Tuesday, August 19, 2008
Tests & Procedures Electromyography (EMG)
(Myogram)
What is EMG?
Electromyography (EMG) measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle. The test is used to help detect neuromuscular abnormalities.
During the test, one or more small needles (also called electrodes) are inserted through the skin into the muscle. The electrical activity picked up by the electrodes is then displayed on an oscilloscope (a monitor that displays electrical activity in the form of waves). An audio-amplifier is used so the activity can be heard.
EMG measures the electrical activity of muscle during rest, slight contraction, and forceful contraction. Muscle tissue does not normally produce electrical signals during rest. When an electrode is inserted, a brief period of activity can be seen on the oscilloscope, but after that, no signal should be present.
After all of the electrodes have been inserted, you may be asked to contract the muscle, for example, by lifting or bending your leg. The action potential (size and shape of the wave) that this creates on the oscilloscope provides information about the ability of the muscle to respond when the nerves are stimulated. As the muscle is contracted more forcefully, more and more muscle fibers are activated, producing action potentials.
A related procedure that may be performed is nerve conduction velocity (NCV). NCV is a measurement of the speed of conduction of an electrical impulse through a nerve. NCV can determine nerve damage and destruction, and is often performed at the same time as EMG. Both procedures help to detect the presence, location, and extent of diseases that damage the nerves and muscles. Please see this procedure for additional information.
Interpretation of the test results:
A healthy muscle will show no electrical activity (no signs of action potential) during rest, only when it contracts. However, if the muscle is damaged or has lost input from nerves, it may have electrical activity during rest. When it contracts its electrical activity may produce abnormal patterns.
An abnormal EMG result may be a sign of a variety of muscle or nerve disorders, including polymyositis (an inflammatory muscle disease that causes decreased muscle power), muscular dystrophy (a chronic genetic disease that progressively affects muscle function), myasthenia gravis (a genetic or immune disorder that occurs at the point where the nerve connects with the muscle), and myotonic (stiff) muscles.
Reasons for the Procedure
EMG is often used along with nerve conduction velocity (NCV) to differentiate a muscle disorder from a nerve disorder. NCV detects a problem with the nerve, whereas EMG can detect diseases stemming from problems with the muscle itself, as well as other problems that result from influences on the muscle from other systems, such as nerves.
EMG may be done to identify the cause of symptoms, such as muscle weakness, deformity, spasticity, atrophy, and stiffness. It may be used to detect whether someone is experiencing true muscle weakness or weakness because of pain or psychological reasons.
EMG may be used to evaluate many problems/disorders including, but not limited to, the following:
neuromuscular diseases, such as myasthenia gravis
motor problems, such as involuntary muscle twitching
nerve compression or injury, such as carpal tunnel syndrome
nerve root injury, such as sciatica
muscle degeneration, such as muscular dystrophy
There may be other reasons for your physician to recommend EMG.
Risks of the Procedure
Some discomfort, similar to the feeling of an injection or an acupuncture needle, may be felt when the needle electrodes are inserted into the muscle. Afterwards, the muscle may feel sore for a few days and a bruise may appear at the needlestick site.
The insertion of the electrodes may also cause false results on a muscle biopsy or during blood tests in which muscle enzymes are measured.
EMG is usually contraindicated in persons receiving anticoagulant therapy (blood thinning medication such as Coumadin) because the needle electrodes may cause bleeding within the muscle.
It also may be contraindicated in persons with extensive skin infections due to the risk of spreading infection from the skin to the muscle.
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
Certain factors or conditions may interfere with EMG test results. Swelling, bleeding, or obesity may interfere with the transmission of electrical waves to the electrodes, and thereby alter the EMG results. Medications such as skeletal muscle relaxants, cholinergics, and anticholinergics may also interfere with EMG test results.
Before the Procedure
Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
Generally, fasting is not required before the test. In some cases, cigarettes and caffeinated beverages, such as coffee, tea, and cola may be restricted two to three hours before testing.
Notify your physician about any over-the-counter or herbal supplements you are taking.
Notify your physician if you have a pacemaker.
Dress in clothes that permit access to the area to be tested or that are easily removed.
Stop using lotions or oils on your skin for a few days before your procedure.
A sedative or pain reliever may be prescribed before the procedure. If a sedative is given before the procedure, you may need to have someone drive you home afterwards.
Based upon your medical condition, your physician may request other specific preparation.
During the Procedure
An EMG procedure may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.
The EMG is performed by a neurologist (a physician who specializes in brain and nerve disorders), although a technologist may also perform some portions of the test.
The EMG is usually performed immediately following a nerve conduction study (a test that measures the flow of current through a nerve before it reaches the muscle rather than the response of muscle itself).
Generally, an EMG procedure follows this process:
You will be asked to remove any clothing, jewelry, hairpins, eyeglasses, hearing aids, or other metal objects that may interfere with the procedure.
If you are asked to remove clothing, you will be given a gown to wear.
You will be asked to sit or lie down for the test.
A neurologist will locate the muscle(s) to be studied.
The skin will be cleansed with an antiseptic solution. Next, a fine, sterile needle will be inserted into the muscle. A metal plate will be positioned under you.
Ten or more needle insertions may be necessary for the test. You may experience slight pain with the insertion of the electrode, but it is usually painless.
If the test is painful you must tell your examiner because this can interfere with the results.
You will be asked to relax and then perform slight or full-strength muscle contractions.
The electrical activity from your working muscle will be measured and displayed on the oscilloscope.
An audio-amplifier may also be used so that both the appearance and sound of the electrical potentials can be evaluated. If the recorder is attached to an audio-amplifier, you may hear a sound like hail on a tin roof when you contract your muscle.
After the Procedure
Pain medication may be administered and warm compresses may be applied to the affected area immediately following the procedure.
Some muscle soreness may persist for a day or so following the procedure. Notify your physician if you experience increasing pain, tenderness, swelling, or pus at the needle insertion sites.
Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.
Online Resources
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.
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Electromyography (EMG) Introduction
Electromyography (EMG) Introduction
Electromyography, or EMG, involves testing the electrical activity of muscles. Often, EMG testing is performed with another test that measures the conducting function of nerves. This is called a nerve conduction study. Because both tests are often performed at the same office visit and by the same personnel, the risks and procedures generally apply to both tests.
Muscular movement involves the action of muscles and nerves and needs an electrical current. This electrical current is much weaker than the one in your household wiring.
In some medical conditions the electrical activity of the muscles or nerves is not normal. Finding and describing these electrical properties in the muscle or nerve may help your doctor diagnose your condition.
EMG may aid with the diagnosis of nerve compression or injury (such as carpal tunnel syndrome), nerve root injury (such as sciatica), and with other problems of the muscles or nerves. Less common medical conditions include amyotrophic lateral sclerosis, myasthenia gravis, and muscular dystrophy.
Risks
People usually have a small amount of discomfort during EMG testing because of pin insertion. Disposable needles are used so there is no risk of infection.
During nerve conduction studies, small electrodes are taped to the skin or placed around fingers. You typically experience a brief and mild shock, which may be a bit unpleasant. Most people find it only slightly annoying.
EMG Preparation
No specific preparation is needed for the testing.
During the Procedure
During EMG, small pins or needles are inserted into muscles to measure electrical activity. The needles are different than needles used for injection of medications. They are small and solid, not hollow like hypodermic needles. Because no medication is injected, discomfort is much less than with shots.
You will be asked to contract your muscles by moving a small amount during the testing.
With nerve conduction studies, small electrodes will be taped to your skin or placed around your fingers. You typically will experience a mild and brief tingling or shock, which may be a bit unpleasant.
The person who administers the test will explain the procedure. Often muscle activity is monitored through a speaker during the test, which may make a popping or soft roaring noise. The EMG technician will be looking at an oscilloscope, which looks like a small TV set during the procedure.
Testing may take 30-60 minutes.
After the Procedure
If you are having this test in a doctor’s office, you will be sent home following the procedure without any restriction of activities. Some people may have minor aches and pains from the testing.
Next Steps
The report of the testing will be sent to the doctor who ordered the test. The ordering doctor will discuss the results with you or your doctor.
Synonyms and Keywords
electromyography, EMG, nerve conduction studies, electrical activity of muscles, nerve compression, nerve injury, carpal tunnel syndrome, nerve root injury, sciatica, amyotrophic lateral sclerosis, myasthenia gravis, muscular dystrophy.
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