Easy EMG: A Guide to Performing Nerve Conduction Studies and Electromyography

301 Pages·2022·34.056 MB·English

by  Lyn D Weiss, Jay M. Weiss, Julie K. Silver

Easy EMG
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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
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EASY EMG, THIRD EDITION ISBN: 978-0-323-79686-6
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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
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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).