NCV STUDIES IN A ROUTINE PHYSIOTHERAPY CLINIC - OUT OF THE BOX THINKING

Many a times in our clinics we come across patients who often say that they are not better with pain inspite of a lot of hard work by us. We as a Physiotherapist would have tried hard with all possible electrotherapy modalities and manual therapy. We would have then thought and rethought our assessment. And after all the trials we would have jumped into conclusion that the patient presents with a psychosomatic ailment. This is because it is very easy to give this conclusion. Admist all these assessments and treatment plans we fail to think that there can be something else which we probably have missed out. Lets discuss

A patient with Low back pain with Lower limb radiculopathy coming to a Physiotherapy management. We would have tried Electrotherapy, Manualtherapy, Neurodynamics for quite sometime. Still we are not able to help the patient out with lower limbs radicular symptoms.WHAT TO DO?

I WOULD SUGGEST OUT OF THE BOX THINKING -  Can any one have a faintest of idea that these patients can have some form of Neuropathy or Tarsal Tunnel Syndrome also????? Why not????? Same symptoms....Lowerlimbs paraesthesia, sensory affection, at times motor weakness. These are the patients who may have reached middle age, may be diabetic. Vitamin B12 deficiency is not  unknown now a days. With so many known factors one of the differential diagnosis for such cases can be Neuropathy. At times patient's footwear, foot posture and alignment can be at fault which may be responsible for symptoms probably Tarsal Tunnel Syndrome. But since MRI confirmed Spinal Root compression, patient was referred to us for Radiculopathy. We Physiotherapists kept on following the same protocol as referred .MRI is a sensitive test which gives anatomical lesion. It is not specific. Now instead if we had a EMG NCV instrument in our clinic, we could have performed atleast a NCV study and reconfirmed. In radiculopathy, NCV studies are usually normal and in Neuropathy they are abnormal and in Tarsal Tunnel Syndrome only Tibial Nerve abnormal. Just performing them dont need us to interprete. This is just a screening tool for a physiotherapist. But this indeed can help him and entire management changes. What say isnt it?????Discussion on this is unending. Lot to convey lot of information to share. May be some other time.

ANOTHER SCENARIO.......

A patient with lateral epicondylitis. Patient coming to a Physiotherapist since long. We would have tried Ultrasound, Phonophoresis, Manualtherapy like Mulligan mobilization, Taping, Strengthening exercises etc. Yet the patient would say he is not fine. The pain still persists. We would attribute it to his / her occupation. Would give vocational training, all advises. All in vain. Probably a stage would come where we would tell the patient to start ignoring the pain and continue doing the work. Now if we as a Physiotherapist with offbeat thought process, EMG NCV equipment as a screening tool handy and a good knowledge of anatomy, would quickly screen Radial Nerve to rule out Supinator Tunnel Syndrome wouldnt it work? What do you think? Radial Nerve gets entrapped at the same sight mimicking lateral epicondylitis. So finally we have reached the exact diagnosis. And our patient will be finally happy. Now tell me who proved to be a saviour? NCV study. Isn't it?

Suprascapular nerve palsy often mistaken as Rotator cuff tear, Pronator Teres Syndrome mistaken as Carpal Tunnel Syndrome, L5 Radiculopathy mistaken as Common Peroneal nerve Injury around fibular head and the list here is unending

Often a Physiotherapist thinks he is not certified to perform the test or sign a report. Then why should he buy this equipment. Few think that this is a speciality of a Neurophysiotherapist. But a newer perspective needs to be instilled. Simple NCV studies can help us diagnose certain conditions faster and we dont need to sign a report and give a report for it. We have studied NCV studies in our undergraduate and even Post graduate program. Why hesitate to screen our patient with it? But this can definitely help our patients and in turn help our practice

Why only Neurophysiotherapist? Why not Orthophysiotherapist or a Community therapist? Someone who sees degenerative diseases or even trauma and nerve injuries? Combination of neurology with biomechanics will definitely give best perspective when we consider a patient as a whole. How can we see a brain and nerves separately, bones and muscles separately when after all entire body is one

PHYSIOTHERAPISTS NEED TO SEE SUBJECT WITH A DIFFERENT AND A BROADER PERSPECTIVE. WE KNOW BODY FUNCTIONS AND MECHANICS AND HENCE WE CAN DEFINITELY GIVE A GOOD INSIGHT INTO DIFFERENTIAL DIAGNOSIS.