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Interpreting EMG and NCS Results

EMG and NCS tests are used together to diagnose diseases of the peripheral nerves and muscles. EMG involves inserting a needle electrode into muscles to measure electrical activity, while NCS uses surface electrodes to measure nerve impulse transmission speeds. Together they provide complementary information about motor and sensory nerve function and whether axons or myelin sheaths are affected. Abnormal EMG readings can indicate denervation, reinnervation, or myopathic processes. NCS evaluates conduction velocities, amplitudes, durations and blocks to localize neuropathies.

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795 views4 pages

Interpreting EMG and NCS Results

EMG and NCS tests are used together to diagnose diseases of the peripheral nerves and muscles. EMG involves inserting a needle electrode into muscles to measure electrical activity, while NCS uses surface electrodes to measure nerve impulse transmission speeds. Together they provide complementary information about motor and sensory nerve function and whether axons or myelin sheaths are affected. Abnormal EMG readings can indicate denervation, reinnervation, or myopathic processes. NCS evaluates conduction velocities, amplitudes, durations and blocks to localize neuropathies.

Uploaded by

nadiyasyadina
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Interpreting EMG and NCS

Results
ElectrodiagnosticTestsHelpDiagnoseDiseasesofPeripheral
NerveandMuscle
ByPeterPressman,MDReviewedbyaboardcertifiedphysician.
UpdatedMay07,2016
Electromyography(EMG)andnerveconductionstudies(NCSs)arevaluablediagnostictools
thathelpneurologistslocateanddeterminethecausesofdiseasesthataffectmusclesand
peripheralnerves.InEMG,asmallneedleisinsertedintoamuscleinordertomeasureelectrical
activity.Innerveconductionstudies,electrodesareplacedontheskinoverlyinganerve,and
otherrecordingelectrodesareattachedatadifferentpointoverthesamenerve.
Asmallshockisapplied,andtheelectricalimpulseisrecorded.
WhileEMGandNCSsaredifferenttests,they'reoftenusedtogetherbecausetheinformation
gainedfromeachtestiscomplementarythatis,thetwoteststogethertendtobemore
informativethaneitherusedalone,exceptinspecificsituations.

Understanding NCS Results


Theelectricalsignalsentalongtheaxonofanerveiscalledanactionpotential.Innerve
conductionstudies,theseactionpotentialsareartificiallygeneratedbyelectricalstimulationin
ordertoassesshowtheaxonresponds.
Therearetwomainportionstoanerveconductionstudy:sensoryandmotor.Recordingfroma
sensorynervegivesasensorynerveactionpotential(SNAP),andrecordingfromamuscleyields
acompoundmuscleactionpotential(CMAP).
OthertermsyoumayencounterinanEMGorNCSreportincludethefollowing:

Amplitude:Theelectricalsignalisrepresentedasawave,andtheamplitudeisitsheight.

ConductionVelocity(CV):Theconductionvelocitydescribesthespeedatwhichthe
electricalimpulsetravelsalongthenerve.

Duration:Thisdescribesthewidthofanelectricalwave.

ConductionBlock:Thediminutionofsignalacrossananatomicalregionsuchasthe
wrist.Thissuggestsnerveentrapment,asincarpaltunnelsyndrome.

Freflex:TheFwavesisakindofelectricalecho,inwhichtheimpulsetravelsuptothe
spineandthenbackdownalongthesamefiber.Ittherebygivesasenseoftheconduction
alongtheentirelengthofamotornerve.

Hreflex:TheHwaveistheelectricalequivalentofareflexintheleg.Animpulse
travelstothespinalcordviaasensorynerve,thentravelsbackalongamotornerve.

Thesemeasuresgiveinformationaboutbothmotorandsensorycomponentsoftheperipheral
nervoussystem.Theyalsosuggestwhethertheaxonorthemyelinsheathofnervesismore
damagedbyaneuropathy.Myelinhelpsactionpotentialstravelfaster,andsoinproblemsof
myelin(myelinopathies),conductionvelocityismoredecreased.Inproblemswiththeaxon
(axonopathies),fibersthatareintactcanconductsignalsatnormalspeeds,buttherearefewer
fibers,whichleadstoaweakersignalanddecreasedamplitude.

Understanding EMG Results


WhenanEMGisperformed,electricalactivityfrommusclefibersismeasuredanddemonstrated
aswavesonascreenandstaticlikenoisesplayedonaspeaker.
Thetechnicianbothlistenstothesesoundsandwatchesthemonitorinordertodetect
abnormalities.
Whenanervestimulatesamuscletocontract,theresultisabriefburstofelectricalactivity
calledamotorunitactionpotential(MUP).Indiseasesofperipheralnerves,musclessometimes
starthavingspontaneousactivityontheirown.ThiscanbedetectedbyEMGasfibrillationsand
positivesharpwavesonthemonitor.Sometimestheabnormalitycausesvisiblemuscletwitches
calledfasciculations.
Ifanervehasbeeninjuredandthenregrows,thenervetendstobranchouttoincludeawider
area.ThiscausesabnormallylargeMUPS.

Incontrast,MUPSareabnormallysmallorbrief,andsuggestthepresenceofadiseaseofa
muscle(amyopathy).
DoctorsinterpretingEMGresultsmayalsomentiontheterm"recruitmentpattern."Asamuscle
iscontracted,nervefiberssignalmoreandmorebitsofmuscle(calledmotorunits)tojoininand
help.Inaneuropathicdisorder,theamplitudeofdifferentmotorunitsisstrong,butthereare
fewerofthembecausethenerveisunabletoconnecttoasmanyunits.Inmyopathies,the
numberofmotorunitsisnormal,buttheamplitudeissmaller.
Thepatternofelectricaldischargesfromthemusclecangiveadditionalinformationastothe
causeoftheproblem,andmayevenhelpdeterminehowlongaproblemhasbeenpresent.
TheinterpretationofEMGandNCSsisnotalwaysstraightforwardandmaynotalwaysleadto
justonepossiblediagnosisbutthetestscanreducethenumberofdiagnosticpossibilities.
Sources:

AlportAR,SanderHW,ClinicalApproachtoPeripheralNeuropathy:AnatomicLocalizationandDiagnosticTesting.Continuum;Volume18,No1,February2012

BlumenfeldH,NeuroanatomythroughClinicalCases.Sunderland:SinauerAssociatesPublishers2002

What is an EMG, and How


Does it Work?
By Erica Jacques
Updated December 30, 2014
What EMG is:
EMG, or electromyography, is a test that measures muscle strength. When you have
an EMG, a thin needle-like electrode is inserted through your skin into the muscle.
This electrode picks up detailed readings from your muscle, detecting the strength
of its contraction.
Why You Might Have an EMG:

Some chronic pain disorders can cause or be caused by muscular weakness.


Readings from an EMG can help your doctor determine if you have generalized
muscle weakness, or muscle weakness that is caused by a neurological problem.
EMGs are often performed in conjunction with a nerve conduction velocity test
(NCV) to diagnose certain neurological disorders like carpal tunnel syndrome or
sciatica.
What EMG Feels Like:
While you may have some discomfort during your EMG, most tests are not painful.
The needle electrode is thin, though it may feel unpleasant as it is inserted. During
the test you should feel little, if any, discomfort. Some people experience muscle
tenderness for a day or two after the test, and some have minimal bleeding from
the EMG needle sites. Most people, however, find EMGs to be painless.
Preparing For Your EMG:
Fortunately, you wont need to do much to prepare for your EMG, other than arriving
to your appointment on time. Most providers ask that you not apply anything topical
to the test areas. In other words, dont use any lotion or pain creams on until the
test is over. Before you arrive at your appointment, ask your doctor if he plans on
performing any other tests that may require preparations.
Source:
Medline Plus. Medical Encyclopedia: Electromyography. Accessed 6/9/09.http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003929.htm

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