Easy EMG: A Guide to Performing Nerve Conduction Studies and Electromyography PDF
Preview Easy EMG: A Guide to Performing Nerve Conduction Studies and Electromyography
Easy EMG This page intentionally left blank T H I R D E D I T I O N Easy EMG A Guide to Performing Nerve Conduction Studies and Electromyography Authors Illustrator LYN D. WEISS MD DENNIS J. DOWLING Chair of Physical Medicine and Rehabilitation DO FAAO NYU Langone Hospital Long Island Director of Osteopathic Medicine Professor of Rehabilitation Medicine Services NYU Long Island School of Medicine Department of Physical Medicine and Mineola, NY, USA Rehabilitation Family Medicine Department JAY M. WEISS MD Nassau University Medical Center Long Island Physical Medicine and East Meadow, NY, USA Rehabilitation Director of OMM Assessment Jericho, NY, USA National Board Osteopathic Medical Associate Professor of Clinical Physical Examiners Medicine and Rehabilitation Conshohocken, PA, USA State University of New York Stony Brook College of Medicine Stony Brook, NY, USA JULIE K. SILVER MD Associate Professor Department of Physical Medicine and Rehabilitation Harvard Medical School Boston, MA, USA For additional online content visit expertconsult London, New York, Oxford, Philadelphia, St Louis, Sydney, Toronto Elsevier 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 EASY EMG, THIRD EDITION ISBN: 978-0-323-79686-6 Copyright © 2023 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2016, 2004. Library of Congress Control Number: 2021944559 Content Strategist: Humayra R. Khan Content Development Specialist: Akanksha Marwah Publishing Services Manager: Deepthi Unni Project Manager: Sindhuraj Thulasingam Design Direction: Brian Salisbury Printed in India Last digit is the print number: 9 8 7 6 5 4 3 2 1 C O N T E N T S Preface vii Dedication ix Video Table of Contents xi 1. What Is an EMG? 1 Julie K. Silver 2. Why Perform Electrodiagnostic Studies? 5 Julie K. Silver 3. About the Machine 9 Julie K. Silver 4. Nerve Conduction Studies 17 Lyn D. Weiss n Jay M. Weiss 5. Electromyography 37 Lyn D. Weiss n Jay M. Weiss 6. Injuries to Peripheral Nerves 67 Lyn D. Weiss 7. How to Plan Out the Examination 73 Lyn D. Weiss 8. Pitfalls 99 Lyn D. Weiss 9. Carpal Tunnel Syndrome 109 Lyn D. Weiss 10. Ulnar Neuropathy 117 Lyn D. Weiss 11. Radial Neuropathy 125 Julie K. Silver 12. Radiculopathy 131 Lyn D. Weiss 13. Spinal Stenosis 139 Lyn D. Weiss 14. Fibular (Peroneal) Neuropathy 141 Julie K. Silver 15. Tarsal Tunnel Syndrome 147 Julie K. Silver n Jay M. Weiss 16. Peripheral Polyneuropathy 151 Lyn D. Weiss v Contents vi 17. Myopathy 157 Julie K. Silver 18. Brachial Plexopathies 161 Julie K. Silver n Jay M. Weiss 19. Lumbosacral Plexopathies 171 Julie K. Silver n Jay M. Weiss 20. Motor Neuron Diseases 179 Lyn D. Weiss 21. Critical Illness Neuropathy and Myopathy 181 Lyn D. Weiss 22. Inflammatory Neuropathies 185 Lyn D. Weiss 23. Neuromuscular Junction Disorders 189 Lyn D. Weiss 24. How to Write a Report 193 Lyn D. Weiss 25. Tables of Normals 199 Lyn D. Weiss 26. Reimbursement 203 Jay M. Weiss GLOSSARY OF EMG TERMS 209 APPENDIX 1: Figures for Table 4.3 (Nerve Conduction Studies Setup) 211 APPENDIX 2: Figures for Table 5.4 (Common Muscles—Innervation, Location, and Needle Placement) 219 APPENDIX 3: Summary of Electrodiagnostic Findings in Specific Clinical Conditions 263 Index 273 P R E F A C E We realize that many residents struggle with learning the basics of electrodiagnostic testing. We hope that this book provides a foundation that is easy to understand. This is not meant to be a comprehensive text. It is meant, rather, to serve as a bridge to more in-depth textbooks. This third edition includes updates and additional chapters. In addition, we hope that the video clips will clarify the technical aspect of electrodiagnostic testing. The first three chapters are intro- ductory in nature. They briefly review what electromyography (EMG) testing is and why we do it. Chapter 4 assesses nerve conduction studies. The needle portion of the examination is discussed in Chapter 5. Chapter 6 reviews the effects of injuries on peripheral nerves. Suggestions on how to plan out the examination are reviewed in Chapter 7. Chapter 8 examines some of the pitfalls that all electromyographers should recognize. Chapters 9 through 20 review some of the commonly encountered clinical entities that the beginning electromyographer might encounter. Chapter 24 gives suggestions on how to write a complete electrodiagnostic report. Chapter 25 details the commonly accepted normal values for electrodiagnostic laboratory tests. It should be stressed, however, that each laboratory should develop its own set of normals based on its own particular patient population and electrodiagnostic equipment. Reimbursement issues are discussed in Chapter 26. It should be noted that this book does not represent the complete spectrum of electrodiag- nostic testing. Since this book is specifically targeted at novices in the field, some of the more complex testing, including somatosensory evoked potentials, blink reflex, and single-fiber EMG, is not discussed. Although this text does review a great deal of technical information, the most important les- son one can learn, which is stressed repeatedly throughout the text, is that the electrodiagnostic test is an extension of the history and physical examination. We are physicians, first and foremost, with obligations to provide our patients with compassionate and quality care. We hope this book inspires lifelong learning. Lyn D. Weiss MD Jay M. Weiss MD Julie K. Silver MD vii This page intentionally left blank The authors would like to dedicate this book to our teachers, to our mentors, and especially to our students. Jay and Lyn Weiss want to thank the people who have taught us the most about what is important in life—our children (Ari, Lauren, Helene, Kyle, Stefan, Becca, Rachel, Benjamin, Olivia, Levon, Evelyn, and Mason).
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