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EMG

ELECTROMYOGRAPHY
Recording muscle action potentials that occurs spontaneously or in response to volitional or stimulated activation using an extra cellular recording technique is called Electromyography

ELECTROMYOGRAM
An individual record of compound muscle action potentials is called an Electromyogram

NORMAL EMG

Procedure
The procedure of electromyography compares the electrical activity of skeletal muscle fibers at rest and during voluntary activation of muscle

Extra cellular recording


The upward deflection of the oscilloscopic trace signifies that the active electrode is negative with respect to the reference one . The reverse is true in nonbiologic sciences

STEPS
1. Insertional activity 2. Activity at rest 3. Activity upon minimal activation and recruitment patterns 4. Activity during maximal activation

Insertional activity
When a needle electrode is inserted into a muscle or moved within it A brief burst of electrical activity Positive or negative high frequency spike in a cluster. Mechanical stimulation or injury of muscles Injury potential crisp static sound It usually stops when the needle stops moving or in the next 2 to 3 seconds

Activity at rest
Electrically silent Spontaneous activity - Abnormality Normal or pathologic

Spontaneous activity
Refers to the electrical activity that may recorded from a fully relaxed muscles after cessation of insertion activity Not produced by voluntary contraction

End plate activities


Motor end plate region Indicates incorrect positioning of electrode Two types End plate noise End plate spikes

End plate noise


(low amplitude noise)

Monophasic negative potentials Irregular high frequency pattern of discharges 0.5 -3 ms, less than 100 micro volts (10 40) Sea shell sound Spontaneous miniature endplate potentials

End plate spikes


(high frequency intermittent spikes)

Biphasic potentials with initial negativity 3-5 ms,100-200 micro volts Sputtering fat in frying pan Mechanical activation of nerve terminal

Motor unit potential


Sum of the muscle action potentials supplied by an AHC Higher Amplitude and longer duration than single muscle fibre

Factors influencing MUP


1. Physiological 2. Technical

Physiological
Age Sex Temperature Fatigue Innervation ratio Fibre density, Propagation velocity,

Parameters
Duration Amplitude Phases (Shape) Rise time Area

Technical
Type of needle electrode Location of needle in the muscles Size of the recoding surface area Choice of oscilloscope sensitivity, sweep, filters, methods of storage and display Activation procedure

Duration
Initial take off to the point of return to base line 5 15 ms Measure of conduction velocity, length of muscle fibre, membrane excitability, and synchrony of muscle fibre of a motor unit Fibres more than 1 mm away from the electrode contribute to the initial and terminal portions of MUP

Amplitude
Peak to peak
Depends upon the size and density of muscle fibres synchrony of firing proximity of needle to the muscle fibre Age temperature muscle examined

Phases
Triphasic ( + - + ) Portion of waveform between the departure and return to the baseline polyphasic More than 4 phases Polyphasic not exceed 5 15 % Turns Some potentials show directional changes without crossing base line Serrated potential - desynchronization

Rise time
Time lag from the initial positive peak to subsequent negative peak Distance of needle electrode from the muscle fibres Less than 500 microseconds acceptable Usually 100 200 microseconds Sharp crisp sound proximity of unit Dull sound reposition the needle closer to the muscle fibres

Area
Integration of the rectified action potential over the duration of either negative spike or entire potential 1. number and diameter of muscle fibre closest to the electrode and their potentials 2. number and diameter of muscle fibres contributing to the recorded potential and their individual potentials 5 20 fibres situated within the radius of 1.5 mm

Recruitment
Activation of number of motor units Size principle Hennemans Small to larger motor units 1. Recruitment of previously inactive motor units 2. More rapid firing of already active units

Interference patterns
Simultaneous activation of different units preclude recognition of individual motor unit potentials Depends Descending input from cortex Number of motor unit capable of discharging Firing frequency Wave form of individual potential Probability of phase cancellation

Cont
Good recruitment complete interference pattern
Normal muscles provide good recruitment with a complete obliteration of the base line on the oscilloscope

Types Interference patterns


Good recruitment complete interference pattern Fair recruitment - partial interference pattern Poor recruitment - single unit interference pattern

ABNORMAL EMG

Insertional activity
Increased Reduced denervation, myotonia and polymyositis

metabolic disorders and myopathies

Spontaneous activity
Pathologic : 1. Fibrillations 2. Positive sharp waves 3. Fasciculations 4. Complex repetitive discharges 5. Myotonic discharges 6. Myokymia 7. Neuromyotonia 8. cramp

Fibrillations
Spontaneous depolarization Single muscle fiber Not visible through skin Small amplitude and short duration Biphasic with initial positivity Classical indicator of LMN disorders Rain falling on a roof or wrinkling a tissue paper At least three separate sites within a muscle - abnormal

less than 5 ms, 1 mV (20 - 200 micro volts, 2 ms) Rate of discharge - 2 20 per second Found in denervated muscles Appear after 4 5 weeks
Denervation hypersensitivity, increasing the number of Ach receptor Increase in membrane irritability

Positive sharp waves


Long duration biphasic potential with initial sharp positivity followed by a long duration negative spike Saw tooth appearance Dull thud sound Positive phase less than 5 ms and 1mV Negative phase 10 100 ms Rate discharge 2 100 per second

Single muscle fiber injured by electrode Associated with fibrillation potential MUP and Myotonic discharges also has same wave form

Fasciculations
Same dimension as MUP but occurs spontaneously Associated with a visible twitch or flicker of a muscle Low pitched thump Discharge rate 50 per second, irregular It seen in normal muscle

Spontaneous depolarization of bundles of muscle fibers or a whole motor unit Origin is not clearly known Spinal cord or any where along the peripheral nerve

CONTRACTION FASCICULATION

During voluntary contraction, muscle twitching may be seen with chronic Neurogenic lesion Enlargement of motor unit

Complex repetitive discharges


Repetitive and synchronous firing of group of muscle fiber 50 micro volt to 1 mV, 50 100 ms Slow and fast rate between 5 to 100 Hz Pseudo Myotonic discharges Do not have waxing and waning quality Appear and disappear suddenly Ephaptic activation of groups of adjacent muscle fibers Consist of 10 0r more distinctive potentials separated by intervals of less than 0.5 ms to 200 ms Bizarre high frequency discharge

Myotonic discharges
Two types 1. Positive waves 2. Brief spikes Both wave forms recorded after Waxing and waning quality Frequency is 40 100 Hz Dive bomber sound Abnormality in the muscle membrane
needle insertion or voluntary contraction or muscle percussion

Positive sharp waves 2 5 ms in duration Resembling positive sharp waves Brief spikes: Biphasic (+ - ) Less than 5 ms Resembling fibrillation

SPONTANEOUS MUP
Fasciculation Myokymia Neuro myotonia cramps

Myokymia

Neuromyotonia

cramps

Motor unit potential


Changes in Duration Amplitude phases

Myogenic
SLAP MUP
Short duration, low amplitude and polyphasic

Neurogenic
HALD MUP
Higher amplitude, long duration and Polyphasic

Interference patterns
Fair recruitment partial interference pattern
If there are gaps in recruitment Poor recruitment single unit interference pattern if there are discreet MUP on screen

Cont
Myogenic
No gaps but low amplitude

Neurogenic - Gaps present but high amplitude