Nerve Conduction Testing and Electromyography for the Physical Therapist: Techniques, Interpretation and Differential Diagnosis

This book was developed to assist physical therapy students and clinicians in learning the techniques, interpretation and use of electroneuromyography evaluation in the differential diagnosis of patients with neuromuscular disorders. It provides the physiological basis and techniques of this diagnostic test through the use of nerve conduction studies and needle electromyography. Readers will learn the application of these techniques to the upper and lower extremities, plus the interpretation of results/reports through case studies. Differential diagnosis of abnormalities that are distributed throughout the neuromuscular system will be presented. Knowledge of basic anatomy related to peripheral nerve and root distributions is being assumed. Table of Contents CHAPTER ONE 1 Introduction to Electrophysiological Evaluation - Peripheral Nerve and Muscle 1 CHAPTER TWO 17 Instrumentation used in Electroneuromyography Examinations 17 CHAPTER THREE 23 Upper Extremity Motor Nerve Conduction Studies & Sensory Nerve Action Potential’s (SNAP's) 23 Motor Nerve Conduction Studies - Overview 23 Sensory Nerve Conduction Studies 42 CHAPTER FOUR 53 Lower Extremity Motor Nerve Conduction Studies & Sensory Nerve Action Potential’s 53 Motor Nerve Conduction Studies 54 Sensory Nerve Conduction Studies 61 CHAPTER FIVE 66 Advanced Techniques of Nerve Studies - Late Responses 66 Somatosensory Evoked Potentials (SSEP’s) 66 Brainstem Auditory Evoked Potentials (BAER's) 69 Visually Evoked Potentials (VEP's) 69 H- Reflex 70 F- Wave Testing 72 Repetitive Nerve Stimulation - Myasthenia Gravis 73 CHAPTER SIX 78 Diagnostic Electromyography 78 CHAPTER SEVEN 92 Problem Solving in Electroneuromyography and Case Studies 92 Case Study # 1: Carpal Tunnel Syndrome 95 Case Study # 2: Age 5 – Duchenne MD (DMD) 96 Case Study # 3: Suspected L5 Root Compression 97 Case Study # 4: Suspected Peripheral Polyneuropathy 99 Case Study #5: EMG Report #1 100 Case Study #6: EMG Report #2 102 Case Study #7: EMG Report #3 103 Case Study #8: Gun Shot Wound to the Cauda Equina, L1 - L2. 105 Case #9: Anterior Glenohumeral Joint Dislocation 107 Case #10: Mid Humeral Fracture 107 Case #11: Multiple Sclerosis 107 Case #12: Isolated Scapula Winging 107 Case #13: Idiopathic Bell’s Palsy 107 Appendix A 111 Anatomical Correlates and Associated Impairments 111 Appendix B 113 Common Causes of Peripheral Neuropathies 113 Appendix C 114 Upper Extremity - Root and Peripheral Nerve Innervations 114 Lower Extremity - Root and Peripheral Nerve Innervations 115 References 116

Gary Krasilovsky, PT, PhD, SST is Executive Officer, Graduate Center DPT Program and Associate Professor & Director, Hunter College/Graduate Center DPT Program of the City University of New York. He has been a physical therapy clinician, educator, and researcher for almost forty years. He earned a BS degree in Special Education from the University of Missouri, and a Certificate in Physical Therapy, MA and PhD in Physical Therapy from New York University. His career in physical therapy included ten years at the Rusk Institute of Rehabilitation Medicine of NYU, where he worked as a clinician, researcher, and received advanced training and mentoring in the electrodiagnostic department. He also was senior physical therapist in the Jerry Lewis Muscular Dystrophy clinic based at Rusk Institute and was Chief of Physical Therapy at Norwalk hospital. He began his full time teaching career at Hunter College in 1987 and became acting program director two years later. He has continued to serve as program director since 1992 and teaches clinical neurology, adult neurological rehabilitation, electroneuromyography and therapeutic exercise. He has published in various peer-reviewed journals and textbooks on various areas related to physical therapy, with an emphasis on neurology based topics. Dr. Krasilovsky is also certified as a Schroth Scoliosis Therapist.