Note amanina jamain NERVE CONDUCTION STUDIES AND ELECTROMYOGRAM(EMG) 1.

NERVE CONDUCTION STUDIES -usually done before the EMG. -it is done to evaluate how well and how fast the nerves conduct the electrical impulse. Parts of EMG machine used in nerve conduction studies > 1. Headbox to connect electrodes 2. Computer to process data 3. Monitor to display the recordings 4. Electrical stimulator 5. Electrodes. The electrodes or needles >
y
four types of electrodes will be attached to skin. o Active(recording) electrode on the muscle belly over the motor end-plate. o Reference electrode (passive) placed distally over the muscle-tendon junction. o Stimulator over the nerve that supplies the muscle. o Ground electrode between stimulating and recording electrodes. Usually, surface patch electrodes are used to test motor nerve because they are easy. If we want to test the sensory nerve, ring electrodes are used. Needles are usually used to evaluate nerves that lie deep in tissue, such as sciatic nerve in thigh and in obese people. Needles are more accurate than surface electrodes.

y y y

Parts of evaluation of nerve conduction studies > 1. Terminal latency time between initiation of stimulus and onset of action. -in median nerve, the normal value = below 4.5 milliseconds -in carpal tunnel syndrome(median nerve) = more than 4.5 milliseconds. 2. Amplitude -distance between the peak and bottom of the wave. -in median nerve, the normal value should be more than 3.5 millivolts. 3. Nerve conduction velocity -obtained by calculating the distance between recording electrode and stimulating electrodes, and the time taken for the electrical impulse to travel in between both electrodes. -normal velocity in UL = more than 45 m/s. -normal velocity in LL = more than 35 m/s.

2.

ELECTROMYOGRAPHY

-measures the electrical activity of the muscles. -normally, needles are used instead of surface patch electrodes. (needles are more accurate) -can be tested on any muscle.

Note amanina jamain Parts of evaluation of electromyography > 1. Resting activity -measured when the muscles are relaxing. -normal isoelectric. -if there s fibrillation = signs of lesion in Anterior Horn Cells 2. Motor unit AP -when the muscle is minimally contracting. -normal - the amplitude is usually 300 millivolt. -normal - the duration is usually 10m/sec. -usually, 7 squares are covered in normal graph. -decrease in amplitude (less than 300 millivolt) and duration myopathy. -exaggerated amplitudes (giant waves) and duration neuron lesion.

3. Interference pattern -when the muscle is maximally contracting against resistance. (ask the patient to resist the examiner s handpush) -normal waves extreme high and low waves. -in neuropathic patient decrease amplitude, interrupted pattern (have isoelectric lines in between) -in myopathic patient decrease amplitude, not interrupted pattern. EMG signs of diseased patient >
y y y y y

Neuropathy
An action potential amplitude that is twice normal due to the increased number of fibres per motor unit. An increase in duration of the action potential (longer time) A decrease in the number of motor units in the muscle (as found using motor unit number estimation techniques) Decrease amplitude of interference pattern, and interrupted pattern

y y y y y

Myopathy A decrease in duration of the action potential A reduction in the amplitude A decrease in the number of motor units in the muscle (in extremely severe cases only) Decrease amplitude of interference pattern, but not interrupted pattern.

Demyelinating diseases y Refer to nerve conduction studies. y Slowing of conduction velocities and terminal latencies (longer terminal latency). Axon problems y refer to nerve conduction studies. y Decrease in amplitude and velocities.