EMG Lesion Localization and Characterization: A Case Studies Approach takes a unique approach to electrodiagnostic (EDX) medicine, using case studies and exercises to teach clinical reasoning and build technical skills. The first section presents basic principles, reviewing pertinent nerve and muscle anatomy, physiology, and pathophysiology along with study techniques, measurements, and pitfalls. The second section emphasizes how to most effectively utilize the book’s featured case studies, followed by 60 cases covering the range of disorders encountered in the EMG lab and organized by regional and multiregional disorders of the upper and lower extremities, brachial plexopathies, generalized disorders, and challenging cases.
Through the EDX case studies, lesion localization and characterization are demonstrated and discussed step-by-step using a floating text box that tracks the findings for each case. Cases begin with the clinical features, which dictate the initial EDX studies performed. The results of those studies drive the next round of testing, which continues until the abnormality has been localized and characterized and a diagnosis is made. In this manner, the dynamic nature of electrodiagnostic testing and process of sequential study analysis is reinforced, just as it would be in the EMG laboratory.
Authored by two leading experts in neurology and electrodiagnostic medicine, all aspects of lesion localization and characterization are extensively covered, including calculations of lesion severity for demyelinating conduction block and axon loss lesions and calculations of various types of motor unit action potential recruitment frequencies. The book features a large number of anatomical drawings, charts, and EDX images in order to illustrate the skills of lesion localization and characterization comprehensively. By conveying the “cognitive approach” to EDX medicine, EMG Lesion Localization and Characterization merges clinical knowledge with real-life cases to better instruct residents, fellows, technicians, and neuromuscular providers in the field of electrodiagnostic medicine.
Key Features:
Includes 60 cases covering all major neuromuscular disorders
Presents basic and advanced anatomic, physiologic, pathophysiologic, and temporal principles and concepts pertinent to EDX medicine
EDX studies are evaluated as they are collected, providing insight into the principles underlying electrodiagnostic medicine
Through sequential step-by-step analysis of findings, the decision-making process required in the EMG laboratory is simulated
Purchase includes access to the ebook for use on most mobile devices or computers
Author(s): Mark A. Ferrante, Bryan Tsao
Edition: 1
Publisher: Springer Publishing Company
Year: 2019
Language: English
Tags: Neurology; Electrodiagnostic Medicine; Rheumatology; Physical Medicine & Rehabilitation; Exercise Injuries & Rehabilitation
Cover
Title
Copyright
Contents
Case Studies
Preface
Acknowledgments
Share: EMG Lesion Localization and Characterization
Part I: The Fundamental Neuroscience Underlying Electrodiagnostic Medicine
Chapter 1: Pertinent Anatomy, Physiology, and Pathology
Introductory Comments
The Goals of Electrodiagnostic Examination
The EDX Examination Is an Independent Study
Basic Anatomy and Organization of the Peripheral Neuromuscular System
Plexus Anatomy
Nerve Anatomy
Anatomy and Physiology of the Membrane
The Transmembrane Potential
Action Potential Generation
Action Potential Propagation
Connective Tissue Elements of the Nerve
Anatomy and Physiology of the Neuromuscular Junction
Presynaptic Region
Synaptic Space
Postsynaptic Region
Anatomy and Physiology of Muscle
Excitation–Contraction Coupling
Neural Control of Muscle
Motor Units, Muscle Fibers, and Force
References
Chapter 2: Nerve Conduction Studies
Basic Concepts
Electrodes
Volume Conduction
Orthodromic Versus Antidromic Techniques
Motor Nerve Conduction Studies
Belly–Tendon Method
E1 and E2 Electrode Placement
Physiologic Temporal Dispersion
What We Measure and What It Means
The Value of the Motor Response
Sensory Nerve Conduction Studies
Technique
Measurements
Mixed Nerve Conduction Studies
The NCS Manifestations of Pathology
Introduction
How Focal Demyelination Affects Action Potential Propagation
Motor NCS Manifestations
Sensory NCS Manifestations
The Timing of NCS Manifestations
References
Chapter 3: Repetitive Nerve Stimulation Studies
Introductory Comments
Low Frequency RNS
Postexercise Facilitation and Postexercise Exhaustion
High Frequency RNS
References
Chapter 4: The Needle EMG Examination
Introductory Comments
Motor Unit Anatomy and Physiology Pertinent to Needle EMG
The Importance of the MUAP Duration
Motor Unit Recruitment
Needle EMG Technique
Needle EMG Measurements and Their Meanings
Insertional Phase
Resting Phase
Activation Phase
References
Chapter 5: Needle EMG Examination Abnormalities
Introductory Comments
Insertional Phase
Decreased Insertional Activity
“Increased” Insertional Activity
Resting Phase
Fibrillation Potentials, Positive Sharp Waves, and Insertional Positive Sharp Waves
Fasciculation Potentials and Cramp Potentials
Myotonic Potentials
Neuromyotonia
Grouped Repetitive Discharges and Myokymia
Complex Repetitive Discharges
Activation Phase
MUAP Morphology
MUAP Recruitment
MUAP Stability
References
Chapter 6: Peripheral Nerve Injuries
Introductory Comments
Nerve Injury Classification
The Seddon Classification System
The Sunderland Classification System
Nerve Injury Type
Stretch Injuries
Compression Injuries
Transection Injuries
Correlations Between Pathophysiology and Clinical Features
Correlations Between Pathophysiology and Lesion Acuteness
References
chapter 7: Assessing Lesion Severity
Introductory Comments
Clinical Grading
Electrodiagnostic Grading
The EDX Study Manifestations
EDX Manifestations Based on Severity
EDX Manifestations Based on the Timing of the Study
The Utility of the Motor Response in Lesion Severity Assessment
The Utility of the Sensory Response in Lesion Severity Assessment
The Utility of the Needle EMG in Lesion Severity Assessment
Fibrillation Potentials
Motor Unit Action Potentials
Mechanisms of Reinnervation
Collateral Sprouting
Proximodistal Axon Regeneration
Determining the Potential for Reinnervation
References
Chapter 8: Lesion Localization and Characterization
Lesion Localization
Nerve Conduction Studies
The Cell Bodies of Origin of the Sensory and Motor Axons
An Example of Lesion Localization
Lesion Characterization
Example 1—Calculating Axon Loss and Demyelinating Conduction Block Severity Using the Motor Responses
Example 2—Sample EDX Case and Terminology
Example 3—Using Deductive Reasoning to Identify a Proximal Demyelinating Conduction Block
Muap Waveform Analysis
MUAP Measurements and Stability
MUAP Recruitment Pattern Analysis
Reference
Part II: Case Studies in Electrodiagnostic Medicine
Chapter 9: Case Studies
Introductory Comments
EDX Case Study Organization
The Case-Box
Table Descriptors
MUAP Recruitment Descriptors
MUAP Morphology Descriptors
When the Needle EMG Findings Vary
Abbreviations Used
EDX Case Studies
Introduction
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comment
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Conclusion
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Conclusion
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Conclusion
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Conclusion
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Conclusion
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Conclusion
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Nerve Conduction Studies
Needle EMG Study
EDX Conclusion
Final Comments
Clinical Thoughts
Needle EMG Study
EDX Conclusion
Final Comments
Clinical Thoughts
Nerve Conduction Studies
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
EDX Study Impression
Final Comments
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
EDX Study Impression
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comment
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Impression
Final Comments
Clinical Thoughts
Nerve Conduction Studies
Needle EMG Study
EDX Study Conclusion
Final Comments
Clinical Thoughts
Sensory and Motor NCS (Day 4)
Complete NCS Studies (Day 25)
Needle EMG Study
EDX Study Conclusion
Follow-Up NCS (4 Months)
Follow-Up Needle EMG Study
Clinical Thoughts
Sensory Nerve Conduction Studies
Motor Nerve Conduction Studies
Needle EMG Study
EDX Examination Conclusion
Three-Month Follow-Up Nerve Conduction Studies
Needle EMG Study
Index
