When it is needed?

1. A patient is complaining of numbness.

2. A patient is complaining of tingling (paresthesias).
3. A patient has pain.
4. A patient has weakness.
5. A patient has a limp.
6. A patient has muscle atrophy.
7. A patient has depressed deep tendon reflexes.
8. A patient has fatigue.
REACTION OF REGENERATION TEST
 F-G TEST
 Faradic response-innervated muscles
 Galvanic response- innervated /denervated
 Wallarian degeneration and degeneration
STRENGTH-DURATION CURVE
CHRONOXIE & RHEOBASE
 1. The root word “rheo”
means current and “base”
means foundation: thus the
rheobase is the foundation,
or minimum, current
(stimulus strength) that will
produce a response.
 2. The root word “chrona”
means time and “axie” means
axis: chronaxie, then, is
measured along the time axis
and, thus, is a Duration that
gives a response when the
nerve is stimulated at twice
the rheobase strength.
GALVANIC TWITCH-TETANUS RATIO
TEST
 Continuous DC used
1 : 3.5to 6.5
 In denervation unity occurs, both happens with same
intensity
NERVE EXCITABILITY TEST
 MONOPHONIC PULSED CURRENT IS USED
 Between normal and affected side stimulation
amplitude difference

chronoxie amplitude
0.3 ms 3.5mA
1.0 ms 2mA
 EMG-MUAP
 A motor unit is defined as one
motor neuron and all of the muscle fibers it
innervates. When a motor unit fires, the
impulse (called an action potential) is
carried down the motor neuron to the
muscle. The area where the nerve contacts
the muscle is called the neuromuscular
junction, or the motor end plate. After the
action potential is transmitted across the
neuromuscular junction, an action potential
is elicited in all of the innervated muscle
fibers of that particular motor unit. The sum
of all this electrical activity is known as a
motor unit action potential (MUAP)
CMRR-common mode rejection
ratio
S1+n - S2+n OUTPUT
 If output is less the CMRR is
high and the machine is more
reliable
  Biphasic/triphasic(90%)
WAVEFORM  Polyphasic(10%)
EMG CIRCUIT

Filters-
Rectifiers
notch
Preamplifier Amplifier –raw to Sound/osc
Signal 1mV
50x
filter, high
20-200x integrated illoscope
pass,
EMG
lowpass
ELECTRODES
MONOPOLAR NEEDLE
CONCENTRIC NEEDLE
BIPOLAR CONCENTRIC NEEDLE
NORMAL EMG
Spontaneous activity
ABNORMAL EMG
INDICATIONS
 Diseases of muscle,  Neuropathy
nerve and NMJ  Myopathy
 Radiculopathy
 Myelopathy
FINDINGS OF EMG
 fibrillation+ PSW-acute  High frequency
unresolved nerve injury dicharge- many causes

 Fasciculation – problem  Large MUAP-chronic

in nerve cell body or axonal injury due to new
spinal cord terminal branches
>5to7mV

 Small MUAP-myopathy
< 1mV
FINDINGS OF EMG