Piriformis Syndrome Diagnosis
After years of negative tests for the determination of my chronic pain, I finally found the right physician to perform the right test. Or, more accurately, I was finally referred to the right physician. In February 2012 I had a Provocative EMG. I can’t stress this next point enough…a Provocative EMG is not the same test as a Standard EMG!
Standard EMG Failure
The Standard EMG I had on June 2, 2011 showed no cause for my chronic sciatic pain. In fact, the test results were very normal. The summary results were:
“The nerve conduction study showed a normal right sural SNAP. The bilateral saphenous SNAPs were unelicitable. The right peroneal and tibial CMAPs and F wave latencies were normal. The needle study of selected muscles in the right lower extremity and lower lumbosacral paraspinal muscles was normal.
The Interpretation: Normal study. There is no definite electrophysiologic evidence of a right lower lumbosacral radiculopathy, sciatic neuropathy, myopathy, or peripheral neuropathy in this study.”
You can read the full Standard EMG Study here. I removed the physician name to protect their identity, as well as other personal information. I don’t hold them accountable for not discovering that I had Piriformis Syndrome. It was no one’s fault; it was simply not the correct test. The neurologist that ordered the Standard EMG had never heard of Piriformis Syndrome. I’m reminded of the saying, “You don’t know what you don’t know.”
Provocative EMG Success
On March 1, 2012 I had a Provocative EMG. The test lasted about twenty minutes and the results were concrete evidence that I had Piriformis Syndrome. I wrote “had” versus “have” because on July 5th, 2012 I had two surgical procedures which successfully treated my case of Piriformis Syndrome. However, had I not had a positive Provocative EMG I may not have been an ideal candidate for the surgery.
“Standard nerve conduction studies are within fairly normal limits. The motor and sensory nerve distal latencies, amplitudes, and conduction velocities are all within fairly normal limits, indicating there is no focal nerve compression or peripheral neuropathic process present. F waves are also within normal limits. Special testing of the latent responses with the hip in various stages of hip flexion and internal rotation revealed progressive prolongation of the H and F wave latencies and diminution of the H wave amplitude to significant degrees. This is consistent with sciatic nerve compression at the level of the piriformis muscle. I would also note that I have not yet seen a patient that is as flexible as Mr. Stehling have a positive provocative test. Needle EMG parameters are all normal, indicating there is no compressive radiculopathy or plexopathy present nor any denervation associated with the sciatic nerve compression.”
You can read the detailed Provocative EMG Study here. Again, I removed the physician name and other personal information. My hope is that other people suffering from Piriformis Syndrome will get a Provocative EMG as soon as possible.
An important Note: In the event you review the Provocative EMG Study, and you’re not sure what you’re looking at I’ll break it down. The H Wave test results are the answers I was searching for for the last five years. Many physicians and MRIs didn’t or couldn’t detect what this simple test did in a matter of a few minutes.
About Provocative EMG
H reflex is a monosynaptic reflex elicited by percutaneous submaximal stimulation of tibial nerve and recorded from the gastroe-soleus muscle.
The first row of data shows my test results when laying flat on my back without any flexing/bending of the legs (Note: this is the only position I was in for the Standard EMG). Rows 2 and 3 show my test results when performing the stretch shown below.
H Wave Latency is the first column of data (reading left-to-right). As you can see, the latency increased when performing this stretch, meaning the nerve signal speed slowed down (due to sciatic nerve compression at the piriformis muscle level).
H Wave Amplitude is the second column. As you can see the nerve signal strength decreased by 81%. Again, this is due to my sciatic nerve being significantly compressed at the piriformis muscle level when performing this stretch.
I’m unable to offer insight into the third column…sorry but I forget the significance explained by the physician.
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