Atlas of Nerve Conduction Studies and Electromyography

About this book

• High--quality anatomical illustrations of skeletal muscles that include nerve, plexus, and root supply
• Photographs of each muscle in healthy subjects to identify optimum site of EMG needle insertion
• Clinical features of the major conditions affecting peripheral nerves
• Electrodiagnostic strategies for confirming suspected lesions of the peripheral nervous system

Beautifully and lavishly illustrated, Atlas of Nerve Conduction Studies and Electromyography demystifies the major conditions affecting peripheral nerves and provides electrodiagnostic strategies for confirming suspected lesions of the peripheral nervous system.

Building on the success of the landmark Atlas of Electromyography, this new text is divided into sections based on the major peripheral nerves. It contains detailed illustrations of each nerve along with a discussion of its anatomy, followed by a thorough outline of the clinical conditions and entrapment syndromes that affect the nerve, including a list of the etiologies, clinical features, and electrodiagnostic strategies used for each syndrome. Routine and special motor and sensory nerve conduction studies are shown in an anatomical illustration. In addition, each muscle supplied by the peripheral nerve is illustrated showing the root, plexus, and peripheral nerve supply to the muscle and is accompanied by a corresponding human photograph. Written text provides information about the nerve conduction studies, muscle origin, tendon insertion, voluntary activation maneuver, and the site of optimum needle insertion, which is identified in the figures by a black dot or a needle electrode.

Atlas of Nerve Conduction Studies and Electromyography is the perfect anatomical guide for neurologists, specialists in physical medicine and rehabilitation, and electrodiagnostic medicine consultants, while also providing support for individuals in residency training programs, critical care medicine, neurological surgery, and family practice.

Readership: Neurologists, specialists in physical medicine and rehabilitation, and electrodiagnostic medicine consultants. It will also be of interest to individuals in residency training programs, critical care medicine, neurological surgery, and family practice.

Table of contents

1. Overview of Nerve Conduction Studies
How the peripheral nervous system conveys information
Stimulating and Recording Electrodes
Electrode Amplifiers and Ground Electrode
Reducing Artifacts and Interference
Electrical Safety
Temperature Effect
Effect of Aging
Motor Nerve Conduction
Measurements of the compound muscle action potential
Calculating conduction velocity
Sensory Nerve Conduction
Measurements of the sensory nerve action potential
Role of dorsal root ganglia (DRG) in localizing lesions
Late Responses: F-wave and H-reflex
Types of Nerve Injury
Neurapraxia
Features of demyelination
Axonal loss injury
Features of axonal loss
Wallerian degeneration
Ion channel disorders (channelopathies)
Features of channelopathies
Due to toxins,
Due to autoimmune conditions,
Due to genetic mutations

2. Overview of Electromyography
The motor unit
Innervation ratio
Muscle selection for needle EMG
The needle EMG examination
Insertional activity
Spontaneous activity
Fibrillation potentials
Positive sharp waves
Numeric grading scale to semi-quantify fibrillation potentials
Fasciculation potentials
Complex repetitive discharges
Myotonic discharges
Myokymic discharges
Neuromyotonic discharges
Isaac's syndrome and peripheral nerve hyperexcitability (PNH) syndrome
Cramp discharges
End-plate activity
Motor unit potentials (MUPs)
MUP parameters
Rise time
Duration
Amplitude
Phases and turns
Firing pattern and recruitment
Henneman's Size Principle
In neurogenic disorders
In myopathic disorders
Complications related to needle electromyography

3. Brachial Plexus
Upper trunk lesion
Middle trunk lesion
Lower trunk lesion

4. Median Nerve
Carpal tunnel syndrome
Anterior interosseous nerve syndrome
Pronator teres syndrome
Ligament of Struther's syndrome
Nerve conduction studies
Motor
Short segment (<"inching technique>")
F-wave
Martin-Gruber anastomosis
Sensory
Comparative studies for diagnosing carpal tunnel syndrome
Digital branch injury
Needle electromyography
Abductor Pollicis Brevis
Opponens Pollicis
Flexor Pollicis Brevis, Superficial Head
First and Second Lumbricals
Pronator Quadratus
Flexor Pollicis Longus
Flexor Digitorum Profundus, Digits 2 and 3
Flexor Digitorum Superficialis (sublimis)
Palmaris Longus
Flexor Carpi Radialis
Pronator Teres

5. Ulnar Nerve
Ulnar neuropathy at the elbow (retrocondylar groove)
Ulnar neuropathy at the elbow (cubital tunnel syndrome)
Ulnar neuropathy at the wrist (Guyon's canal)
Nerve conduction studies
Motor
Short segment (<"inching technique>")
F-wave
Martin-Gruber anastomosis
Riches-Cannieu anastomosis (<"all ulnar hand>")
Sensory
Needle electromyography
Adductor Pollicis
Flexor Pollicis Brevis, Deep Head
First Dorsal Interosseous
Second, Third, and Fourth Dorsal Interossei
Palmar Interossei
Third and Fourth Lumbricals
Abductor Digiti Minimi
Opponens Digiti Minimi
Flexor Digiti Minimi
Flexor Digitorum Profundus, Digits 4 and 5
Flexor Carpi Ulnaris

6. Radial Nerve
Radial nerve lesion in the arm
Radial nerve lesion in the axilla
Posterior interosseous nerve syndrome
Superficial radial nerve lesion
Nerve conduction studies
Motor
Sensory
Anomalous innervation to ulnar dorsum of hand
Needle electromyography
Extensor Indicis Proprius
Extensor Pollicis Brevis
Extensor Pollicis Longus
Abductor Pollicis Longus
Extensor Digitorum Communis and Extensor Digiti Minimi
Extensor Carpi Ulnaris
Supinator
Extensor Carpi Radialis, Longus and Brevis
Brachioradialis
Anconeus
Triceps, Lateral Head
Triceps, Long Head
Triceps, Medial Head

7. Axillary Nerve
Axillary nerve lesion
Motor nerve conduction study
Needle electromyography
Deltoid, Anterior Fibers
Deltoid, Middle Fibers
Deltoid, Posterior Fibers
Teres Minor

8. Musculocutaneous Nerve
Musculocutaneous nerve lesion
Nerve conduction studies
Motor
Sensory (lateral cutaneous nerve of the forearm)
Needle electromyography
Brachialis
Biceps Brachii
Coracobrachialis

9. Medial Cutaneous Nerve of the Forearm
Lesion of the medial cutaneous nerve of the forearm
Sensory nerve conduction study

10. Suprascapular Nerve
Suprascapular nerve lesion
Motor nerve conduction study
Needle electromyography
Infraspinatus
Supraspinatus

11. Dorsal Scapular Nerve
Dorsal scapular nerve lesion
Needle electromyography
Rhomboideus Major and Minor
Levator Scapulae

12. Long Thoracic Nerve
Long thoracic nerve lesion
Motor nerve conduction study
Needle electromyography
Serratus Anterior

13. Subscapular Nerves and the Thoracodorsal Nerve
Needle electromyography
Teres Major
Latissimus Dorsi

14. Medial and Lateral Pectoral Nerves
Needle electromyography
Pectoralis Major
Pectoralis Minor

15. Cervical Plexus
Needle electromyography
Sternocleidomastoid
Trapezius
Levator Scapulae

16. Phrenic Nerve
Phrenic nerve lesion
Phrenic nerve conduction studies
Needle electromyography
Diaphragm

17. Sacral Plexus
Sacral plexus lesion

18. Sciatic Nerve
Sciatic nerve lesion
Needle electromyography
Semitendinosus
Semimembranosus
Biceps Femoris (Long Head)
Biceps Femoris (Short Head)

19. Tibial Nerve
Tarsal tunnel syndrome
Nerve conduction studies
Motor
F-wave
Sensory (sural nerve)
H-Reflex
Medial and lateral plantar (mixed nerve)
Needle electromyography
Gastrocnemius, Medial Head
Gastrocnemius, Lateral Head
Soleus
Tibialis Posterior
Flexor Digitorum Longus
Flexor Hallucis Longus
Popliteus
Abductor Hallucis
Flexor Digitorum Brevis
Flexor Hallucis Brevis
Abductor Digiti Minimi (Quinti)
Adductor Hallucis

20. Common Peroneal Nerve
Common peroneal mononeuropathy at the knee
Nerve conduction studies
Motor (Extensor digitorum brevis)
F-wave
Accessory deep peroneal nerve
Motor (tibialis anterior)
Short segment (<"inching technique>") across the knee
Sensory (superficial peroneal)
Needle electromyography
Tibialis Anterior
Extensor Digitorum Longus
Extensor Hallucis Longus
Peroneus Tertius
Extensor Digitorum Brevis
Peroneus Longus
Peroneus Brevis

21. Superior Gluteal Nerve
Needle electromyography
Gluteus Medius
Gluteus Minimus
Tensor Fasciae Latae

22. Inferior Gluteal Nerve
Needle electromyography
Gluteus Maximus

23. Pudendal Nerve
Pudendal nerve lesion
Needle electromyography
Sphincter Ani Externus (External Anal Sphincter)
Levator Ani

24. Lumbar Plexus
Lesion of the lateral femoral cutaneous nerve (meralgia paresthetica)
Lateral femoral cutaneous nerve conduction study
Needle electromyography of abdominal wall muscles
External Oblique, Internal Oblique and Transversus Abdominis

25. Femoral Nerve
Femoral nerve lesion
Nerve conduction studies
Motor
Sensory (saphenous nerve)
Needle electromyography
Iliacus (Iliopsoas)
Pectineus
Sartorius
Rectus Femoris
Vastus Lateralis
Vastus Intermedius
Vastus Medialis

26. Obturator Nerve
Obturator nerve lesion
Needle electromyography
Adductor Longus
Adductor Brevis
Adductor Magnus
Gracilis

27. Paraspinal Muscles
Needle electromyography
Cervical Paraspinal
Thoracic Paraspinal
Lumbosacral Paraspinal

28. Cranial Nerves and Muscles
Facial motor conduction studies
Blink reflex studies
Needle electromyography
Frontalis
Orbicularis Oculi
Orbicularis Oris
Masseter
Tongue

29. Dermatomes and Peripheral Nerve Cutaneous Distributions