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An Imprint of Springer Publishing McLean EMG GUIDE SECOND EDITION Samuel K. Chu Prakash Jayabalan Christopher J. Visco McLean EMG Guide cchhuu7722112299__PPTTRR__FFMM__ii--xxvviiiiii__0033--2211--1199..iinndddd ii 2211--MMaarr--1199 55::0099::5544 PPMM cchhuu7722112299__PPTTRR__FFMM__ii--xxvviiiiii__0033--1199--2200..iinndddd iiii 2211--MMaarr--1199 1111::0044::5500 AAMM McLean EMG Guide Second Edition Editors Samuel K. Chu, MD Assistant Professor Northwestern Feinberg School of Medicine Attending Physician Shirley Ryan AbilityLab Chicago, Illinois Prakash Jayabalan, MD, PhD Assistant Professor Northwestern Feinberg School of Medicine Attending Physician Scientist Shirley Ryan AbilityLab Chicago, Illinois Christopher J. Visco, MD Ursula Corning Associate Professor Sports Medicine Fellowship Director Residency Program Director Vice-Chair of Education Department of Rehabilitation and Regenerative Medicine Columbia University College of Physicians and Surgeons New York-Presbyterian Hospital New York, New York An Imprint of Springer Publishing cchhuu7722112299__PPTTRR__FFMM__ii--xxvviiiiii__0033--1199--2200..iinndddd iiiiii 2211--MMaarr--1199 1111::0044::5500 AAMM Visit www.springerpub.com and http://connect.springerpub.com ISBN: 978-0-8261-7212-9 ebook ISBN: 978-0-8261-7213-6 DOI: 1 0.1891/9780826172136 Acquisitions Editor: Beth Barry Compositor: S4Carlisle Publishing Services Copyright © 2019 Springer Publishing Company. Demos Medical Publishing is an imprint of Springer Publishing Company, LLC. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. M edicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in particular our understanding of proper treatment and drug therapy. The authors, editors, and publisher have made every effort to ensure that all information in this book is in accordance with the state of knowledge at the time of production of the book. Nevertheless, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the contents of the publication. Every reader should examine carefully the package inserts accompanying each drug and should carefully check whether the dosage schedules mentioned therein or the contraindications stated by the manufacturer differ from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Library of Congress Cataloging-in-Publication Data Names: Chu, Samuel K., editor. | Jayabalan, Prakash, editor. | Visco, Christopher J., editor. Title: McLean EMG guide / [edited by] Samuel K. Chu, Prakash Jayabalan, Christopher J. Visco. Other titles: McLean course in electrodiagnostic medicine | EMG guide Description: Second edition. | New York : Demos Medical, [2019] | Preceded by McLean course in electrodiagnostic medicine / [edited by] Christopher J. Visco, Gary P. Chimes. c2011. | Includes bibliographical references and index. Identifiers: LCCN 2019002642 (print) | LCCN 2019003919 (ebook) | ISBN 9780826172136 | ISBN 9780826172129 (alk. paper) | ISBN 9780826172136 (ebook) Subjects: | MESH: Electrodiagnosis–methods | Neuromuscular Diseases–diagnosis Classification: LCC RC77 (ebook) | LCC RC77 (print) | NLM WB 141 | DDC 616.07/547–dc23 LC record available at https://lccn.loc.gov/2019002642 Contact us to receive discount rates on bulk purchases. We can also customize our books to meet your needs. For more information please contact: [email protected] Publisher’s Note: New and used products purchased from third-party sellers are not guaranteed for quality, authenticity, or access to any included digital components. Printed in the United States of America. 19 20 21 22 23 / 5 4 3 2 1 cchhuu7722112299__PPTTRR__FFMM__ii--xxvviiiiii__0033--1199--2200..iinndddd iivv 2211--MMaarr--1199 1111::0044::5533 AAMM This book is dedicated to Jim, may his memory live on. cchhuu7722112299__PPTTRR__FFMM__ii--xxvviiiiii__0033--1199--2200..iinndddd vv 2211--MMaarr--1199 1111::0044::5533 AAMM cchhuu7722112299__PPTTRR__FFMM__ii--xxvviiiiii__0033--1199--2200..iinndddd vvii 2211--MMaarr--1199 1111::0044::5533 AAMM Contents Contributors xi Preface xvii Share MCLean EMG Guide SECTION I. INTRODUCTION 1. Introduction to Electrodiagnostics 3 Gautam Malhotra 2. Instrumentation 9 Gautam Malhotra 3. Systematic Approach to Learning and Performing Nerve Conduction Studies 13 Gautam Malhotra, Jason Bitterman, and Chae K. Im SECTION II. NERVE CONDUCTION STUDIES 4. Upper Limb Motor Studies 23 Matthew C. Oswald and Khushboo Doshi 5. Upper Limb Sensory Studies 29 Byron J. Schneider and David J. Kennedy 6. Lower Limb Motor Studies 37 Berdale Colorado 7. Lower Limb Sensory Studies 41 Jacqueline Neal and Nida Gleveckas-Martens 8. F-Waves 55 Solomon Rojhani and Akhil Chhatre 9. H-Refl exes 61 Leslie Rydberg cchhuu7722112299__PPTTRR__FFMM__ii--xxvviiiiii__0033--1199--2200..iinndddd vviiii 2211--MMaarr--1199 1111::0044::5533 AAMM viii | Contents SECTION III. NEEDLE EMG 10. Basic EMG Technique 67 Christian M. Custodio 11. Basic Approach to EMG Waveform Recognition 73 Gautam Malhotra and Chae K. Im 12. Motor Unit Action Potential Analysis 81 Anirudh Gupta, Kasser Saba, and W. David Arnold 13. Recruitment 87 Monal Desai and W. David Arnold SECTION IV. IMPORTANT CONCEPTS FOR INTERPRETING STUDIES 14. Orthodromic and Antidromic Nerve Conduction Studies 97 Daniel A. Goodman 15. Temporal Dispersion and Phase Cancellation 101 Mary Ann Miknevich and Jenna Meriggi 16. Interpreting Studies 107 Joelle Gabet and Wendy M. Helkowski 17. Common Anomalies 115 Nabela Enam and Nigel Shenoy SECTION V. COMMON CLINICAL ENTITIES 18. Carpal Tunnel Syndrome 127 Leslie Rydberg 19. Ulnar Neuropathy at the Elbow 135 Akinpelumi Beckley and Susie S. Kwon 20. Radial Neuropathy 143 Jonathan S. Kirschner and Carlo Milani 21. Anterior Interosseous Nerve Lesions 153 Patrick J. Barrett 22. Fibular (Peroneal) Neuropathy 159 Rohini Sweta Rao and Aaron Jay Yang 23. Tibial Neuropathy 169 Brian F. White cchhuu7722112299__PPTTRR__FFMM__ii--xxvviiiiii__0033--1199--2200..iinndddd vviiiiii 2211--MMaarr--1199 1111::0044::5566 AAMM Contents | ix 24. Femoral Neuropathy 177 Dan Cushman 25. Lumbosacral Radiculopathy 185 Nathan P. Olafsen and Daniel T. Probst 26. Cervical Radiculopathy 195 Ryan Doyel and Monica E. Rho 27. Facial Nerve and Blink Studies 203 Kevin Carneiro and William Filer 28. Repetitive Stimulation and Neuromuscular Junction Disorders 211 Trevor Gessel and Nassim Rad 29. Peripheral Neuropathy 217 Michael Mallow 30. Brachial Plexopathy 221 Christopher J. Visco and Idris Amin 31. Motor Neuron Disease 231 Dena Abdelshahed, Ankita Dutta, Chae K. Im, and James F. Wyss 32. Myopathy 239 Gautam Malhotra 33. The Use of Ultrasound With Electrodiagnosis 245 Jeffrey A. Strakowski SECTION VI. CHECKLISTS AND ANSWERS 34. Checklists 255 35. Answers to Multiple-Choice Questions 263 Index 281 cchhuu7722112299__PPTTRR__FFMM__ii--xxvviiiiii__0033--1199--2200..iinndddd iixx 2211--MMaarr--1199 1111::0044::5566 AAMM