Electromyography

Electromyography or EMG is a diagnostic test that understands the physiological of muscles thereby assessing their health. Electromyography involves inserting a needle electrode through the skin into the muscle. This electorde detects electrical activity in the muscles and nerves controlling the muscles. A patient is asked to flex or contract the muscles so that the response of the muscle to the nerve stimuli is observed. An electromyograph is used to detect and measure electric potential that is generated by the contracting muscles. Other indicators to the proper functioning of the muscles and their corresponding nerves are the size, duration and frequency of electric signals received from them. EMG is often conducted along with a nerve conduction velocity test.

The EMG test is used to diagnose any possible weakness or impaired muscle strength due to neurological problems. Some discorders that can lead to abnormal readings on EMG test are cervical spondylosis, myasthenia gravis, carpal tunnel syndrome, myopathy, Brachial plexopathy, Guillain Barre syndrome, sciatic nerve dysfunction and mononueritis multiplex. EMG test aids in differentiating between a muscle and nerve disorder. The muscle may feel tender after the EMG test with localised bruising.

Nerve Conduction Study

A medical diagnostic tool used to evaluate the ability of the motor and sensory nerves for electrical conduction is the Nerve conduction study. Nerve conduction studies are performed by medical specialists in neurophysiology, physiatry and neurology with sub-specialization in electro diagnostic medicine. The common measurement made during this test is called Nerve conduction velocity or NCV. This is conducted to determine the damage and destruction caused to nerves.

Procedure

The procedure is to stimulate the nerve with surface electrode patches attached to the skin. Two electrodes are placed on the skin over the nerve. One electrode stimulates the nerve with a mild electrical impulse. The resulting electrical activity is recorded by another electrode. This testing is repeated in about 2 - 3 places along the arms or legs. After the procedure, the nerve conduction speed is calculated by measuring the distance between electrodes and the time it takes for electrical impulses to travel between electrodes.

The nerve conduction velocity (speed) is then calculated by measuring the distance between electrodes and the time it takes for electrical impulses to travel between electrodes.

A related procedure that may be performed is electromyography (EMG). An EMG measures the electrical activity in muscles and is often performed at the same time as NCS. Both procedures help to detect the presence, location and extent of diseases that damage the nerves and muscles.

Prior to the procedure

This study does not require any fasting or sedation prior to the procedure. But body temperature must be maintained before and during the procedure as low body temperature slows nerve conduction. Keep the doctor informed in case of any medicine or herbal supplements you might be taking. You must stop using lotions or oils on your skin a few days before the procedure. Based on your medical condition, the doctor may request any other specific preparation.

During the procedure

A nerve conduction study is performed as an outpatient procedure although procedures may vary depending upon the condition and doctor's practices. The study is performed by a neurologist although a technologist may perform portions of the test. During the procedure, the patient is asked to remove any clothing, jewelry, hairpins, eyeglasses, hearing aids, or any other metal objects that may interfere with the procedure.

The patient is asked to either sit or lie down for the test. A recording electrode is attached to the skin over the nerve with a special paste. A stimulating electrode is placed at a known distance away from the recording electrode. The nerve is stimulated by a mild and brief electrical shock through the stimulating electrode. You might experience minor discomfort for a few seconds. The patient senses rapid tingling in the area. The stimulation of the nerve and the response are displayed on an oscilloscope.

What does the test results indicate?

Generally, the nerve conduction velocity would be around 50 to 60 meters per second. But it tends to vary from person to person and from one nerve to another.

The speed of the nerve conduction study is related to the diameter of the nerve and the degree of myelin sheath (which is a type of insulation) around the nerve. While a normally functioning nerve will transmit a stronger and faster signal, a damaged nerve will be slower. The larger the wire, the better the insulation and more consistent and stronger will be the signal.

If results are abnormal, they may be due to some sort of neuropathy or damage to the nerve resulting from a traumatic injury or nerve. Sometimes, other diseases may also cause the impulses to slow down. It could be due to conduction block that is an obstacle to the impulse within the nerve or due to demyelination or damage to the myelin sheath.

Why nerve conduction study?

Nerve conduction study is done along with EMG to differentiate a nerve disorder from a muscle disorder. While nerve conduction study detects whether the nerve has any problem, EMG detects whether a muscle is functioning properly in response to the nerve's stimulus. Whenever there is any neurologic injury or disorder, nerve conduction studies often combined with needle electromyography measure are used. This helps in identifying cause for any pain or weakness in the limbs from spinal nerve compression or injury.

Nerve conduction studies are used primarily for evaluation of numbness, tingling and burning or weakness of arms and legs depending upon the part of the body the symptom is present. Physical examination by the doctor and patient's history help to direct the investigation. A number of disorders are diagnosed by nerve conduction studies - carpal tunnel syndrome, Gullian-Barre syndrome, peripheral neuropathy, spinal disc herniation, ulnar neuropathy and others.

Risks of the procedure

Although the voltage of electrical pulses used in this study is quite low, there may be risks depending upon specific medical conditions. Certain factors such as damage to the spinal cord, severe pain before the test and body temperature may affect the test. In case you are using cardiac defibrillator or pacemaker, adequate precautions need to be taken.

Tennis Elbow

When there is inflammation of the tendons on the outside of the elbow at the lateral epicondyle of the upper arm, the condition is known as tennis elbow. This condition is caused by certain repetitive movements of the wrist Tennis players are not the only people who are affected by this condition, which is also known as lateral epicondylitis. Activities like hedge clipping, tennis, excessive use of a screwdriver or hammer, painting or any such activity that involves repetitive motion of the wrist which also requires constant gripping may lead to tennis elbow. Though, the real cause of tennis elbow is not clearly defined, it is due to tears of the tendons that attach the forearm muscles to the bone of the arm at the elbow joint.

Symptoms of tennis elbow

• Pain over the outside (lateral) of the elbow
  
• Pain while lifting or carrying objects or gripping even light objects such as a coffee cup.
  
• Pain radiates down the forearm.
  
• Tenderness is felt on or below the joint's bony prominence.
  
• Pain due to tennis elbow may last for about 6 to 12 weeks.
  
• The discomfort may be for a short duration or it may last for several years.

Normally the pain due to tennis elbow sets in gradually, though at times it may also occur suddenly. Most patients complain of pain in the dominant arm. Manual workers like painters, plumbers, carpenters and gardeners who use their hands face the risk of developing this symptom. Many sports participants like racquet sports players, golfers, fencers are also prone to tennis elbow syndrome.

Tennis elbow is not simply caused by inflammation of the tendons alone, consider experts. The degenerative process either due to aging, or repetitive use of the forearm may also be responsible. If there is poor blood flow in that area, it does not heal completely and accessing nutrition and oxygen necessary for healing becomes difficult. This condition will lead to small tears in the tendon because of its degeneration and is revealed as symptoms of tennis elbow.

X-rays help to diagnose tennis elbow for patients who have the usual symptoms near their forearm. If the doctor has any confusion, an EMG is sometimes obtained to confirm the diagnosis of a tennis elbow. Pain over the outside of the elbow may sometimes occur due to instability of the joint, elbow arthritis and radial tunnel syndrome. Though the symptoms of these conditions are normally distinct, they can be confusing at times.

Even after the initial injury is healed, these areas tend to tear again. Hemorrhage will result because of this condition and there will be formation of rough, granulated tissue and calcium deposits within the surrounding tissues. Inflammation is caused due to leakage of collagen. The blood flow in this area is cut off because of the pressure developed due to inflammation. It can also squeeze the radial nerve that controls muscle in the arm and hand.

When your elbow is involved in any activity, always take care to warm up your arm for a few minutes before starting. Apply a pack of ice over the arm for 15 or 20 minutes, if you experience severe pain in that area after use. If the usual measures like rest, anti-inflammatory medications and stretching routine do not yield good results, then in rare cases surgery is considered. Tennis elbow can be prevented by:

• Lifting objects with the palm facing your body.
  
• Using hand weights, you can do strengthening exercises.
  
• Before starting any stressful activity, stretch the relevant muscles by grasping the tips of your fingers.
  
• Be cautious to avoid a relapse. Try to modify or just discontinue the action that caused the strain. Frequent breaks during the activity will help prevent this condition.
  
• Strapping a band around your forearm just below the elbow will help as a support. Using bands can cut off blood circulation and thus delay healing and so it is best to use these bands only after tennis elbow has healed completely.