EMG-Course

WCN 2013
wolfgang.grisold@wienkav.at

department neurology, KFJ

hospital Vienna
WCN 2013, Vienna

Disclosures

There are no commercial disclosures.

The author is a member of the UEMS/EBN and a trustee of the WFN

EMG - Learning
objectives
This is a practical basic approach towards electromyography (EMG) and
includes:
Electromyography (EMG)
Spontaneous activity
Motor unit potentials
Recruitment and interference pattern
Single fiber EMG
Pitfalls and cautions
Reporting

EMG
Needle
Recording area
Needle insertion
Rest, relaxation, posture
EMG screen
Loudspeaker
EMG equipment (amplifier, filter,

recording)

Report

Needle types

Kimura 45

Electrophysiology is an
extension of clinical neurology
Neurogenic

Myopathic

NMJ

Neuronopathy
Radiculopathy
Plexopathies
Gen. neuropathies
mononeuropathies

Generalized
Proximal
Distal
Focal
eurogenic

Postsynaptic: MG
Presynaptic:
LEMS,
Neuromyotonia

NCV
mononeuropathies

NCV/Rep.

Rep.

EMG
distribution
acute/chronic
myotonic
discharges

EMG
Neuromyotonia

EMG
Innervation
denervation
reinnervation
distribution

sfSSFEMG
SFEMG

Central

EMG
Recruitment

Elements of EMG
analysis
Spontaneous activity
MUAP (motor unit potentials)
IF pattern (recruitment, interference pattern)

Spontaneous activity
Endplate potentials
Fibrillation
Positive sharp wave
Fasciculation
CRD
Myotonia/Pseudomyotonia

Endplate

Fibrillation

Kimura 312

Positive sharp wave

Fibrillation1

Fibrillation 2

Fasciculation

ELECTROMYOGRAPHY IN CLINICAL PRACTICE ISBN: 978-0-323-02899-8

Copyright 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Complex
repetitive
discharges
CRD

CRD

Myotonic
dystrophy

Myokymia

Douplets

Neuromyotonia

Cramps

MUAP
Duration
Amplitude
Rise Time
Spike duration
Phase and Turns
Stability and variation

Types of MUAPS

Polyphasia

Long duration

Katiriji 76

Nascent (regen.)

From:Lawrence J. Kagen (Editor) The Inflammatory Myopathies

Analysis
Manual
Computer-Assisted Quantitative Analysis of User Selected MUP
Several others (eg MUNE)

The concept of normal values

Recruitement/Interference pattern

From: J Neurol Neurosurg Psychiatry 2005;76:ii32ii35 doi:10.1136/jnnp.2005.069211

Interference pattern Turn/Amplitude

Single Fiber EMG:

SFEMG
Identify the presence of a disorder of neuromuscular transmission when other
electrophysiologic assessments are normal.
Follow the course of mild defects of neuromuscular transmission.
Identify the presence of signs of regeneration in neurogenic and myopathic
Fiber density
Calculate muscle fiber membrane propagation velocity

 Fiber density reflects the packing density of

muscle fibers within the recording area of the
single fiber electrode. It correlates with the degree
of motor unit potential polyphasia in concentric
needle EMG recordings. Fiber density is increased
in neurogenic and myopathic disease.

Jitter measures the latency variability of muscle

fiber action potentials within the same motor unit.
It reflects the variability in rise time of the end
plate potential, providing a sensitive indicator of a
mild defect of neuromuscular transmission.

What do you need ?

SFEMG needle or
Concentric needle
Spontaneous vs simulated
Software

Jitter

Artefacts
Electrode noise
Amplifier noise
Defect recording electrodes
Movement artifact
Electrostatic and magnetic interference
Radio- and mobile phone interference

EMG complications
Anticoagulation and bleeding
Lymph edema and skin
Infections
Peripleural muscles
Pacemaker
Obese patients
Low pain tolerance

 Muscle Nerve: 1. Al-Shekhlee A, et al. Iatrogenic complications and risks of

nerve conduction studies and needle electromyography. Muscle Nerve
2003;27:517-526.

Examples of Diseases
Localizing
Distribution
Myopathies
Polygraphy
Interventions

Interventions
Botulinus toxin treatment
Infiltration
Pain therapy

Text

Reporting normal Rt biceps brachii

Rt. biceps brachii muscle

Conditions: good, impression: normal muscle,
no atrophy
At 6/6 positions no spontaneous activity. The
mean duration of the MUAPs is 10,5 ms (age
related normal value 10 ms), which
corresponds to + 5 %. Maximal contraction
shows an interference pattern with an
amplitude of 2 mV.

Verlag/Wien
The ABC of EMG. A Practical
Introduction on Kinesiological
Electromyography Peter
Konrad. Noraxon INC. USA.
Cohen JA et al. Peripheral
Nerve and Muscle
Disease.Oxford University
Press 2009
Dr Mike Bradley . Atlas of
musculoskeletal ultrasound
anatomy. Stanmore, Middlesex
LONDON SAN FRANCISCO
cambridge
Al-Shekhlee A, et al. Iatrogenic
complications and risks of
nerve conduction studies and
needle electromyography.

4.

Shapiro BE, Preston DC. Electromyography. Saunders, Elsevier, 2005

5.

Mills KR,The basics of electromyography. J Neurol Neurosurg Psychiatry 2005;76:ii32-ii35 doi:10.1136/jnnp.2005.069211

6.

Eva L. Feldman, Wolfgang Grisold, James W. Russell, Udo A. Zifko. Atlas of Neuromuscular Diseases.A Practical Guideline.
(First edition). 2005 Springer-Verlag/Wien

7.

The ABC of EMG. A Practical Introduction on Kinesiological Electromyography Peter Konrad. Noraxon INC. USA.

8.

Cohen JA et al. Peripheral Nerve and Muscle Disease.Oxford University Press 2009

9.

Dr Mike Bradley . Atlas of musculoskeletal ultrasound anatomy. Stanmore, Middlesex LONDON SAN FRANCISCO
cambridge

References

10. Al-Shekhlee A, et al. Iatrogenic complications and risks of nerve conduction studies and needle electromyography.
Muscle Nerve 2003;27:517-526.

11. Rubin, MD Katirji, Bashar. Electromyography in clinical practice: a case study approach/Bashar Katirji2nd ed.2007 by
Mosby, Inc.,

12. Ludin HP.Praktische Elektromyographie. Enke Verlag, 3. Auflage. Stuttgart, 1988.

13. Kimura J. ELECTRODIAGNOSIS IN DISEASES OF NERVE AND MUSCLE.(3rd ed). OXFORD UNIVERSITY PRESS .2001

14. Daube JL.Devon I. Rubin,CLINICAL NEUROPHYSIOLOGY Third Edition. Oxford University Press 2009.