I am on the computer all day, so I think if I had carpal tunnel, I may have been able to notice it sooner.
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Navy - I do not know if there is a diagnostic test for lymphedema or if it is diagnosed by process of elimination. When I noticed the right arm was swollen, an ultra sound showed that it was not a clot, but showed lots of fluid. When I called the oncologist, she referred me to a lymphatic therapist who immediately recognized that something was very wrong since it was occurring opposite side of where lymph nodes removed. After more imaging and biopsy, a new ER+ tumor found in R-axilla. The CT scans I get every 3-4 months does not include the affected arm, I wonder if it should and if it would change the treatment for the lymphedema, which is now being treated with compression sleeve/glove and pumping. I will ask. This site describes testing/diagnosis/treatment. https://www.mayoclinic.org/diseases-conditions/lym... On another thread, a few women describe having surgery with lymph node transfer.
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heres a little wrap up on my lymphadema/ nerve thing : yesterday I saw my lymphadema therapist & the swelling is slightly better, no worsening. They have a kind of imaging machine that measures the fluid. I am ordering a Solaris tribute night sleeve & will use it during the day, I think, when the compression sleeve hurts too much to wear. Weirdly my arm goes almost to normal when I sleep ( I don't use night compression ). Also I am going to order a juzo soft sleeve in a 15/20 compression to see if the lesser compression might work better for me. ( I tried a jobst 15/20 strong & didn't like it, it was a very thick, heavy fabric & really hurt to wear. I really like the the juzo soft ). I've read a few things that mention that small boned women do better with a lower compression. Also I was approved for the flexitouch & it's kind of pricy, but think I'll probably go with it.
Saw the orthopedic surgeon this morning to go over the nerve conduction test (emg) He said there was no nerve compression or pinching, just signs of previous nerve damage in the hand & nerve irritation. He & the neurologist thought it was probably from chemo treatment, 10 years ago, & it just recently flared up, possibly from the lymphedema swelling, but maybe not, maybe just coincidence. So he suggested wearing a wrist brace at night - pain is in my hand/ wrist area mostly - & is referring me to an occupational therapist who specializes in arm, shoulder, hand. The emg showed no brachial plexus involvement - that was my fear, so lots of relief there. So just some pesky long term after effects...
My very best wishes to you all, your input has been so helpful!!
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