Atlas of Nerve Conduction Studies and Electromyography

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. A. Arturo Leis, Clinical Professor of Neurology, University of Mississippi Medical Center, Electrodiagnostic Consultant, Mississippi Methodist Rehabilitation Center, and Michael P. Schenk, Director, Department of Biomedical Illustration Services, University of Mississippi Medical Center 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