Checkpoint: The Good, Bad, and Ugly: Planning NCS With Case Studies-Dr. Simmons Presentation

Dr. Simmons Presentation

Pdf Summary

The document is a comprehensive planning guide and case assessment overview for Upper Limb Nerve Conduction Studies (NCS), authored by Daniel B. Simmons, MD. It details protocols and considerations for diagnosing nerve conditions using electrodiagnostic methods.<br /><br />**Key Highlights:**<br />1. **False Positives:**<br />   - Testing multiple nerves can increase the likelihood of false positives.<br />   - It’s recommended to minimize the number of tests and avoid relying on single data points. A dual abnormality requirement for diagnosis helps maintain a low false positive rate.<br /><br />2. **Case Studies:**<br />   - **Case 1:** A 40-year-old female with bilateral hand paresthesias indicating moderate median neuropathy at the wrist with no axon loss, which is a good prognosis.<br />   - **Case 2:** A 78-year-old male experiencing long-term numbness and hand weakness, diagnosed with very severe median neuropathy with sensory axon loss.<br />   - **Case 3:** A 28-year-old female with mild carpal tunnel syndrome, indicating very mild median neuropathy at the wrist.<br />   - **Case 4:** A 38-year-old male with finger numbness and elbow discomfort showing mild ulnar neuropathy localized to the retrocondylar groove.<br />   - **Case 5:** A 55-year-old diabetic male with progressive hand weakness indicating severe non-localizable ulnar neuropathy with axonal damage.<br />   - **Case 6:** A 64-year-old female with intermittent hand numbness revealed no median neuropathy at the wrist but pending further EMG results.<br /><br />3. **Technical Guidance:**<br />   - Recommendations emphasize precise test selection based on symptoms to avoid unnecessary testing.<br />   - Inching studies are suggested for precise localization of nerve issues at the elbow.<br /><br />4. **Summary Recommendations:**<br />   - Reject the “test everything” strategy; focus tests based on clinical presentation.<br />   - Always aim for two abnormal tests for reliable diagnosis.<br /><br />5. **References and Resources:**<br />   - The document cites several medical texts and studies to support practices, including works by Preston, Shapiro, and other experts in electromyography and neuropathy.<br /><br />6. **Feedback and Credits:**<br />   - Attendees are encouraged to provide feedback via the AANEM app and record their continuing education credits.<br /><br />This summary provides a consolidated outline of the principles, case examples, and best practices for conducting upper limb NCS efficiently and accurately.

Keywords

Upper Limb Nerve Conduction Studies

NCS

nerve conduction studies

nerve conduction study

Daniel B. Simmons

electrodiagnostic methods

false positives

median neuropathy

ulnar neuropathy

technical guidance

case studies

diagnosis

nerve conduction studies

nerve conduction study

ncs

ncv