COMMENTARY

5 Tests to Avoid in Back Pain

Nathan Wei, MD; Bret S. Stetka, MD

November 06, 2013

Leave Nerve and Muscle Function Alone

The Recommendation: Do not use electromyography (EMG) and nerve conduction studies (NCS) to determine the cause of axial lumbar, thoracic, or cervical spine pain.

The Rationale: EMG and NCS are measures of nerve and muscle function. They may be indicated when there are symptoms that raise concern about neurologic injury or disorder, such as the presence of leg or arm pain, numbness, or weakness associated with compression of a spinal nerve. Because spinal nerve injury is not a cause of neck, mid-back, or low back pain, EMG and NCS have not been found to be helpful in diagnosing the underlying causes of axial lumbar, thoracic, and cervical spine pain.

Dr. Wei's Bottom Line: I agree and I disagree here. Purely localized back pain is generally not associated with nerve impingement; however, there are exceptions. In particular, thoracic radiculitis can be a diagnostic problem. I have seen this in patients with Lyme disease. The presence of radiculopathy may alter the course of treatment, and therefore electrical studies should be used if indicated.

The most common cause of radiculitis is generally degenerative disc disease. As a resident, I saw patients with tuberculous abscesses causing radiculitis. Fortunately, this is rare.

One should not forget that referred pain can be confused with radiculitis. An example might be gallbladder disease that causes referred pain to the tip of the scapula or ruptured ectopic pregnancy that can cause diaphragmatic irritation and "pseudoradicular" pain. Preherpetic neuralgia can also be a "fooler."

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