Start with the motor unit
Motor unit & electrophysiology
Identify whether you are recording a nerve response, a muscle response or one motor unit.
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NCV / EMG LEARNING
Core knowledge
33 topics connecting principles, technical quality and clinical reasoning.
Measure latency, amplitude and velocity
Latency, amplitude & conduction velocity
Reproducible measurements require explicit cursors, distances and units.
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Exclude technical artifacts first
Temperature, distance & artifacts
Rechecking distance and limb temperature often improves interpretation more than another test.
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Reference limits need context
Method-matched reference limits
Match the population and technique before consulting a numerical limit.
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The four phases of needle EMG
Insertion, rest, activation, recruitment
Structure the examination around insertion, rest, slight contraction and increasing effort.
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Recognize activity at rest
Spontaneous activity
Describe regularity, morphology and firing pattern before assigning pathological meaning.
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Compare neurogenic and myopathic patterns
MUAP morphology & recruitment
Relate motor-unit morphology and number to the force being produced.
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Understand the time course of injury
Timing & reinnervation
EDX is a snapshot of an evolving process. Early preserved responses do not exclude injury.
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Separate axonal and myelin features
Axonal loss vs demyelination
Interpret low amplitude and slowing within the complete pattern.
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Conduction block and temporal dispersion
Conduction block & temporal dispersion
Compare amplitude, area and duration when assessing proximal and distal responses.
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F waves and H reflexes
F waves & H reflex
Late responses assess long pathways but rarely localize a single lesion alone.
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Localize median slowing at the wrist
Carpal tunnel syndrome
Use comparisons under the same hand conditions to identify focal median abnormalities.
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Ulnar nerve: elbow, wrist or C8–T1?
Ulnar localization
Cross-check the across-elbow segment, DUC and non-ulnar muscles.
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A localization pathway for foot drop
Foot drop: fibular, sciatic or L5
Connect dorsiflexion, eversion, inversion and hip abduction.
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Build a case for radiculopathy
Cervical & lumbosacral radiculopathy
A myotomal pattern across peripheral nerves supports root localization.
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Distinguish plexus and root lesions
Brachial & lumbosacral plexopathy
Combine sensory responses, muscles across nerves and paraspinal findings.
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Brachial Plexopathy
Brachial Plexopathy
An overview of plexus anatomy, electrodiagnostic localization, lesion patterns and common causes.
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Classify polyneuropathy patterns
Polyneuropathy patterns
Organize findings by distribution, fiber type, time course and physiology.
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Recognize a myopathic pattern
Electrodiagnosis of myopathy
Understand what recruitment and distribution reveal, and what EMG cannot name alone.
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Motor neuron disease and its mimics
Motor neuron disease & mimics
Integrate lower motor neuron evidence with progression and upper motor neuron signs.
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Repetitive stimulation and the NMJ
Repetitive nerve stimulation
A stable baseline CMAP is essential before interpreting decrement or increment.
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Jitter and single-fiber EMG
Jitter & single-fiber EMG
High sensitivity does not imply disease specificity.
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Acquired demyelinating neuropathies
Acquired demyelinating neuropathies
Use formal criteria to avoid overcalling minor slowing.
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EDX during an acute GBS course
Guillain–Barré syndrome
Early and follow-up findings may differ. One negative study must not stop clinical assessment.
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Recognize anomalous innervation
Anomalous innervation
An anatomical variant can explain a CMAP pattern that otherwise looks pathological.
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Safety and informed participation
Safety & informed participation
Balance the question being asked with risk and the person's willingness to participate.
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Write a clinically useful report
From findings to an impression
Separate measurements, inferences and limitations.
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Choose muscles that test localization
Hypothesis-driven muscle sampling
Each sampled muscle should answer a distinct anatomical question.
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Facial, blink and respiratory studies
Facial, blink reflex & respiratory studies
Understand the questions specialized techniques can answer and their limits.
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Use ultrasound alongside EDX
Neuromuscular ultrasound
Combine structural and dynamic information with physiological localization.
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Small-fiber disease with normal NCS
Small-fiber neuropathy
Know the scope of routine testing before interpreting a negative result.
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Neuropathy and myopathy in the ICU
Critical illness polyneuropathy & myopathy
Find useful information despite edema, cold and limited participation.
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Myotonia and peripheral nerve hyperexcitability
Myotonic vs neuromyotonic discharges
Similar names can describe activity from different physiological sources.
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