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to see a list of articles like this one Co-Management of Severe Conditions Prolotherapy as an Adjunct to Chiropractic Care Ultrasound for Evaluation of the Wrist |
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A Letter Released
to Chiropractic Physicians on May 9, 2007 A Local Resource for Neurodiagnostic Testing Doctors of Chiropractic with and without equipment for electromyography (EMG) and nerve conduction studies (NCS) may find it
useful to refer to Dr. Taub for neurodiagnostic testing. Chiropractic physicians often use EMG and
NCS as extensions of their clinical examinations. As a physiatrist, board certified in
electromyography, Dr. Taub can perform your neurodiagnostic testing with needle
EMG, NCS, and diagnostic sonography. Economic
Considerations for Chiropractic Patients: Steve Troyanovich,
DC writes that some insurance policies arbitrarily limit coverage for
services performed by chiropractors.1 Limitations may exist in the form of
a limited number of visits, a dollar limit per year, a dollar limit per
visit, or only paying for manipulation.
Occasionally, chiropractic physicians who can perform
electrodiagnostic testing may find that doing so proves disadvantageous to
the patient because of arbitrary limitations on the patient’s insurance. When this is the case, referring to a
physiatrist for the testing may help maximize the patient’s benefits for
needed chiropractic care that only a chiropractor can provide. Rationale for Ordering Neurodiagnostic Testing: Doctors use needle EMG and nerve
conduction studies to diagnose disorders affecting primary motor cells,
primary sensory nerve cells, nerve roots, plexuses, peripheral nerves,
neuromuscular junctions, and muscles (especially lumbar radiculopathy,
cervical radiculopathy, carpal tunnel syndrome, and peripheral
neuropathy). Electrodiagnostic
testing can help differentiate radiculopathy, peripheral nerve entrapment, plexopathy, and peripheral neuropathy. The information provided by these tests can
prove useful in chiropractic treatment decisions. For example, when damage to the median
nerve is occurring, your referral to surgical treatment can preserve the
function of the nerve, but a confirmed case of carpal tunnel syndrome can be
managed with conservative treatment per your practice’s protocol.2 The goals of every EMG & NCS include:
Neurodiagnostic Ultrasound: Published research over the past
seven years demonstrates that ultrasonography can diagnostically image the anatomy
of the carpal tunnel, cubital tunnel, median nerve,
and most superficial body structures.3-6 Ultrasound
and EMG serve as mutually complimentary diagnostic tools. In 15% to 27% of symptomatic patients with
focal neuropathies, only one of the two techniques reveal pathologic
findings.7,8 Researchers showed nerve conduction studies
to have a sensitivity of 78% when trying to verify ulnar neuropathy at the
elbow. When ultrasound and EMG are used together,
sensitivity rises to 98%.9 Refer to the
private practice of Neal S. Taub,
Physiatrist: Regarding EMG and NCS, multiple chiropractic authors have commented on the
importance of examiner expertise and the quality of the analysis.10,11 Neal S.
Taub, MD is a physiatrist board certified in electromyography. Dr. Taub also has the capacity to use
diagnostic ultrasound to increase the sensitivity of testing around the wrist
and elbow. As a private, referral
based practice, it is the role of Dr. Taub’s office to perform the testing that falls under the
physiatrist realm and to return the patient to the referring practitioner’s
comprehensive care. |
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References:
© BMA
2007 |
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Home Stroke Rehabilitation About Neal Taub, MD What is a Physiatrist |
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