Electromyography (EMG)

-What is it? A diagnostic procedure to measure the electrical activity of several muscles and the nerve
cells (motor neurons) that control them by analyzing the Motor Unit Action Potentials (MUAPs).
-Why order? Help to diagnose diseases that damage muscle tissue, nerves, or the junctions between
muscle and nerve. Commonly used in patients with unexplained pain, numbness, and/or weakness. Used
to Dx Tarsal Tunnel Syndrome, Peripheral Neuropathy, Neuromuscular disorders, Nerve Palsy or
Paralysis, and Radiculopathy.

-MUAP analysis- Isolate 20 different MUAPs for each muscle being studied and measure their individual
durations, amplitudes, and number of phases. Results are calculated and compared with normal values
for that particular muscle and age group.

-Normal- Triphasic waveform, No spontaneous activity

-Abnormal- Positive sharp waves, fibrillations, occasional fasciculations, polyphasic MUAPs.
Spontaneous activity = axonal damage
Fibrillation action potentials develop in muscle fibers 2-4 weeks after motor axons have been cut
or injured (axonotmesis, neurotmesis).
The fibrillation potential in involved muscle fibers is the single most significant diagnostic finding
of nerve damage.
Neuropathic- After re-innervation by collateral sprouting, the number of muscle fibers per motor
unit increases, producing long duration, high amplitude, and polyphasic MUAPs.
Myopathies- The number of functional muscle fibers in the motor unit decreases, leading to short
duration, small amplitude, and polyphasic MUAPs.

-Example 1: Abnormal spontaneous potentials present in the tibialis anterior and extensor hallucis longus
may be indicative of either a common peroneal nerve problem, a deep peroneal nerve problem, or an L-5
nerve root condition. However, a normal examination of the peroneus longus muscle would localize the
abnormality to the deep peroneal nerve.
-Example 2: Tarsal Tunnel evaluation. Abductor Hallucis is used to analyze the medial plantar nerve and
Abductor digiti minimi is used for the lateral plantar nerve. If any muscle proximal to the tarsal tunnel (PT,
FDL,Gastroc) is abnormal, more muscles need to be checked for proximal tibial or sciatic neuropathy,
lumbosacral plexopathy, etc. If proximal muscles are normal then the Dx would be Tarsal Tunnel
Syndrome.
-Also, it is nearly impossible to diagnose tarsal tunnel syndrome in patients with polyneuropathy.

-Limitations
Physiologically sensitive but not disease specific. They do not identify the causative agent. Must
use clinical findings.
Many variables prevent the publication of universally accepted normal values which include:
Skin temperature, gender, height, BMI, and the test operators experience.
After 30 years of age, the motor conduction velocity slows by ~1 m/s per decade and
sensory conduction velocity slows by ~2 m/s per decade.
Intrinsic foot muscles are avoided if possible in EMG because they are painful, difficult or near
impossible to activate, and reinnervation is commonly found in normal patients due to repetitive
trauma from shoes and running.
Kane, N. M., and A. Oware. "Nerve conduction and electromyography studies."Journal of neurology 259.7 (2012): 1502-1508.
Preston, David C., and Barbara Ellen. Shapiro. Electromyography and Neuromuscular Disorders: Clinical-electrophysiologic Correlations. 2nd ed.
Philadelphia: Butterworth-Heinemann, 2005.
http://www.noraxon.com/docs/education/abc-of-emg.pdf