Nerve Conduction Testing and Electromyography for the Physical Therapist: Techniques, Interpretation and Differential Diagnosis

This book was developed to assist physical therapy students and clinicians in learning the techniques, interpretation and use of electroneuromyography evaluation in the differential diagnosis of patients with neuromuscular disorders. It provides the physiological basis and techniques of this diagnostic test through the use of nerve conduction studies and needle electromyography. Readers will learn the application of these techniques to the upper and lower extremities, plus the interpretation of results/reports through case studies. Differential diagnosis of abnormalities that are distributed throughout the neuromuscular system will be presented. Knowledge of basic anatomy related to peripheral nerve and root distributions is being assumed. Table of Contents CHAPTER ONE 1 Introduction to Electrophysiological Evaluation - Peripheral Nerve and Muscle 1 CHAPTER TWO 17 Instrumentation used in Electroneuromyography Examinations 17 CHAPTER THREE 23 Upper Extremity Motor Nerve Conduction Studies & Sensory Nerve Action Potential’s (SNAP's) 23 Motor Nerve Conduction Studies - Overview 23 Sensory Nerve Conduction Studies 42 CHAPTER FOUR 53 Lower Extremity Motor Nerve Conduction Studies & Sensory Nerve Action Potential’s 53 Motor Nerve Conduction Studies 54 Sensory Nerve Conduction Studies 61 CHAPTER FIVE 66 Advanced Techniques of Nerve Studies - Late Responses 66 Somatosensory Evoked Potentials (SSEP’s) 66 Brainstem Auditory Evoked Potentials (BAER's) 69 Visually Evoked Potentials (VEP's) 69 H- Reflex 70 F- Wave Testing 72 Repetitive Nerve Stimulation - Myasthenia Gravis 73 CHAPTER SIX 78 Diagnostic Electromyography 78 CHAPTER SEVEN 92 Problem Solving in Electroneuromyography and Case Studies 92 Case Study # 1: Carpal Tunnel Syndrome 95 Case Study # 2: Age 5 – Duchenne MD (DMD) 96 Case Study # 3: Suspected L5 Root Compression 97 Case Study # 4: Suspected Peripheral Polyneuropathy 99 Case Study #5: EMG Report #1 100 Case Study #6: EMG Report #2 102 Case Study #7: EMG Report #3 103 Case Study #8: Gun Shot Wound to the Cauda Equina, L1 - L2. 105 Case #9: Anterior Glenohumeral Joint Dislocation 107 Case #10: Mid Humeral Fracture 107 Case #11: Multiple Sclerosis 107 Case #12: Isolated Scapula Winging 107 Case #13: Idiopathic Bell’s Palsy 107 Appendix A 111 Anatomical Correlates and Associated Impairments 111 Appendix B 113 Common Causes of Peripheral Neuropathies 113 Appendix C 114 Upper Extremity - Root and Peripheral Nerve Innervations 114 Lower Extremity - Root and Peripheral Nerve Innervations 115 References 116