FILED: BRONX COUNTY CLERK 01/06/ :22 PM INDEX NO /2017E NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/06/2018
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2 Test Date: 2/18/2015 atient: Johanna Toomey DOB: 1970 hysician: R. C. Krishna, M.D. 5' 1" Sex: Female Height: ID#: limb temp 33.3C Weight: 125 lbs. Nerve Conduction Studies Motor Summary Table Site NR- Onset (ms) O- Amp (mv) Site1 Site2 Delta-0 (nis) Dist (cm) Vet (m/s) Left Median Motor (Abd oll Brev) Wrist Elbow Wrist Elbow Right Median Motor (Abd oll Brev) Wrist Elbow Wrist Elbow Left UInar Seg Motor (Abd Dig Minimi) wriat B Elbow Wrist S B Elbow Right Ulnar Seg Motor (Abd Dig Minimi) Wrist B Elbow Wrist B Elbow Sensory Summary Table Site NR eak (ms) -T Amp (µv) Site1 Site2 Delta- (ms) Dist (cm) Vel (m/s) Left Median D2 Sensory (2nd Digit) Wrist Wrist 2nd Digit Right Median D2 Sensory (2nd Digit) Wrist Wrist 2nd Digit Left UInar Sensory (5th Digit) Wrist Wrist 5th Digit Right Ulnar Sensory (5th Digit) Wrist Wrist 5th Digit F Wave Studies NR F-Lat (ms) L-R F-Lat (ms) Left Median (Mrkrs) (Abd oll Brev) Right Median (Mrkrs) (Abd oll Brev) Left U1nar (Mrkrs) (Abd Dig Min) Right Ulnar (Mrkrs) (Abd Dig Min) EMG Side Muscle Nerve Root Ins Act Fibs sw Amp Dur oly Recrt Int at Comment Right Deltoid Axillary C5-6 Nml 0 0 Nml Nml Nml Nm1 Complete Right Biceps Musculocut C5-6 Nm1 0 0 Nml Nal Nml Nml Complete Right Triceps Radial C6-7-8 Nml 0 0 Nml Nml Nml Nml Complete
3 atient: Toomey, Johanna Test Date: 2/18/2015 age 2 Right ExtDigCom Radial (ost Int) C7-8 Nm1 0 0 NmI Nml Nmi Nml Complete Right FlexCarUln U1nar C8-TI Nml 0 0 Nm1 Nm1 Nml Nm1 Complete Right 1stDorInt U1nar C8-TI Nml 0 0 ill Nml Nnd Nm1 Complete I-' Left Deltoid Axillary C5-6 Nm NmI Nml Nml Nml Complete Left Biceps Musculocut C5-6 Nml Nm1 Nm1 Nml Nml Complete Left Triceps Radial C6-7-8 Nm1 0 0 Nm1 Nml Nml Nml Complete Left ExtDigCom Radial (ost Int) C7-8 Nml 0 0 Nml Nml Nml Nml Complete Lea FlexCarU1n U1nar CS-TI Nm1 0 0 Nml Nml Nm1 Nm1 Complete Left 1stDorInt Ulnar C8-T1 Nm1 0 0 Nml Nml Nml Nm1 Complete Left Abd oll Brev Median C8-T1 Nm1 0 0 Nm1 Nml Nml Nml Complete Right Abd oll Brev Median C8-T1 Nml 0 0 Nm1 Nrni Nml Nm1 Complete araspinal EMG Side Muscle Nerve Root Ins Act Fibs sw Comment Right C4-5 arasp Rami C4-5 NmI 0 0 Right C5-6 arasp Rami C5-6 Nml 0 0 Right C6-7 arasp Rami C6-7 Nml 0 0 Right C7-8 arasp Rami C7-8 Nml 0 0 Right C8-T1 arasp Rami C8-T1 Nml 0 0 Left C4-5 arasp Rami C4-5 Nml 0 0 Left C5-6 arasp Rami C5-6 Nm1 l+ 1+ Left C6-7 arasp Rami C6-7 Nml 0 0 Left C7-8 arasp Rami C7-8 Nml 0 0 Left C8-T1 arasp Rami C8-T1 Nm1 0 0 FINDINGS: Evaluation of the Right Median D2 Sensory nerve showed prolonged distal peak latency (4.3 ms) and decreased conduction velocity (Wrist-2nd Digit, 33 m/s). All remaining nerves (as indicated in the NCV tables) were within normal limits, All F Wave latencies were within normal limits. EMG needle evaluation of the Left deltoid, the Left biceps, and the Left C5-6 arasp showed slightly increased spontaneous activity. All remaining muscles (as indicated in the EMG scoring table) showed no evidence of electrical instability. IMRESSIONS: The above electrodiagnostic study reveals evidence of a mild right sensory median nerve neuropathy at the wrist. This is consistent with the clinical diagnosis of Carpal Tunnel Syndrome. The above eletrodiagnostic study reveals evidence of left C5 - C6 radiculopathy. R. C. Krishna, M.D. M.D,
4 atient: Toomey, Johanna Test Date: 2/18/2015 age 3 Waveforms: NCV[LettMedianMotor] NCV[RightMedianMotor] NCV[LeftUInarSegMotor] 'V Wrfst: Wrist Wrist: S b 0,...,..., 0...,...,, bow: - - B Elbow: ~ ~. ~ ~ 0' S 5000µVIDiv 5 ms/dty 5000pV/Div 5 ms/div 5000µV/Div 5 ms/div NCV[RightUlnarSegMotorl ~~ NCV[LeftMedianD2Sensory] NCV[RightMedianD2Sensory] ,..p w I: w, VIS O TT T... I ' B Elbow:
5 atient: Toomey, Johanna Test Date: 2/18/2015 age 4 NCV[LeftUlnarSensory] NCV[RightUlnarSensoryl FWave[LeftMet an(mrkrs)] Wrist:..T T Wrist: 20uV/Div 2 ms/piv 70pV/Div 2 ms/div 5000pV/Div 500µV/Div 5 ms/div FWave[RightMrdian(MrKrs)] FWave[LeftUlmr (Mrkrs)] Tr 1 IF2 IF:I Ac ~F Tr tt t pV/Div 500pV/Div 5 ms/div 5000pV/Div 500pV/Div 5 ms/div FWave[RightUnar (Mrkrs)]
6 Test Date: 5/6/2015 atient: Johanna Toomey DOB: 1970 hysician: R. C. Krishna, M.D. 5' 1" Sex: Female Height: ID#: tern 33.3C Weight: 125 lbs. Nerve Conduction Studies MotorSummary Table Site NR Onset (ms) O- Amp (mv) Site1 Site2 Delta-0 (ms) Dist cml Vel (m/s) I4ft eroneal Motor (Ext Dig Brev) Ankle B Fib Ankle B Fib Right eroneal Motor (Ext Dig Bruv) Ankle B Fib Ankle B Fib IAft 11bial Motor (Abd Hall Brev) Arthle Right Tibial Motor (Abd Han Brev) Ankle Sensory Summary Table Site NR eak (ms) -T Amp (µv) Sitel Site2 Delta- (ms) Dist (cm) Vet (m/s) IAftSural Sensory (Lat Mall) Calf Calf Lat Mall Right Sural Sensory (Lat MaU) Calf Calf Let Mall F Wave Studies NR F-Lat (ms) L-R F-Lat (ms) I4ft eroneal (Mrkrs) (EDB) Right eroneal (Mrkrs) (EDB) IAft Tibial (Mrkrs) (Abd Hallucis) Right Tibial (Mrkrs) (Abd Hallucis) H Reflex Studies NR H-Lat (ms) L-R H-Lat (ms) Iaft Tibial (Gastroc) Right 11bial (Gastroc)
7 atient: Toomey, Johanna Test Date: 5/6/2015 age 2 EMG Side Muscle Nerve Root InsAct Fibs sw Amp Dur oly Recrt Intat Comment Right AntTibialis Dp Breron IA-5 Nml 0 0 Nml Nm1 Nml Nml Complete Right eroneuslong Sup Breron L5-Sl Nml l+ l+ Nm! Nmi Nml Nml Complete Right MedGastroc Tibial Sl-2 Nml l+ l+ Nml Nml Nml Nml Complete Right BicepsFemL Sciatic L5-S2 Nml 0 0 Nml Nml Nml Nml Complete Left AntTibialis Dp Br eron IA-5 Nml 0 0 Nm1 Nml Nml Nml Complete Left eroneus Long Sup Br eron LS-Sl Nml 1+ l+ Nml Nm1 Nml Nml Complete Left MedGastroc Tibial S1-2 Nm) Nml Nml Nml Nm1 Complete Left BicepsFemL Sciatic L5-S2 Nml 0 0 Nml Nml Nml Nml Complete araspinal EMG Side Muscle Nerve Root InsAct Fibs sw Comment Right L34 arasp Rami L34 Nml 0 0 Right IA-5 arasp Rami IA-5 Nml 0 0 Right L5-SIarasp Rami L5-SI Nml l+ l+ Left L34 arasp Rami L34 Nml 0 0 Left IA-5 arasp Rami IA-5 Nml 0 0 Left L5-Slarasp Rami L5-S1 Nml l+ l+ FINDINGS: All nerve conduction studies revealed normal latencies, amplitudes and conduction velocites. All F Wave latencies were within normal limits. EMG needle evaluation of the Right peroneus longus, the Right medial gastrocnemius, the Left peroneus longus, the Left medial gastrocnemius, the Right L5-S1arasp, and the Left L5-S1arasp showed slightly increased spontaneous activity. All remaining muscles (as indicated in the EMG scoring table) showed no evidence of electrical instability. IMRESSIONS: The above eletrodiagnostic study reveals evidence of bilateral LS - S1 radiculopathy. R. C. Krishna, M.D.
8 atient: Toomey, Johanna Test Date: 5/6/2015 age 3 Waveforms: NCV[tert eroneafmotort NCV(RighteroneatMoto NCV[LeftTibialMotor] ' Ankle: Ankle: Ankle:. 0., Rb: Fib : 5000pV/Div 5 rns/div 5000µV/Div 5 ms/div 5000µV/Div 5 ms/div.. kfcvlrfghftrbkrfmotor». f{cv»ieft SrssfSeissrr/» NCVpaint SuralSensory} p ' ~. - ~ Calf. it' T. T..... Ankle: 5000µV/Div 5 rrwdiv 50pVl% 2 me/div 50 pwdiv 2 mwdw FWave[Leftertneal(Mrkrs)] FWave[RightEuneal(Mrios)] FWave[LeftTibitI(Mrkrs)] Tr 1 ' Tr 1 Trg frs Tr4.... A v Tr 1 Act V/Dfv 500 VIDiv 10msloiv 50QOV/Div 500 V/Div 10ms/Div 5000 V/Div 500 V 1Qmsl
9 atient: Toomey, Johanna Test Date: 5/6/2015 age 4 FWwe [RightTN Mtrs) H.Renex( A Tibiall H-ReAex[FWd Tibial Tr 1 Tr 1 T7 Tr0 ~l r J' py/Div 500py/Div 10ms/Div 2000pV/DM000pV/Div 10ms/Div 2000µV/DM000pV/Div 10ms/Div
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