When EMG Isn’t Enough: Expanding Your Neuropathy Workup

When EMG Isn’t Enough: Expanding Your Neuropathy Workup

It’s a common story: a patient has classic neuropathy symptoms—burning, tingling, numbness but their EMG comes back “normal.” The result? They're told nothing is wrong, or worse, they’re labeled anxious or overly sensitive.

As an independent physician, this is your opportunity to explain what others missed: EMG doesn’t catch everything. And when it comes to small fiber neuropathy, EMG may miss the diagnosis entirely.

Understanding EMG’s Limitations

Electromyography (EMG) and nerve conduction studies (NCS) are excellent tools for large fiber neuropathies. But they have significant blind spots:

• Small fiber nerves, which carry pain and temperature signals, are not measured

• Early or mild neuropathy may not show changes

• EMG can't detect autonomic or sensory changes felt by the patient

In short: normal EMG ≠ normal nerves.

The Value of the Independent Model

In a direct-pay or concierge setting, you're not bound by narrow diagnostic algorithms. You can expand your evaluation using a mix of:

• Clinical history (look for burning, tingling, temperature sensitivity)

• Sensory exams (pinprick, temperature, monofilament, vibration)

• Balance tests (Romberg, gait, heel-toe walk)

• Functional labs (B12, MMA, homocysteine, glucose, autoimmune markers)

These are powerful tools that give you the full picture without the wait or cost of referral testing.

When Patients Hear “It’s All in Your Head”…

…you can be the doctor who listens. Many patients have suffered for years with unexplained symptoms. Validating their experience and offering clarity builds trust and long-term loyalty.

Want to Be the Physician Who Actually Finds the Cause?

Book a Strategy Session with John Hayes Jr., MD to learn what protocols empower independent physicians to identify neuropathy when others miss it and deliver results that change lives.