Nerve Conduction

Velocity
 It was developed first in 1948

 NCV tests are used to determine the speed

with which a peripheral motor or sensory
nerve conducts an impulse
 Itis one of the imp diagnostic procedure
that provides information about the
extent of nerve injury or muscle disease

 Done on any peripheral nerve that is

superficial enough to be stimulated
through the skin at two different points
CONDUCTION VELOCITY
 Velocity = Distance/Time
 CMAP (Compound Motor Action
Potential)- MNCV
 SNAP (Sensory Nerve Action Potential)-
SNCV
 CV= D/PL-DL
 CV- m/sec
 Measurement of latency difference
eliminates the effects of residual
latency
CONTRAINDICATIONS

 Cardiac pacemakers
 Cardiac catheters
 Central venous pressure lines
ELECTRODES
 Stimulating Electrode

 Bipolar electrode
extending from plastic
casing
ELECTRODES
 Ground electrode  Green color
 Absorbs other waves
from environment
Surface electrodes are used to
record the evoked potentials
 Surface Electrodes Sensory or Ring Electrodes
MNCV
 COMMONLY TESTED NERVES
 Ulnar nerve – Abductor digiti minimi
 Median nerve - Abductor pollicis brevis
 Common Peroneal nerve – Extensor digitorum
brevis
 Posterior Tibial nerve – Abductor halluces
 Less commonly tested:-
 Radial nerve
 Femoral nerve
 Sciatic nerve
Technique of Application
 Skin should be cleaned
 Distal muscle innervated by a nerve is selected
 Active recording –over belly -cathode
 Reference recording –over tendon –anode
 Ground electrode -over neutral area between electrodes
 Stimulating electrode -placed such that cathode directed
towards recording electrodes
 For accurate measurement, distance between 2 points of
stimulation should be at least 10 cm. reduces the error due to
faulty distance measurement
MNCV

 Median nerve - APB

 CMAP

Onset latency- time in ms from the stimulus artifact to 1st negative

deflection of CMAP
CALCULATION
 Motor march- proximal to distal
 For sensory- distal to proximal
 Orthodromic- normal
physiological pathway
 Antidromic – opp. To NPP
SENSORY NCV
 Sensory conduction can be measured
orthodromically or antidromically
 Orthodromic–distal portion of nerve is
stimulated and SNAP is recorded at a
proximal point along the nerve
 Antidromic–nerve is stimulated
proximally and SNAP recorded distally
 COMMONLY TESTED NERVES
 MEDIAN NERVE
 ULNAR NERVE
 SURAL NERVE
 MEDIAL AND LATERAL PLANTER NERVES
SNCV
SNAP
PARAMETERS
 Latency
 Orthodromic latency < antidromic latency
 Amplitude
 Antidromic amplitude > orthodromic amplitude
 Duration
 Residual latency not applicable to sensory N conduction
 Distance = between stimulating & recording site ( single
stimulation site) in mm
 Shape
 Antidromic potential- initial positivity absent
VARIABLES AFFECTING NCV

 PHYSIOLOGICAL VARIABLES
 Age
 Upper limb versus lower limb
 Temperature
 Myelination
 Diameter of axon
VARIABLES AFFECTING NCV

 TECHNICHAL VARIABLES
 Stimulating system
 Recording system
 Stimulation of unintended nerves
 Anomalous Crossover
F-WAVE

 F-wave was first described by Magladary and McDougal

in 1950.
 It is elicited by supramaximal stimulation.
 Only conducted from motor nerve.
 It is used to diagnose the condition where more
proximal axon is involved.
F-WAVE
F-WAVE

 Also used in pharmacological studies of spasticity as a

measure of alpha motor neuron excitability.
 Normal value of latency :
Upper limb - 30 ms
Lower limb – 60 ms
 Take 10 successive trials.
H-REFLEXES

 Also called Hoffmann’s reflex.

 It is useful for radiculopathy and peripheral neuropathy.
 Used in testing the integrity of the sensory and motor
monosynaptic pathways of S1 nerve roots, and to a
lesser extent at C6 and C7.
 Submaximal stimulus is applied.
H-REFLEXES
H-REFLEXES

 Elicited in
Soleus
Flexor carpi radialis
 H-reflex latency = 0.46 (leg length in cm) + 9.14 + 0.1
(Age in year)
Standard variation +5.5ms
 Normal value :- 29.8 ms + 2.74 ms
H-REFLEXES

 Slow latency is indicative of abnormal dorsal root

function.