Easy EMG,A Guide to Performing Nerve Conduction Studies and Electromyography 3rd ed 2023

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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.

What Is an EMG?

  Electrodiagnostic studies seem confusing at first. Remember this: the entire purpose of electrodi-
agnostic studies is to help you figure out whether there is a problem with nerves, muscles, or both,
and if so, where the problem is occurring (Fig. 1.1). The American Association of Neuromuscu-
lar and Electrodiagnostic Medicine uses the term electrodiagnostic medicine (which is sometimes
abbreviated to EDX) to define the medical subspecialty that utilizes neurophysiologic techniques
to diagnose, evaluate, and treat patients who are believed to have or who have documented physi-
cal impairments of the nervous, neuromuscular, and/or muscular systems.
We all recognize that the nervous system is a complicated part of our anatomy. Indeed, many
medical students, residents, and fellows find their initial exposure to these tests and the courses
in which they are taught overwhelming. However, the truth is that they are fairly straightforward
and easy to understand.


If you do not believe this, think back to when you were a small child learning to read. At first,
all of the letters in the alphabet did not make sense. Some had loops, some had straight lines,
some had angled lines, and some had all of these. However, once you figured out all the letters,
suddenly you could look at them anywhere and they made sense to you. Of course, you still could
not read; that came later. Even after you learned the alphabet, the higher-level task of reading (at
some point not too long after you learned the alphabet) eventually became a breeze. So, too, will
electrodiagnostic studies become a breeze.



Think of the first half of this book as learning the alphabet. You will need to simply memorize
some terms and try to understand when to use them and in which context they are meaning-
ful—just like the alphabet letters. The second half of this book is the part where you learn to read
or to put the things you have memorized to use in a logical way so that when electrodiagnostic
studies are ordered, you can understand what information is being conveyed and how to perform
the study. Keeping with the alphabet/reading example, more advanced electrodiagnostic textbooks
(and clinical experience under experienced electromyographers) will teach you the equivalent of
grammar and higher-level skills that are extremely important. Nevertheless, you do not need to
know all that at first. Go through every chapter in this book, and just like you learned the alphabet
and then learned to read, you will begin to become literate in electrodiagnostic studies—only it
will happen much faster this time!



The term electrodiagnostic studies really encompasses a lot of different tests. The most common
tests done (and the ones that will be presented in this book) are nerve conduction studies (NCS)
and electromyography (EMG). Often people refer to both NCS and EMG as just EMG because
these two tests are nearly always done together. But when you are talking with people who are
familiar with electrodiagnostic testing, to avoid confusion it is best to speak of and write about
(especially in your medical record documentation) these components separately. The tests can
provide different information; however, both tests assess the electrical functioning of nerves and/
or muscles.
It is interesting to note that electrodiagnostic studies originated in the 19th century but have
been used consistently only within the past 30 to 40 years. This is because the machines became





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