What We Do

Electromyography (EMG), and nerve conduction studies (NCS) are performed to assess the integrity of your nerves and muscles. It is usually ordered to ascertain if a patient’s symptoms are due to a problem with a nerve or nerves. It is less commonly ordered to evaluate for the possibility of muscle disease.

Electromyography (EMG), and nerve conduction studies (NCS) are performed to assess the integrity of your nerves and muscles. It is usually ordered to ascertain if a patient’s symptoms are due to a problem with a nerve or nerves. It is less commonly ordered to evaluate for the possibility of muscle disease.

The test is not pain free, but only uncomfortable. A calm patient will experience less discomfort than a tense, anxious one.

There are no side effects from the NCS exam. Some bruising may occur on occasion with the EMG exam, but this is temporary. The intramuscular electrode used for the EMG exam is a very fine wire with teflon coating, much smaller in diameter than the hollow needle used for the drawing of blood or injections. The EMG electrode is used only once, then discarded.

Usually the test will take 30 to 60 minutes. More complicated cases may take longer.

You may shower or bathe normally, using deodorant. Please do not use cream or lotion on your skin. If your arms are to be tested, a short sleeve shirt may be advisable. You may be asked to change into a gown.

Nerves are made of soft tissue cables that exit the spinal cord as nerve roots, and travel to the extremity or trunk. They convey information to and from the brain. Sensory nerves carry information regarding sensation to the spinal cord and brain. Motor nerves carry electric impulses from the brain through the spinal cord, terminating in a muscle. Muscles contract as the result of chemical and electrical impulses generated through a peripheral nerve.

Depending on the nerve, symptoms of numbness, tingling, motor weakness, or clumsiness are suspicious of a nerve-related problem.

The usual mechanism of damage is for the nerve to be constricted or compressed by various anatomic structures. Nerves can be cut during trauma. Various medical conditions such as Diabetes can cause nerve problems. Toxic effects from various medications, exposure to certain organic compounds, or excessive of intake of alcoholic beverages can affect the nerves. Lack of important nutritional elements can cause nerve disease.

Carpal tunnel syndrome (CTS) implies the compression of the median nerve in the palm. Symptoms include numbness and tingling of the thumb, index and middle fingers. Motor weakness affecting the thumb may occur in more advanced cases. Symptoms are provoked by activities performed with a flexed wrist such as driving.

This condition implies a compression of the ulnar nerve at the inner elbow. This is the area called the “funny bone”. Symptoms include numbness and tingling of the little and ½ of the ring finger. Motor weakness of hand and forearm muscles will occur in more advanced cases. Symptoms are usually provoked by periods of positioning with a bent elbow, or when the inner aspect of the elbow is resting on a support.

The ulnar nerve may become entrapped at the wrist. The symptoms may include numbness and tingling of the little and ½ of the ring finger, and weakness of the hand muscles. This condition can be brought about after a fall and fracture to the wrist, or by compression of the area of the palm used when biking, performing push-ups, or pushing heavy weights at the gym.

This condition implies damage of multiple nerves, usually affecting the lower extremities first, then the upper extremities. Symptoms will include numbness and tingling, usually first in the feet and legs, then hands and arms, in a so called “stocking-glove distribution”. Advanced cases will demonstrate motor weakness of the feet and hands, then in the more distal, possibly more proximal muscles of the arms and legs. Causes of peripheral polyneuropathy include a relation to medical conditions such as Diabetes, after suffering from certain infectious diseases such as Guillen Barre syndrome, exposure to toxins such as lead, excessive alcohol intake, as a side effect from certain medications, or simply hereditary in nature. Many times the underlying cause of a patient’s peripheral polyneuropathy is unable to be determined.

Fractures, Arthritis, Replants, Replants of Limbs, Trigger Finger, Tendon Injuries, Amputations, Industrial or Traumatic Injuries, Activities of Daily Living Problems, Burn Injuries, Crush Injuries, Tennis Elbow or Golfer’s Elbow, Cumulative Trauma, RSD or Complex Regional Pain, Nerve Injuries, Congenital Abnormalities, Joint Replacements, Carpal Tunnel Syndrome, Dislocations, Strains or Sprains, Soft Tissue Wounds or Injuries, Repetitive Motion Injuries, Dupuytren’s Disease, Tendinitis, Lacerations, Dexterity Problems, Sports Injuries, Shoulder Injuries

Our therapists have advanced skills in the treatment of hand and upper extremity conditions. Our occupational therapists/certified hand therapists have close relationships with the Center's surgeons for optimal coordination of your treatment.

Upon the doctor's referral to our hand therapy department, our therapy secretary will make an appointment for you to be seen in our therapy department. Many walk-in patients are seen on the same day as their visit with the hand surgeon. Clarification of the doctor's orders can easily occur verbally with your physician present in the facility. Your care will also be coordinated with your insurance carrier, worker's compensation rehabilitation coordinator, primary care physician or referring physician. Updates of your current progress will be reported to your doctor on an ongoing basis to ensure appropriate continuity of care.

Depending on the nature of the upper extremity problem and the type of intervention, average therapy sessions last 30 minutes to 1 hour and encompass a single session or continue for months.

Your insurance may dictate how many visits you are allowed for treatment. Please contact your insurance company to clarify your policy so that the therapist can customize your treatment to your available visits. While we do see patients covered by most insurance companies, it is best to understand your coverage before treatment begins. Some insurance carriers will pay for therapy services, but may restrict you in where you may be seen or what type of equipment may be used.

Depending on the type of services required, referrals may come from a variety of sources. While the Hand & Shoulder Center's physicians refer most of our patients, other physicians may refer. Employers, insurance companies, attorneys, patients and families may recommend our rehabilitation services, however physician orders are necessary for evaluation and treatment of patients.