ELECTROMYOGRAPHY

INTRODUCTION y Electromyography (EMG) is a technique for evaluating and recording the activation signal of muscles. y EMG is performed using an instrument called an electromyography, to produce a record called an electromyogram. y An electromyograph detects the electrical potential generated by muscle cells when these cells contract, and also when the cells are at rest. y Muscles are stimulated by signals from nerve cells called motor neurons. This stimulation causes electrical activity in the muscle, which in turn causes the muscle to contract or tighten. The muscle contraction itself produces electrical signals DEFINITION 

Electromyography (EMG) measures the response of muscles and nerves to electrical activity. Its used to help determine muscle conditions that be causing muscle weakness, including muscular dystrophy and nerve disorders

OBJECTIVES  EMG is most often used when people have symptoms of weakness and examination shows impaired muscle strength. It can help to differentiate primary muscle conditions from muscle weakness caused by neurologic disorders PROCEDURE  For the purpose of EMG, a needle electrode is inserted into the muscle (the insertion of the needle might feel similar to an injection). The signal from the muscle is then transmitted from the needle electrode through a wire (or more recently, wirelessly) to a receiver/ amplifier, which is connected to a device that displays a readout. The results are either printed on a paper stripper, more commonly, on a computer screen WHAT CAN EMG DIAGNOSE? EMG can diagnose three kinds of disease that interfere with normal muscle contraction 1. Diseases of the muscle itself (most commonly muscular dystrophy in children) 2. Diseases of the neuromuscular junction, which is the connection between a nerve fiber and the muscle it supplies 3. Diseases upstream in nerve roots (which can be due to either nerve damage or ongoing nerve injury) NORMAL VALUES  Muscle tissue is normally electrically silent at rest. Once the insertion activity (caused by the trauma of needle insertion) quiets down, there should be no action potential on the oscilloscope. When the muscle is voluntarily contracted, action potentials begin to appear. As contraction is increased, more and more muscle fibers produce action potentials until a disorderly group of action potentials of varying rates and amplitudes (complete recruitment and interference pattern) appears with full contraction ABNORMAL VALUES  Disorders or conditions that cause abnormal results include the following:  Polymyositis  Denervation (reduced neuron stimulation)  Carpal tunnel syndrome  Amyotropic Lateral Sclerosis (ALS)  Myopathy (Muscle degeneration, may be caused by a number of disorders, including muscular dystrophy)

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Myasthenia gravis Alcoholic neuropathy Axillary nerve dysfunction Beckers muscular dystrophy Brachial plexopathy Cervical spondylosi Dermatomyositis Distal median nerve dysfunction Duchenne muscular dystrophy Facio-scapulohumeral muscular dystrophy (Landouzy-Dejerine) Familial periodic paralysis Femoral nerve dysfunction Friedrichs ataxia Guillain-barre Lambert-Eaton syndrome Moroneuritis multiplex Mononeuropathy Peripheral neuropathy Radial nerve dysfunction Sciatic nerve dysfunction Sensorimotor polyneuropathy Shy-Drager syndrome Thyrotoxic periodic paralysis Tibial nerve dysfunction Ulnar nerve dysfunction

 Bleeding (minimal)  Infection at the electrode sites (minimal) SPECIAL CONSIDERATION  Trauma to the muscle from EMG may cause false results on blood tests (Creatine kinase), a muscle biopsy or other tests