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Fundamentals of Nerve 
Conduction Studies & EMG
GGooaall ooff EEDDXX 
LLooccaalliizzaattiioonn SSeevveerriittyy 
MMuussccllee NNeerrvvee NNMMJJ 
FFiibbeerr ttyyppee PPaatthhoollooggyy TTeemmppoorraall CCoouurrssee 
SSeennssoorryy AAxxoonnaall HHyyppeerr aaccuuttee 
MMoottoorr ddeemmyyeelliinnaattiinngg AAccuuttee 
MMiixxeedd SSuubbaaccuuttee 
AAccqquuiirreedd HHeerreeddiittaarryy CChhrroonniicc
Nerve Conduction Studies 
A medical test where peripheral nerves are 
electrically stimulated and responses are 
recorded over nerve or muscle
Nerve Conduction Studies include 
1) Routine Studies 
A) Motor nerve conduction 
B) Sensory nerve conduction 
C) Late responses 
2) Special Studies 
Repetitive Stimulation, SSEP, MEP, VEP
Motor nerve conduction studies 
1. Electrodes placed over muscle 
2. Supra maximal stimulus applied over 
nerve to muscle 
3. Compound motor action potential 
recorded (CMAP)
Motor nerve conduction studies 
1. Stimulus repeated at second site 
2. Second CMAP recorded 
3. Distance measured between stimulation 
sites (cm)
Data reported for motor studies: 
1. Distal latency 
2. Amplitude of CMAP (each site) 
3. Conduction velocity between sites 
(calculated) 
Data compared to normal data and 
interpretation provided
Sensory nerve conduction studies 
1. Electrode placed over sensory cutaneous 
branch of nerve 
2. Stimulus applied to nerve 
3. Sensory nerve action potential recorded 
(SNAP)
Late responses: F-waves 
1. F-waves results from small number of motor 
neurons activated by antidromic 
(back-firing) 
2. Variable in amplitude and latency 
3. Commonly minimum latency is measured 
4.Supra maximal stimulus are applied
HH RReefflleexx 
11-- IItt iiss aa ttrruuee rreefflleexx ((iitt hhaass aaffffeerreenntt,, ssyynnaappss && 
aaffffeerreenntt ppaatthhwwaayy)) 
22-- EElliicciitteedd bbyy ssttiimmuullaattiioonn ooff ttiibbiiaall nneerrvvee && 
rreeccoorrddiinngg ffrroomm ssoolleeuuss mmuussccllee 
33-- NNeeeedd ssuubb mmaaxxiimmaall ssttiimmuullaattiioonn
NCS: limitations 
1. Painful stimulations 
2. Temperature sensitive (S>M) 
3. Assess mainly large fibers 
4. Most useful for nerve conditions
Electromyography 
Definition: A medical test where electrical 
impulses are recorded from muscle at rest 
and while contracting. 
The recording is made by 
1. needle – from a needle inserted in the 
selected muscle 
2. surface – from an electrode placed on the 
skin over the selected muscle
Electromyography 
1. Motor neuron or nerve diseases cause 
larger units firing rapidly 
2. muscle disorders give rise to smaller 
MUPs that fire early
NCS: Diagnostic Utility 
1. Nerve diseases 
2. Nerve root disease 
3. Muscle disorders 
4. Neuromuscular Junction disorder
Contra iinnddiiccaattiioonn ooff NNCCSS && EEMMGG 
11-- PPaattiieenntt wwiitthh aarrttiiffiicciiaall ppeeaacceemmaakkeerr 
22-- PPaattiieenntt wwiitthh bblleeeeddiinngg ddiissoorrddeerr

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Emg fundamental

  • 1. Fundamentals of Nerve Conduction Studies & EMG
  • 2. GGooaall ooff EEDDXX LLooccaalliizzaattiioonn SSeevveerriittyy MMuussccllee NNeerrvvee NNMMJJ FFiibbeerr ttyyppee PPaatthhoollooggyy TTeemmppoorraall CCoouurrssee SSeennssoorryy AAxxoonnaall HHyyppeerr aaccuuttee MMoottoorr ddeemmyyeelliinnaattiinngg AAccuuttee MMiixxeedd SSuubbaaccuuttee AAccqquuiirreedd HHeerreeddiittaarryy CChhrroonniicc
  • 3. Nerve Conduction Studies A medical test where peripheral nerves are electrically stimulated and responses are recorded over nerve or muscle
  • 4. Nerve Conduction Studies include 1) Routine Studies A) Motor nerve conduction B) Sensory nerve conduction C) Late responses 2) Special Studies Repetitive Stimulation, SSEP, MEP, VEP
  • 5. Motor nerve conduction studies 1. Electrodes placed over muscle 2. Supra maximal stimulus applied over nerve to muscle 3. Compound motor action potential recorded (CMAP)
  • 6.
  • 7. Motor nerve conduction studies 1. Stimulus repeated at second site 2. Second CMAP recorded 3. Distance measured between stimulation sites (cm)
  • 8.
  • 9. Data reported for motor studies: 1. Distal latency 2. Amplitude of CMAP (each site) 3. Conduction velocity between sites (calculated) Data compared to normal data and interpretation provided
  • 10.
  • 11.
  • 12.
  • 13.
  • 14. Sensory nerve conduction studies 1. Electrode placed over sensory cutaneous branch of nerve 2. Stimulus applied to nerve 3. Sensory nerve action potential recorded (SNAP)
  • 15.
  • 16.
  • 17.
  • 18. Late responses: F-waves 1. F-waves results from small number of motor neurons activated by antidromic (back-firing) 2. Variable in amplitude and latency 3. Commonly minimum latency is measured 4.Supra maximal stimulus are applied
  • 19.
  • 20. HH RReefflleexx 11-- IItt iiss aa ttrruuee rreefflleexx ((iitt hhaass aaffffeerreenntt,, ssyynnaappss && aaffffeerreenntt ppaatthhwwaayy)) 22-- EElliicciitteedd bbyy ssttiimmuullaattiioonn ooff ttiibbiiaall nneerrvvee && rreeccoorrddiinngg ffrroomm ssoolleeuuss mmuussccllee 33-- NNeeeedd ssuubb mmaaxxiimmaall ssttiimmuullaattiioonn
  • 21.
  • 22. NCS: limitations 1. Painful stimulations 2. Temperature sensitive (S>M) 3. Assess mainly large fibers 4. Most useful for nerve conditions
  • 23. Electromyography Definition: A medical test where electrical impulses are recorded from muscle at rest and while contracting. The recording is made by 1. needle – from a needle inserted in the selected muscle 2. surface – from an electrode placed on the skin over the selected muscle
  • 24.
  • 25. Electromyography 1. Motor neuron or nerve diseases cause larger units firing rapidly 2. muscle disorders give rise to smaller MUPs that fire early
  • 26.
  • 27.
  • 28. NCS: Diagnostic Utility 1. Nerve diseases 2. Nerve root disease 3. Muscle disorders 4. Neuromuscular Junction disorder
  • 29. Contra iinnddiiccaattiioonn ooff NNCCSS && EEMMGG 11-- PPaattiieenntt wwiitthh aarrttiiffiicciiaall ppeeaacceemmaakkeerr 22-- PPaattiieenntt wwiitthh bblleeeeddiinngg ddiissoorrddeerr