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NERVE CONDUCTION STUDIESPractical Guide and Diagnostic Protocols
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NERVE CONDUCTION STUDIES
Practical Guide and Diagnostic Protocols
Table of Contents
Title Page ................................................................................................................................................................... 2
Biography .................................................................................................................................................................. 3
Dedication ................................................................................................................................................................. 4
Chapter 1 ................................................................................................................................................................... 5 Definitions
Chapter 2 ................................................................................................................................................................... 6 Basic Anatomy and Physiology of the Peripheral Nervous System
Chapter 3 .................................................................................................................................................................. 10 Principles of Nerve Conduction Studies
Chapter 4 ................................................................................................................................................................... 16 Errors, Pitfalls and Anomalies in Nerve Conduction Studies
Chapter 5 ................................................................................................................................................................... 21 Pathophysiology and Abnormal Findings of Nerve Conduction Studies
Chapter 6 ................................................................................................................................................................... 25 Nerve Conduction Studies Techniques
Chapter 7 ................................................................................................................................................................... 63 Diagnostic Utilities of Nerve Conduction Studies
Chapter 8 ................................................................................................................................................................... 68 Electrodiagnostic Study Protocols
Chapter 9 ................................................................................................................................................................... 78 Repetitive Nerve Stimulation
Appendix 1 ................................................................................................................................................................ 81 Instrumentation
Appendix 2 ................................................................................................................................................................ 82 Safety Protocols
Appendix 3 ................................................................................................................................................................ 83 EMG Laboratory Workflow
Appendix 4 ................................................................................................................................................................ 86 EMG Laboratory Examination Room Set-Up Guide
Appendix 5 ................................................................................................................................................................ 88 Introduction to Needle Electromyography
Appendix 6 ................................................................................................................................................................ 90 Commonly Studied Limb Muscles and Their Innervation
Bibliography ............................................................................................................................................................... 95
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Chapter 6Nerve Conduction Studies Techniques
Median Sensory Nerve (index, middle and thumb)………………………..………………........................................28, 29 & 30 Ulnar Sensory Nerve (antidromic)……………………………….……………………………………………………………………………………….31 Dorsal Ulnar Sensory Nerve (antidromic)…………………………….……………………………………………………………………………….32 Radial Sensory Nerve (antidromic)….……………………………………………………………………………………………………………………33 Median Sensory Nerve (ring finger)………….………………………………………………………………………………………………………….34 Ulnar Sensory Nerve (ring finger)……..………………………………………………………………………………………………………………….35 Median and Ulnar Palmar Mixed Nerve (orthodromic)..……………………………………………………………………….……..36 & 37 Lateral Antebrachial Cutaneous Sensory Nerve (antidromic)……..…………………………………………………………………………38 Medial Antebrachial Cutaneous Sensory Nerve (antidromic)………………………………………………..………………………………39 Median Motor Nerve (APB)…..………………………………………………………………………………………………………………………………40 Ulnar Motor Nerve (ADM and FDI)……………………………………………………………………………………………………….………41 & 42 Median and Ulnar Motor Comparison (2nd Lumbrical/Interossei)…………..……………………………………………………………..43 Radial Motor Nerve (EDC)……………………………………………….…………………………………………………………………………………….44 Musculocutaneous Motor Nerve (Biceps)………………………………………………………………………………………………………………45 Axillary Motor Nerve (Deltoid)……………………………………………………………………………………………………………………………….46 Spinal Accessory Motor Nerve (Trapezius)……………………………………………………………………………………………………………..47 Sural Sensory Nerve (antidromic)…………………………………………………………………………………………………………………………..48 Superficial Peroneal Sensory Nerve (antidromic)……………………………………………………………………………………………………49 Saphenous Sensory Nerve (lower leg)…………………………………………………………………………………………………………………….50 Lateral Femoral Cutaneous Sensory Nerve (thigh)………………………………………………………………………………………………….51 Medial and Lateral Plantar Mixed Nerves (orthodromic)……………………………………………………………………………………….52 Peroneal Motor Nerve (EDB and TA)……………………………………………………………………………………….…….………53 & 54 Tibial Motor Nerve (AH and ADQP)…………………………………………………………………………………………………….…………55 & 56 Femoral Motor Nerve (Rec Fem)……………………………………………………………………………………………………………………………57 H-Reflex (Soleus)……………………………………………………………………………………………………………………………………………………58 Phrenic Motor Nerve (Diaphragm)…………………………………………………………………………………………………………………………59 Facial Motor Nerve (Orbicularis Oculi)……………………………………………………………………………………………………………………60 Blink Reflexes (Orbicularis Oculi)……………………………………………………………………………………………………………………………61 F Waves.………………………………………………………………………………………………………………………………………………………………62 Repetitive Nerve Stimulations for Myasthenia Gravis, Lambert-Eaton Syndrome and Botulism………….……………63 & 64
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Median Sensory Nerve - index (antidromic)
Origin: C6-C7 roots, upper and middle trunk and lateral cord of the brachial plexus, median nerve
Recording Site (G1): Index finger
Reference Site (G2): Index finger
Ground: Palm or top of hand
Stimulation Site: Wrist
Procedure: The recording electrode is placed on the proximal phalanx of the index finger. The reference electrode is placed on the middle phalanx of the index finger. A distance of 13 cm is measured from G1 to the distal wrist crease over the median nerve. The nerve is stimulated at the wrist, proximal to the wrist crease and between the flexor carpi radialis and palmaris longus tendons. The nerve can also be stimulated at the elbow (above the elbow crease, medial to the brachial artery pulse or biceps tendon).
This study can also be performed orthodromically. A bar electrode is placed over the wrist site, with the recording electrode distal. The finger electrodes are connected to the stimulator with the former “G1” electrode acting as the cathode and the “G2” electrode acting as the anode.