MRI vs Nerve Conduction Test

[Jolie, BSN]

Hi all.

I'm not looking for medical advice, since my brother is already under the care of a doctor, just trying to understand the rationale for the diagnostic tests that have (and have not) been ordered.

My brother is 46, and in very good physical condition. He's an avid golfer and runner, and works out with weights regularly. About 2 weeks ago, he got up from a chair and fell to the floor because he could not feel his foot. It was twisted at the ankle, and not placed flat on the floor. He then realized that he had significant numbness and tingling in the foot, and could not feel its position as he walked. Without actually watching his foot, he can't walk properly because his foot "flops". OK, sounds like foot-drop to me. Off to the doctor.

It took him a week to get into his PCP, who agreed that a neuro referral was in order. The PCP ordered routine yearly labwork (CBC, chemistries, lipid profile, thyroid, etc.) but deferred any imaging studies to the neurologist.

It took another week to get into the neurologist who examined him, verified that he likely has nerve impingement, and ordered only a nerve conduction test, stating that it was necessary to determine the cause of the impingement before deciding on a course of treatment.

That's where I get lost. I understand that a nerve conduction test will give information regarding the degree of nerve damage, but don't understand how it will shed light on the CAUSE of the impingement. (The neurologist suggested arthritis vs bulging disc as possible causes.) My concern is that he can't get the test done until mid-May, a full month from now, and 6 weeks from the onset of symptoms. It seems to me that they should do an MRI in the meantime, and I have asked my brother to call the neurologist back and ask about this. I'm concerned that they will wait so long to diagnose this problem that his foot drop may become permanent, and am also concerned that he will fall and really hurt himself in the meantime.

Any thoughts or suggestions? Any insight as to why an MRI has not been ordered? He has "traditional" insurance which allows him to see virtually any doctor and use almost any facility he chooses.

[mom23RN]

Nerve conduction testing can give them a pretty good indication of where the problem is because of the nerves they are testing and where they originate from. Most likely it will be then followed by an MRI to look at the area that the NCT showed the problem originated. This is much easier then trying to do an MRI of the entire spinal column,hips, legs, etc.

[lindarn]

Hi all.

I'm not looking for medical advice, since my brother is already under the care of a doctor, just trying to understand the rationale for the diagnostic tests that have (and have not) been ordered.

My brother is 46, and in very good physical condition. He's an avid golfer and runner, and works out with weights regularly. About 2 weeks ago, he got up from a chair and fell to the floor because he could not feel his foot. It was twisted at the ankle, and not placed flat on the floor. He then realized that he had significant numbness and tingling in the foot, and could not feel its position as he walked. Without actually watching his foot, he can't walk properly because his foot "flops". OK, sounds like foot-drop to me. Off to the doctor.

It took him a week to get into his PCP, who agreed that a neuro referral was in order. The PCP ordered routine yearly labwork (CBC, chemistries, lipid profile, thyroid, etc.) but deferred any imaging studies to the neurologist.

It took another week to get into the neurologist who examined him, verified that he likely has nerve impingement, and ordered only a nerve conduction test, stating that it was necessary to determine the cause of the impingement before deciding on a course of treatment.

That's where I get lost. I understand that a nerve conduction test will give information regarding the degree of nerve damage, but don't understand how it will shed light on the CAUSE of the impingement. (The neurologist suggested arthritis vs bulging disc as possible causes.) My concern is that he can't get the test done until mid-May, a full month from now, and 6 weeks from the onset of symptoms. It seems to me that they should do an MRI in the meantime, and I have asked my brother to call the neurologist back and ask about this. I'm concerned that they will wait so long to diagnose this problem that his foot drop may become permanent, and am also concerned that he will fall and really hurt himself in the meantime.

Any thoughts or suggestions? Any insight as to why an MRI has not been ordered? He has "traditional" insurance which allows him to see virtually any doctor and use almost any facility he chooses.

I would insist on an MRI of the brain to see if their are any demeylinating lesion, AKA Multiple Sclerosis. These are classic symptoms of MS. He really should see a neurologist sooner rather than later, and get on the betasterons that have had a good effect in slowing the progression of the disease. There has also been recent literature that has been published, that has shown something of not only slowing of the progression, but also can prevent the actual developing of MS if these drugs are administered in the early stages of MS, when the first symptoms appear.

While I cannot tell you for certain if he has MS, as I said, these are classic symptoms. I would not tolerate any more delay in diagnostic testing for him. The nerve conduction studies may be helpful in locating where the damage/nerve impairment is, they are not diagnositic, and certainly not anything that can anything that can treat his condition. PM me if you have any questions. You can also go to the MS Society Website, and read for yourself.

Lindarn, RN, BSN. CCRN

Spokane, Washington

[Altra, BSN, RN]

My concern is that he can't get the test done until mid-May, a full month from now, and 6 weeks from the onset of symptoms. It seems to me that they should do an MRI in the meantime, and I have asked my brother to call the neurologist back and ask about this. I'm concerned that they will wait so long to diagnose this problem that his foot drop may become permanent, and am also concerned that he will fall and really hurt himself in the meantime.

If insurance is not a limiting factor, this does seem an unreasonable length of time to wait for diagnostic testing, especially since the condition is affecting your brother's ADLs.

Coincidentally, my DH just underwent a similar series of testing for a problem w/his elbow & forearm -- within 10 days he had seen the PCP, orthopedic MD, & had the nerve conduction test & MRI.

Here's hoping everything goes well for your brother.

[Jolie, BSN]

Thank you all so much for your replies and information. I will pass it along. It seems to me that the waiting time for the nerve conduction test is way over the top. He is in the Cleveland area. Any suggestions as to where he might be able to schedule the test more promptly? The 4 week wait was with the neurologist's office. The Cleveland Clinic had an even longer wait. He has already asked to be put on a cancellation list in hopes of getting it done sooner.

[BittyBabyGrower, MSN, RN]

In the Cleveland area....either CCF or MetroHealth Medical Center. Those are the only two places I would trust.