[Electrodiagnosis and electrotherapy in the orthopedic practice. I. Electrodiagnosis].
Explore the source record for details and available documents.
Action Potentials↗
SEARCH · Search PubMed
Results for “Electrodiagnosis”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[Electrodiagnosis of stimulation and electrodiagnosis of detection in peripheral neurogenic disorders. Attempt at correlation].
Explore the source record for details and available documents.
Action Potentials↗
The electrodiagnosis of ulnar nerve entrapment at the elbow.
Entrapment of the ulnar nerve at the elbow is the second most common focal peripheral neuropathy. Recent advances have facilitated the electrodiagnosis of this common nerve entrapment. The goals of electrodiagnosis are to localize ulnar nerve dysfunction, confirm that the disturbance is confined to the ulnar nerve, and assess the severity of ulnar nerve dysfunction. The goal of this review is to highlight the important advances in anatomy, neurophysiology and methodology that impact upon the electrodiagnosis of entrapment of the ulnar nerve at the elbow, illustrate the limits of electrodiagnosis, and discuss methodological issues that may be the subject of further study. Careful attention to elbow position, temperature, and conservative estimates of conduction block should be part of common practice. Awareness of anatomical variations in structural anatomy, anomalous innervation and fascicular arrangement of ulnar nerve fibers are required to interpret electrodiagnostic studies accurately. The most reliable finding is slowing of the ulnar across-elbow motor nerve conduction velocity to less than 50 m/sec while recording from the abductor digiti minimi muscle, and should be carefully interpreted in the presence of a polyneuropathy or other neurogenic process. Alternative techniques such as relative ulnar slowing in different ulnar nerve segments, use of alternative muscles, sensory and mixed nerve techniques provide complementary information, and like all nerve conduction studies are highly operator-dependent and should be used on a case by case basis. Recent studies have focused the electromyographer's attention on the use of shorter across-elbow segments (2-5 cm). This may offer a reasonable trade-off between sensitivity and measurement error and may result in improved electrodiagnosis.
Animals↗
Physicians' practice patterns in pediatric electrodiagnosis.
The medical literature contains contradictory reports and recommendations regarding pediatric patients' pain and distress during electrodiagnosis. We surveyed 117 pediatric neurologists and physiatrists regarding their practice patterns in pediatric electrodiagnosis; 84 (72%) responded, of whom 44 (52%) regularly perform electrodiagnosis on children (mean = 85 per year, representing 3,667 examinations per year). Respondents reported extreme behavioral distress (eg, screaming, flailing, requiring additional restraint, or attempting to leave the examination table) in 35% of examinations, most often among 2- to 6-year-olds. Pain medications are never prescribed by 45%, occasionally by 48%, and always by 2%; general anesthesia is never administered by 75%, occasionally by 21%. Only 32% reported that any psychological intervention is routinely offered to enhance child coping. Wide variability was found in physicians' preferences about parental presence, order of examinations, demonstration of procedures, and other aspects of electrodiagnosis.
Adolescent↗
Electrodiagnosis in the management of focal neuropathies: the "WOG" syndrome.
The role of electrodiagnosis in managing patients with focal neuropathies is discussed from the differing perspectives of a peripheral nerve surgeon and a practitioner of electrodiagnostic medicine. Both clinical evaluation and electrodiagnosis are useful methodologies, each having limitations. Dr. Dellon labels the overreliance on electrodiagnosis and the "WOG" (Word of God) syndrome, and describes its signs, symptoms, and treatment. Dr. Brown contends Dr. Dellon's crusade is misdirected. The exchange is an eloquent polemic on the virtues and foibles of these different approaches to evaluating peripheral nerve function and the imperative to practice them in a complementary rather than a contentious manner.
Diagnostic Errors↗
Neuromuscular rehabilitation and electrodiagnosis. 4. Pediatric issues.
UNLABELLED: This self-directed learning module highlights the physician's role in the diagnosis and treatment of neuromuscular disorders in pediatric populations. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses both clinical and electrodiagnostic features of common neuromuscular disorders in pediatric populations. The diagnostic value of somatosensory evoked potential is reviewed in a case of traumatic spinal cord injury without radiographic abnormality. Therapeutic interventions of progressive muscular dystrophy are discussed, as well as the differential diagnosis of floppy infant syndrome, the most common pediatric electrodiagnostic referral. OVERALL ARTICLE OBJECTIVES: (a) To become familiar with electrodiagnosis and rehabilitation for common neuromuscular disorders in the pediatric population, (b) to undrstand electrodiagnostic findings of Guillain-Barre syndrome corresponding to pathophysiology, (c) to become familiar with somatosensory evoked potentials, and (d) to be able to make differential diagnosis of floppy infant syndrome based on clinical findings as well as electrodiagnosis.
Botulism↗
Comparison of sensitivity of transcarpal median motor conduction velocity and conventional conduction techniques in electrodiagnosis of carpal tunnel syndrome.
OBJECTIVE: To compare the sensitivity of median wrist-palm motor conduction velocity (W-P MCV) with those of standard sensory conduction techniques in the electrodiagnosis of carpal tunnel syndrome (CTS). METHODS: This study included 280 consecutively suspected CTS patients (360 hands) referred for evaluation and 150 volunteers who served as controls. We determined and calculated (1) median W-P MCV, (2) median motor distal latencies (DL) and median sensory DL for (3) thumb (D1), (4) index (D2) and (5) ring finger (D4), (6) median wrist-palm sensory conduction velocity (W-P SCV) and sensory conduction time (W-P SCT) for index finger and sensory latency differences between (7) median-radial (M-R) for thumb and (8) median-ulnar (M-U) nerves for ring finger. The normal limits were calculated from the median of normal controls +/-2.5 standard deviations. The sensitivities of each test were determined and compared. RESULTS: Among the 360 hands with suspected CTS, 32 hands (8.9%) had normal electrodiagnostic studies and 328 (91.1%) had at least one abnormal electrodiagnostic study. Among the 328 hands with abnormalities, 234 (65%) had abnormal motor DL and 294 (81.7%) had abnormal W-P MCV. The sensitivity was 80.3% for D1, 72.5% for D2, 76.7% for D4, 86.7% for M-R (specificity, 98.7%), 87.2% for M-U (specificity, 96.7%), 80.8% for sensory W-P SCT and 73.6% for W-P SCV. CONCLUSIONS: W-P MCV is a valuable motor conduction technique for the diagnosis of CTS and it is confirmed again that W-P MCV is equal to or more sensitive than W-P SCV and W-P SCT. Furthermore, the findings of the present study are in agreement with the conventional wisdom that internal comparison of latency differences between median and ulnar or radial nerves is the best method for a diagnosis of patients with suspected CTS. Therefore, we recommend that CTS patients be studied according to the following steps: (1) routine sensory and motor DL, (2) if step 1 is negative, then perform and determine W-P MCV or SCT. This may increase the diagnostic yield of 10%, (3) if step 2 is negative, measure the M-U or MR. These are the final and more sensitive techniques in making a diagnosis with an additional diagnostic yield of 10%. SIGNIFICANCE: We provide the evidence of W-P MCV that could be a standard technique for electrodiagnosis of CTS. Furthermore, we make a reasonable flow chart and recommendation for electrodiagnosis of CTS for electromyographers.
Adult↗
Electrodiagnosis reliability in the diagnosis of infant botulism.
Infant botulism is confirmed by isolation of Clostridium botulinum from stool culture or by toxin assay. Although electrodiagnosis has been described as a diagnostic tool in infant botulism, our 11-year review of toxin-confirmed cases suggests that electrodiagnosis is not a reliable tool. In the case report presented, results of electrodiagnosis were negative but enema effluent contained adequate concentrations of organism and toxin to confirm the diagnosis.
Botulinum Toxins↗
Electrodiagnosis in common mononeuropathies and plexopathies.
Electrodiagnosis has a prominent role in the diagnosis of common entrapment neuropathies (carpal tunnel syndrome and ulnar neuropathy at the elbow) and plexopathies (idiopathic brachial plexopathy and diabetic lumbar radiculoplexopathy). The relevant anatomy and pathology of these disorders is reviewed in the context of electrodiagnosis and prognosis.
Brachial Plexus Neuropathies↗
Infantile botulism: pitfalls in electrodiagnosis.
Botulism in infants, unless recognized early, is associated with high mortality and morbidity. The diagnosis is suspected when infants present with sudden onset of weakness, respiratory failure, and constipation and is confirmed by demonstration of botulinum toxin in stool several weeks later. Electrodiagnosis allows quick and reliable confirmation of botulism. Low-amplitude compound muscle action potentials, tetanic or post-tetanic facilitation, and the absence of post-tetanic exhaustion support the diagnosis. Two infants with confirmed botulism did not exhibit the characteristic electrodiagnostic features, demonstrating the pitfalls in electrodiagnosis of infantile botulism.
Biopsy↗
Neuromuscular rehabilitation and electrodiagnosis. 2. Localized peripheral neuropathy.
This self-directed learning module highlights advances in diagnosis and treatment of focal injuries to peripheral and cranial nerves. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Nerve conduction and electromyographic techniques are employed as extensions of the physician's senses in clinical examination and diagnosis. The findings are used to plan treatment, and to predict and measure outcomes. Electrodiagnosis and medical and surgical treatments of nerve injuries are discussed in light of the managed-care utilization review of services.
Cranial Nerve Injuries↗
Acute inflammatory demyelinating polyneuropathy: contribution of a dispersed distal compound muscle action potential to electrodiagnosis.
Prolonged duration of the distal compound muscle action potential (DCMAP) ("DCMAP dispersion") is useful in the electrodiagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) with good specificity in distinguishing CIDP from amyotrophic lateral sclerosis (ALS) and diabetic polyneuropathy, but its role in the electrodiagnosis of acute inflammatory demyelinating polyneuropathy (AIDP) is unclear. This study addresses this issue by determining the optimal cutoff for DCMAP duration using receiver operating characteristic (ROC) analysis in 207 motor nerves from 53 clinically defined AIDP patients compared to 148 motor nerves from 55 ALS patients. We also determined whether the presence of DCMAP dispersion improves the sensitivity of four of the most sensitive published sets of electrodiagnostic criteria for AIDP. Using the ROC-derived optimal DCMAP duration cutoff of 8.5 ms, DCMAP dispersion was found in at least one motor nerve in 66% of subjects with AIDP compared to 9% of subjects with ALS. DCMAP dispersion improved the sensitivity of the four tested criteria sets to 76%-87% from 43%-77%. Moreover, of 13 AIDP patients who met none of the four published criteria sets, 5 (38%) had at least one dispersed DCMAP. These findings indicate that the presence of DCMAP dispersion adds electrodiagnostic sensitivity to the currently published criteria sets, while maintaining reasonably high specificity against a prototypical disorder of the primary motor neuron with axon loss.
Action Potentials↗
AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine.
The electrodiagnosis of carpal tunnel syndrome (CTS) is reviewed, including discussions of old and new techniques of motor and sensory nerve conduction, anomalous innervation, and needle electrode examination. A variety of sensitive nerve conduction studies (NCSs) are available for the evaluation of a patient with suspected CTS. For any particular patient, the NCS method chosen by the clinical neurophysiologist may vary for a number of reasons, including the severity of the deficit and the presence of superimposed conditions.
Carpal Tunnel Syndrome↗
AAEE minimonograph #26: The electrodiagnosis of carpal tunnel syndrome.
The electrodiagnosis of carpal tunnel syndrome is reviewed, including discussions of old and new techniques of motor and sensory nerve conduction, anomalous innervation, needle electrode examination, and one method of examining a patient with suspected carpal tunnel syndrome. The results of electromyographic testing of 505 patients with carpal tunnel syndrome in Rochester, Minnesota, from 1961 to 1980 are compared with results from previous studies. In the appendixes, a method of performing median motor and sensory nerve conduction studies and Mayo Clinic normal values are provided.
Carpal Tunnel Syndrome↗
Electrodiagnosis of human dorsal sacral nerve roots by recording afferent and efferent extracellular action potentials.
Single extracellular nerve action potentials from afferent fibres with various functions were recorded from human sacral nerve roots. It was shown that the potentials from these fibres can have different wave forms (amplitude, duration) and conduction velocities. The smaller potentials with longer durations have lower cut-off frequencies for certain identification than the larger potentials of shorter duration. The conduction velocity diagnosis covers a range of velocities with a factor of about 10. The slowest measured conduction velocities were between 4 and 10 m/sec. The identification of the functions of afferents in nerve roots is possible by calculating conduction velocities and stimulated activity increase measurements. Besides touch and pain fibres from the skin, afferents from mechano-receptors of the urinary bladder and the anal canal could be detected in dorsal sacral roots. There is evidence of motoneurons in the dorsal sacral roots supplying fatigue resistant muscle fibres. Sacral nerve root electrodiagnosis can be used in operations to identify physiologically-stimulated afferents and reflex activated motoneurons and, therefore, possibly will be useful in nerve anastomoses and nerve root stimulations in paraplegia.
Action Potentials↗
Usefulness of segmental and comparative tests in the electrodiagnosis of carpal tunnel syndrome: the Italian multicenter study. Italian CTS Study Group.
The Italian CTS Study Group performed a wide multicentric and multiparametric study to quantify the increase of electrodiagnostic sensitivity using an extended neurophysiological protocol and particularly segmental and comparative tests. The study also evaluated the clinical features of carpal tunnel syndrome (CTS) diagnosed by these tests, using validated physician- and patient-oriented measurements. The study group was composed of 740 patients for a total of 1123 idiopathic CTS hands. Overall, the sensitivity of standard tests (median digit-wrist sensory conduction velocity and wrist-thenar distal motor latency) was 83.5%. Comparative/segmental tests disclosed abnormal findings in a further 11.4% of cases, providing CTS electrodiagnosis in about 7 of 10 "standard negative" cases. The overall sensitivity of the electrodiagnostic protocol was 94.9%. The CTS population diagnosed by segmental/comparative tests had a clinical picture characterized by a high percentage of pain, and severe discomfort but no limitation in functional daily activity. Our data confirm the usefulness of a complete neurophysiological assessment by using segmental/comparative tests when standard tests yield normal results.
Adult↗
Neuromuscular rehabilitation and electrodiagnosis. 1. Mononeuropathy.
UNLABELLED: This self-directed learning module highlights mononeuropathies. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on diagnostic criteria and classifications of mononeuropathies, including carpal tunnel, brachial neuritis, and lumbosacral plexopathy. The timeline status post nerve injury is discussed in relation to findings on electrodiagnostic studies. The differential diagnosis and electrodiagnostic design and interpretation is detailed in the chapter. Treatment options are reviewed. OVERALL ARTICLE OBJECTIVE: To summarize the diagnosis, classification, and treatment of mononeuropathies, from an electrodiagnostic perspective.
Adult↗
Neuromuscular rehabilitation and electrodiagnosis. 2. Peripheral neuropathy.
UNLABELLED: This self-directed learning module highlights peripheral neuropathies. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on diagnostic criteria and classifications of peripheral neuropathy, including diabetic, alcoholic, carcinomatous, human immunodeficiency virus-associated, and critical illness polyneuropathies. Treatment options are reviewed. The causes for difficult to obtain nerve conduction studies are highlighted. OVERALL ARTICLE OBJECTIVE: To summarize the diagnosis, classification, and treatment of peripheral neuropathies.
Antidepressive Agents, Tricyclic↗