AGENDA

ELECTROMYOGRAPHY

Mr3 Leydi Jeanne Gil Clares

November 5, 2018
 MARROW
Table 3. Pathophysiological meaning of motor unit action potential (PAUM) parameters.
PREVIOUS HALL
PAUM abnormality MOTOR NERVE phenomenon
Related anatomical-functional

Reduced amplitude Atrophy of muscle fibers Increase in connective tissue Intense jitter and
A MOTOR
blockage UNIT IS FORMED BY
1. a motoneuron (motor neuron) located in the spinal cord,
Increased amplitude
Spinal cord (cut) its extensionClumping
(axon)ofthat advances
muscle in the peripheral
fibers (reinnervation) nerve
Hypertrophy of muscle fibers
2. and the set Muscle
of muscle fibers innervated by the motor
fiber atrophy
Reduced duration
Motor neuron or
motoneuron 3. neuron. Loss of muscle fibers
Marked blocking of potentials on the motor plate
Increased duration Increase in the number of muscle fibers due to collateral reinnervation
Muscle
Increase in the number of phasesfibers are innervated by α motor fibers or α
Heterogeneous conduction in terminal axonal branches
motor unit

Increase in the width of the motor plate area

and turns motoneurons. Each motor neuron innervates several
Increased variability in the diameter of muscle fibers
Axon muscle fibers that it activates synchronously
Loss of motor units
Increased recruitment frequency Reduction of force generated by motor units
Increased jiggle Altered neuromuscular transmission
- Muscle fibers The sum of the action potentials of each muscle fiber of
the motor unit constitutes
Figure 1. Schematic representation of a motorthe MOTOR UNIT POTENTIAL.
unit with n muscle fibers
culars. The sum of the action potentials (AP) of each muscle fiber (PA,+PA,
Tendon
+..+PA.) captured by the concentric electrode gives rise to the motor unit
Bone potentialis(PAUM).
in relationThe
to the NUMBER
main OF MOTOR
parameters that are UNITS RECRUITED
measured on the PAUM
. Each motor axon divides into a series of waveform are indicated: amp=amplitude; dur=duration; f=phase; g=turn or
Joint
. During a movement,
branches, each of which innervates a unique
controlling the force of muscle fiber contraction. Thus, in the biceps brachii, a
turn IB= baseline.
. During a movement, the control of the contraction force is in relation to the
motoneuron innervates on average 100 muscle fibers that
activate synchronously NUMBER OF MOTOR UNITS RECRUITED
 MILD MUSCLE CONTRACTION
> MOTOR UNIT (UM)
• It allows you to study the Duration, Amplitude and Form of the response of c/UM .
• Smallest functional unit of the motor system.
Formed by an alpha MN, its axon and muscle fibers innervated by it.

or 100 to 2000 fibers in extremities and trunk, with a diameter of 20-90m.

UM STOCK POTENTIAL :
o
It is evaluated in voluntary muscular activity .

TO 7 11
MOTOR UNIT Characteristics
■ PUM are normally biphasic or triphasic
■ A small number of polyphasic potentials can be recorded in every healthy muscle, but
They normally do not exceed 10% of the total potentials

Motor unit potential

between 8 and
14 ms t
u
m
A
m p
p h
l
is 0.5 and 2
a
i s
t e

mV
u d
d u
e r
p
a h
t a
i s
o
n
e

Normal motor unit potentials where their main characteristics are highlighted.
 MOTOR UNIT
AMPLITUDE:
■ It is the main spike and reflects FM + activity close to
the surface of the recording electrode.
■ It represents the density of muscle fibers and distance
with the recording electrode.
■ Measurement from peak to peak.
■ Amplitude less than 2 mv
■ The area of the main spike reflects the activity of the
fibers located within a radius of 2 mm.
■ The average amplitude of isolated PUMs is decreased
in myopathies due to the global reduction in the
number of fibers that contribute to their formation.
■ It is elevated in neuropathic disorders. Well, the
number of muscle fibers that make up the spike of
the PUM is greater due to the increase in fiber
density secondary to compensatory collateral
reinnervation.
Figure 14.13 Morphologies of the motor unit action potential
(MUAP) - The MUAPs. Normal ones have two to four phases. In
chronic neuropathic lesions that occur after reinnervation, the
number of muscle tibias per motor unit increases, resulting in
long-lasting, high-amplitude and polyphasic MUAPs; in
myopathies or in alterations of the neuromuscular junction with
blockade, the number of muscle fibers function tes in the motor
unit decreases. This leads to MUAPs of long duration, small
amplitude and multiphase. cos.
 MOTOR UNIT
DURATION:

■ From initial deflection of the baseline until it returns.

■ Indicates total number of muscle fibers within a MU.
■ Oscillates between 3-15ms.
■ It is related to the anatomical dispersion of the motor plates and the
different impulse conduction times in the muscle fibers from the
motor plate to the recording electrode. Peak
■ Initial and terminal deflections are due to distant fibers Onset latency
■ The greater the number of fibers of a motor unit and the anatomical latency
density of its fibers, the longer the duration of the motor unit's
potential.
■ Decreasing T°c IM increases the duration and amplitude of PUM
■ The average duration of PUMS is decreased in myopathies and
increased in neuropathic processes.
 MOTOR UNIT
PHASE
S:

■ Portion of wave between departure and return to

baseline.
■ Number of baseline crossings + 1.
■ Polyphasic: measures muscle fiber discharge
synchrony > 4 phases
• Normal up to 15% of them
• PUMS with 2 to 4 phases are called simple

• When they have more than 4 phases they are considered

polyphasic.
• Polyphasia increases when there are neuromuscular
alterations, but it is not specific at all, that is, it appears
in both primarily myogenic and neurogenic anomalies.
 Sum of Contractions
• Addition of multiple fibers: Increase in the number of motor units (motor
neuron + innervating muscle fiber) stimulated. One motor unit is stimulated
after the other. Increases contraction force.
• Frequency Summation: Increase in the frequency of contractions. Each
new contraction occurs before the previous one concludes. Increases
contraction force.
• TETANIZATION: Very rapid contractions merge and the contraction
appears to be continuous (sustained).
 RECRUITMENT
IITLMNTIHN LHCTLAk bHATAA

• When a contraction is performed with effort-growth, the frequency of discharges

of the motor units increases and new ones are recruited in a gradual NORMAL MYOPATH
sequence, until with submaximal or maximum effort some PUMs are mixed with Y

the others (interference pattern)

10 " miwyohowpovhmrptor
• If clear isoelectric spaces are observed during a contraction with maximum effort,
at least 50% of the motor units have been lost, and the remaining motor units tend
to discharge at higher frequencies ^ This is then a deficient tracing (or
reduced) and with accelerated potentials, because they beat at high RECRUITMENT
_ . REINNERVATION Ann Knw LOSS OF U ■ ENGINES
frequencies ■ eA Ml Io#

• Several degrees of voluntary deficit pattern are distinguished: high intermediate,

poor intermediate and simple pattern.
• Recruitment frequency ranges between 7 and 20 Hz
• These values are elevated in neurogenic diseases and myopathies.
 Interference pattern
Interference pattern: Electrical activity recorded from a muscle with a needle
electrode during maximal voluntary effort. A complete interference pattern implies
that individual motor unit action potentials cannot be clearly identified. A reduced
interference pattern (intermediate interference pattern) is one in which some of
the individual PAUMs can be identified while other individual PAUMs cannot be
identified due to overlap. The term discrete activity is used to describe the
electrical activity recorded when each of the different PAUMs can be identified
The term single unit pattern is used to describe a single PAUM, which fires at a
rapid rate (i should be specified during an effort maximum voluntary The
contraction force associated with the interference model should be specified See
also recruitment pattern
Interference pattern Intermediate: 1
Reduced interference pattern:
Figure 1611 Interference
1 hoaxes. A Normal. b. Neurogenic. c.
Full intervention
Myopalic.pattern:
In each stroke the client is asked to contract as much as
possible. In normal subjects Therefore, so many motor unit action
potentials (AUAPs) discharge during the maximum period that identifying
neurogenic recruit,
individual units is scientific. In the
there is a reduced number of MUAPs They charge
at high frequency, producing an incomplete interference
pattern . In myopalic remission, even that the number -a MUAPs is

norm. The interference pattern consists of low-

amplitude, low - frequency MUAPs.
2 NEUROMUSCULAR
JUNCTION
NEUROMUSCULAR JUNCTION
This is a privileged area where neurotransmission takes place.

The neuromuscular junction is a particular synapse of each of the close contacts between a
motor axonal ending and a muscle fiber.

Acetylcholine, a neurotransmitter released by the nerve ending, binds to the acetylcholine

receptor in the sarcolemma and triggers an electrical current: the action potential. This spreads
along the sarcolemma and causes the triad to pass a signal from the T tubule to the
sarcoplasmic reticulum, which then releases calcium ions (Ca++).

Once the calcium ions are released, when they diffuse between the protein filaments of actin
and myosin, they cause the contraction of the myophyllins.

200118 - SUMMER'99-
Triad
NEUROMUSCULAR
JUNCTION
 ELECTROMYOGRAPHY

* Set of techniques for recording the electrical activity of skeletal muscle.

Types of pathological activities in each of the Discriminate if the muscle

different phases is normal or pathological

1. Of primarily muscular
1. Needle insertion origin: myopathic or
Repose myogenic pattern
2. slight contraction
Maximum
2. Or due to
contraction
muscle denervation, neurogenic
pattern.
Registration team Lower Extremity:
Gluteus Maximus
Gluteus Medius
Gluteus Minimus

Adductor Brevis
Adductor Longus
Adductor Magnus

" Three electrodes for your Biceps Femoris, LH

Biceps Femoris, SH

recording
Gracilis
Iliopsoas
Pectineus

1. Active electrode Sartorius

Semimembranosus
• . ..

2. Reference Semitendinosus
Tensor Fascie I atae

3. Amplifier ground input

Quadriceps
Rectus Femoris
Vastus Intermedius
Vastus Lateralis

Extn.Halluci
sLng..
Tex.Digitor
Peroneus Brevis
Peroneus Longus
umung.
Flex.Hallucis Lng.

Abductor Hallucis
Adductor Hallucis

MEDIAL GENUINE Extn.Digitorum Hrv

Flex.Digitorum Hrv
Flex.Digiti Minimi
medial gastrocnemius Flex.Hallucis Brevis
Interossei

H
Quadratus Plantae
REGISTRATION TECHNIQUE ELECTROMIOGRAPHIC
ELECTROMYOGRAPHY STUDY
Any skeletal muscle in the body consists of 4 phases.
ELECTROMIOGRAPHIC ACTIVITY

NORMAL muscle in a state of relaxation

PATHOLOGI
CAL
Electrode
In this way, we try to ensure Abnormal
that the number insertion that
of motoneurons discharge
myotonic is
discharges
insertion
small in order to be able activity
to individualize the different unit potentials.
muscle rest Positive waves
space recruitment Fasciculations
temporary recruitment
Fibrillations Complex
HEARING RECOGNITION is important when performing repetitiveandischarges
EMG, paying attention at all
times to the sound system. Mild muscle Motor unit potentials Motor unit potentials in
contraction in myogenic processes
neurogenic
processes
Maximum muscle Recruitment pattern
contraction
 ELECTROMYOGRAPHY
ELECTROMIOGRAPHIC ACTIVITY

NORMA ' DUCK

L electromyogram
Insert
Insertion
Repose
electricActivate
silence

plate noise Insertion

Plaque activity at neuromuscular junction

Plate potentials I1

Soft contraction biphasic or

triphasic PUM

Maximum contraction
interference tracing
eulássabobkdLuhadldaaku
"IFVVMTE'TNPTTW
Figure 7*5. Scheme that summarizes the characteristics of a normal electromyographic pattern. Below is the
interferential electromyographic tracing obtained during a maximum contraction of a normal muscle PUM: motor unit
potentials.
 ELECTROMYOGRAPHY

ELECTROMIOGRAPHIC ACTIVITY

NORMAL PATHOLOGI
CAL
Electrode Abnormal insertion myotonic discharges
insertion activity
muscle rest Positive waves
Fasciculations
Fibrillations Complex
repetitive discharges
Mild muscle Motor unit potentials Motor unit potentials in
contraction in myogenic processes
neurogenic
processes
Maximum muscle Recruitment pattern
contraction
1 INSERTION ACTIVITY

• It is a natural phenomenon in which the inserted needle produces a brief depolarization ^ Presence of
grouped, irregular, positive or negative spikes of short duration (300-500ms) and high frequency .

• It originates from injured muscle fibers or from mechanical stimulation of the electrode.

a)Insertion potentials

b) ) Fibrillations in m. partial denervated

INSERTION ACTIVITY

PATTERN DURATION MORPHOLOGY ETIOLOGY

NORMAL 300-500ms -

-Mono or biphasic spicules

-Waves (+)s
INCREASED >500ms -Spicules -N variant -Denervation -
-Waves (+)s Myopathies -Neuropathies

REDUCED <100ms -Baseline oscillations -Replacement of fat or

fibrous tissue with:
^ muscle ischemia
^ muscular dystrophy
 SPONTANEOUS ACTIVITY
2 REST
NORMAL
• Healthy skeletal muscle at muscular rest is completely SILENT , so it is not possible to record any type of EMG
activity.
• Activity is only observed when the tip of the electrode is located in the nerve ending area of the muscle.
• This type of activity is called neuromuscular plate activity, x irritation of the nerve terminals
• Two kinds of potentials:
• plate potentials
• And the noise of the plate
• They are accompanied by a stabbing pain in the area where the needle was inserted.

Fr download Amplitude Duration

weAy-Vw) —
1. Plate noise KEEP GOING 10-50mV 1-2ms

2. Plate spicules IRREGULAR 100-200mV 3-4ms

^ Possible to observe them together or independently.

 NORMAL SPONTANEOUS ACTIVITY

P NOISE. SPICLES or SPIKES OF P. MOTORBOAT

MOTORBOAT
• SINGLE PHASE potentials (-)s, low amplitude, • BIPHASIC potentials of low amplitude,
duration <2s. duration <4s.
• Induced by terminal axon irritation due to
• They represent miniature sub-threshold PLATE the recording needle.
potentials.
• They activate muscle fiber
• Recorded EC and triggered by Ach release in nervous potential. of action in the
the presynaptic space.
• Crackling sound.
• Seashell sound .
• They have no clinical
• When they appear, the patient complains of significance
pain.
r
3 GENTLE MUSCLE CONTRACTION Motor unit potentials
Table 3. Pathophysiological meaning of motor unit action potential (MUAP) parameters.

PAUM abnormality Related anatomical-functional phenomenon

• During muscle contraction, motor unit potentials will be recorded.
Reduced amplitude
• Their number and frequency will be determined by the degree of muscle contraction.
Atrophy of muscle fibers Increase in connective tissue Intense jitter and
blockage

Increased amplitude
Clumping of muscle fibers (reinnervation) Hypertrophy of muscle fibers
MOTOR UNIT POTENTIAL
Muscle fiber atrophy
Reduced duration Loss of muscle fibers
• The elementary functional unit of muscle contraction is the motor unit.
Marked blocking of potentials on the motor plate
• It is formed by muscle fibers that Increased
are innervated
duration by the same Increase
nerve infiber whose
the number of origin is indue
muscle fibers antoalpha motor
collateral neuron of
reinnervation
the anterior horn.
Heterogeneous conduction in terminal axonal branches
• The discharge of a motor neuronIncrease
generates a nervous
in the number impulse
of phases that in
Increase will
thecause
width ofthe depolarization
the motor plate area of the membrane of
and turns
all the muscle fibers that make up the motor unit and its subsequent Increasedmuscle contraction.
variability in the diameter of muscle fibers
• The motor unit potential is the sum of the action potentials of each of the muscle fibers that constitute the
Loss of motor units
motor unit . Increased recruitment frequency Reduction of force generated by motor units
• The activity that is recorded in electromyography during voluntary muscle contraction is constituted by motor unit
potentials. Increased jiggle Altered neuromuscular transmission
• The number and frequency of discharge will be given by the intensity of the contraction ..
Figure 1. Schematic representation of a motor unit with n muscle fibers
culars. The sum of the action potentials (AP) of each muscle fiber (PA,+PA,
+..+PA.) captured by the concentric electrode gives rise to the motor unit
potential (PAUM). The main parameters measured in the PAIIM waveform are indicated: amn =
am n lit Id ■ Hi Ir= d 11 rani An; f=phase; g=turn . During a movement, the control of the

contraction force is in relation to the NUMBER OF MOTOR UNITS

RECRUITED
PATHOLOGICAL CONDITIONS
• 1RIA MUSCLE DISEASE : Muscle fibers degenerate and disappear > Response of short
duration and low amplitude
• COMMITMENT OF THE PROXIMAL UM (Cel. Antler, radiculopathies) > Entire UM without
innervation .
Some healthy MUs from the same area partially reinnervate some affected fibers > MU
size increases >
abnormally long response in amplitude, duration and polyphasic .
• PERIPHERAL NEUROPATHIES > Axonal degeneration and regeneration > axons in
different stages > polyphasic, decreased amplitude .
Reinnervation process > small amplitude, short duration, polyphasic potential (nascent
potentials)
 RECRUITMENT
3 MAXIMUM MUSCLE CONTRACTION

• As the intensity of the contraction increases, other units are recruited (R. spatial) and the frequency of the discharge increases
(R. Temporary).
• 1* They discharge the small amplitude units and as the intensity of the contraction increases, they discharge larger units.

MOTOR UNIT POTENTIAL

• If the intensity of the muscle contraction is maximum , the number of motor units
recruited and their discharge frequency is higher.
• Interference of some units with others is caused , which prevents their
individualization and the visualization of the baseline.
Amplitude
[mV]

TO MAXIMUM VOLUNTARY EFFORT

INTERFERENCE PATTERN

Figure 1, Surface EMG during intermittent contractions * This layout is called interferential and is the usual one in a healthy muscle during
of the wrist extensor muscle [40}. Reproduced with
permission
maximum voluntary contraction.
■ Under normal conditions, when faced with a maximum effort , a large number of
Ums are recruited, isoelectric spaces are not observed in the baseline and the
PUMs interfere with each other .
■ Variable amplitude between 2-4 mV.

■ It depends on:
■ Activation: ability to increase discharge rate. It is central.
■ Recruitment: ability to add UMs.

■ INCOMPLETE : some motor unit potentials can be identified.

INTE PATTERN IÜ]p%
10 m-
Ec

NORMAL

NEUROGENIC

MYOPATHIC tHulwA+/UA/rH4t-alpisHAet,H*N/
**4HAm/4
 ELECTROMYOGRAPHY

ELECTROMIOGRAPHIC ACTIVITY

NORMAL PATHOLOGI
CAL
Electrode Abnormal insertion myotonic discharges
insertion activity
muscle rest Positive waves
Fasciculations
Fibrillations Complex
repetitive discharges
Mild muscle Motor unit potentials Motor unit potentials in
contraction in myogenic processes
neurogenic
processes
Maximum muscle Recruitment pattern
contraction
ABNORMAL SPONTANEOUS ACTIVITY
1 ABNORMAL INSERTION ACTIVITY Insertional activity is always present in a
healthy muscle. In the pathological muscle it
may be increased, decreased or absent. The decrease or increase in this activity indicates
a decrease or increase in the excitability of the muscle fibers.

MYOTONIC DISCHARGE
• Difficulty in relaxing voluntary muscle contraction generated by a mechanical or
electrical stimulus
• These discharges are evoked by voluntary contraction, percussion, insertion or
movement of the recording electrode.
• They are trains of potentials with the same morphology and with a very high
discharge frequency.
• It is between 50 and 100 impulses per second .
• The amplitude of the potentials and their discharge frequency periodically increases
and decreases .
• Sound like a plane in a dive or an ENGINE changing revs.
• Its amplitude 50 uv and 1 mV .
 MYOTONIC DOWNLOADS 200 msec

EF representation of difficulty in relaxation following

voluntary or percussion-induced contraction.
•Due to the transient hyperexcitability of the muscle fiber.
•CC: Difficulty and slowness in relaxation after contraction
maintained for seconds.
•(-) after several repeated cxs and (+) with the cold and
vigorous activity .

)They reflect activity of individual muscle fibers that discharge

spontaneously and repetitively with a characteristic increase
and decrease of amplitude 20-300uV and frequency 20-200Hz.

• They may present wave morphology or fibrillations.

•Sound similar to acceleration and deceleration of an engine. • Characteristics of myotonic
dystrophies, myotonias
2 MUSCLE REST congenital and others such as;
polymyositis, hyperK periodic
TO FIBRILLATIONS paralysis, hypothyroidism, etc.
—[_____________________Yo___________________
• They are the EC recording of the spontaneous depolarization of an isolated muscle fiber.
• Being considered electrophysiological markers of DENERVATION.
• Typical NEUROPATHIES
• Reproducible discharges in at least 2 different areas suggest involvement at any point along the
lower NM tract.

• (+) its distribution contributes to the topographical dimension of the lesion: ME anterior horn,
radiculopathies, plexopathies, mononeuropathies or axonal polyneuropathies .

• They are recognized by their regular discharge pattern (0.5-10Hz) with gradual slowing down until
disappearing with the sound of “rain falling on the roof”.
• Amplitude: increases in early course and decreases as the reinnervation process progresses.
FIBRILLATIONS

• The time of appearance depends on the length of the axons.

• In root lesions after 7-10 days (m. paraspinal) and up to 6ss in m.
distal extremities .

An occasional fibrillation) is N if the recording needle is close to the Motor Plate.

Abundant and sustained F(+): SERIOUS interruption between nerve and muscle.
>: With heat and administration
<: With the cold and ischemia.
• These are spontaneous depolarizations of muscle fibers in DENERVATED muscle tissue.

POSITIVE BANDS

• It is characterized by its sharp initial deflection (+)

followed by a long-lasting (-) phase with a “dull”
sound.

• Same meaning as fibrillations although the cause of

their different morphology is unknown.

• They usually accompany fibrillations, although

sometimes they can be recorded in isolation and
early in denervation, also in myopathic processes.
 3 FASCICULATIONS

• They are spontaneous, individual discharges of a part or all of the muscle fibers of a MU.
• The ectopic potential generated is transmitted to all axonal endings, so the recording of the potential is the electrical sum of the
depolarized voltages.
• They present identical morphology to the UM potential: amplitude, duration and phases .
• They can be generated in the ME, anterior horn cells and at any point along the MNI axon.
• Clinic: Noticeable brief individual jerks rarely show joint displacement.
• They are observed in lesions of ant horn neurons, radiculopathies, polyneuropathies and compression neuropathies .
I FASCICULATION

FASCICULATIONS
-and
• There are the f. benign , which are not associated with weakness, atrophy or
impaired reflexes.
> caused by nervous tension, anxiety, muscle fatigue, coffee or tobacco.

• The isolated presence of fasciculations is not synonymous with illness. MN

unless accompanied by other manifestations of spontaneous activity
(fibrillations, +s waves) or signs such as weakness, atrophy, hyperreflexia ,
suggestive of involvement of both 1°MN and 2°MN .

Duration: Variable (3-15 ms) Repeat rate: 0.1a 10/s

Amplitude: Variable (300 uV-3 mV) Discharge interval: Irregular
Configuration: three-phase or polyphase SOUND: “BLUNT BANG”
3 GENTLE MUSCLE CONTRACTION Neurogenic
Increased insertion
electromyogram
activity (except
muscle fibrosis)
Repose
Fibrillations
positive potentials

Motor unit potentials

Polyphasic
Increased duration or amplitude

Maximum effort loss of PUM

{deficit or intermediary)
Acceleration

1. Scheme that summarizes the characteristics of a neurogenic

pattern.
• A PARTIAL INJURY OF THE PERIPHERAL NERVE, nerve root,
plexus or second motor neuron causes axonal
degeneration and partial denervation of the muscle.
• If the registration is carried out in the first weeks, a loss of
motor units will be observed , but the characteristics of
the remaining PUM remain unchanged.
.
• RESTRUCTURING OF THE UM
• The nerve fibers that remain undamaged begin to give
collaterals that reinnervate neighboring denervated muscle
fibers. COLLATERAL REINNERVATION
• These facts motivate a greater duration and breadth of
UM's potential
• COMPLETE INJURY, the number of muscle fibers that
innervate is very small, so the UM will be left with a small
number of muscle fibers and immature nerve terminals.
• This unit structure generates motor unit potentials of small
duration and amplitude with very polyphasic morphology
and little stability.
• These potentials are called NASCENT OR REINNERVATION
POTENTIALS.
3 GENTLE MUSCLE CONTRACTION

s of motor unit in mioge processes

muscular on due to direct involvement of the
cos are characterized by their small, very polyphasic
dura ology.
It has a high-pitched, crackling sound very high in the
amplitude and duration of the potential of the muscle
fibers, which causes the units to be smaller in size with
a smaller number and
muscular aces.
 Myopathies or
junctional disorders
neuromuscular with
locks
nes neurop number of functioning
Chronicles muscle fibers in the
einnervac motor unit decreases
e Short-term MUPS. Small
amplitude and
number of scular polyphasic.
fibers per unit
increases, resulting
in MUAPS of long
duration, high
volume and
polyphasic
 RECRUITMENT PATTERN
4 MAXIMUM MUSCLE CONTRACTION

INTERFERENCE PATTERN
• It is determined by the number of FUNCTIONING MOTOR UNITS .
• When a nerve is completely injured, motor unit potentials cannot be recruited as
the transmission of nerve impulses to the muscle is
interrupted. NORMAL
• If the nerve injury is not complete and undamaged nerve
fibers remain, some motor unit potentials will be recruited during the maximum
voluntary contraction test and the muscle force developed will always be less than
that of a healthy muscle.
• THE GREATER THE NERVE INJURY, the less muscle strength and less motor unit
potentials recruited during voluntary contraction.
• Deficit or intermediate layout
NEUROGEN
• This decrease in the spatial recruitment of units is
accompanied by an increase in their temporal recruitment > typical of paresis due
to neurogenic injury.

MYOPATHIC
IWHie#/WMWr4A-dplAHe#,*HAw/#**#*12
Am)4 c
Interference pattern

MUAPs of
a pattern
the
PAUMs
after
others bid
UAPS is snormal,
to the
te in MUAPS de cor

Interference pattern: Electrical activity recorded from a muscle with a needle

electrode during maximal voluntary effort. A complete interference pattern means
that individual motor unit action potentials cannot be clearly identified. A reduced
interference pattern c (intermediate interference pattern) is one in which some of
the individual PAUMs can be identified while other individual PAUMs cannot be
identified due to overlap. The term discrete activity is used to describe the
electrical activity recorded when each of the different PAUMs can be identified.
The term discrete unit pattern is
• MYOPATHIES : No. of UM unchanged, only the No. of muscle fibers is decreased ) Recruit a large
No. of UM to achieve a certain task = “ Early Recruitment ” > Myopathic Pattern.

• NEUROPATHIC CONDITIONS : There is a real decrease in UM , it is not able to recruit enough

UM to clear the baseline = “ Decreased Interference Pattern ” = Early electrical sign of
Neuropathic process.

• ENTRAPMENT NEUROPATHIES : Severity will depend on the intensity and duration of the
compression
• Early stages > Edema only > slowing or absence of nerve conduction across area of
compression > EMG shows no evidence of denervation. Proximal and distal to the compression
area conductivity N.
• Late stages > Affects integrity of the axonal cylinder. No conductivity proximal or distal to
compression area. -> “Incomplete interference pattern”
THREE FUNDAMENTAL ELECTROMIOGRAPHIC PATTERNS