The Political Economy

Successfully correlate electrodiagnostic findings and neuromuscular ultrasound with key clinical findings with Electromyography and Neuromuscular Disorders, 4th Edition. This popular text is the go-to resource for clinicians at all levels of experience who have an interest in neuromuscular medicine, including those studying for the AANEM board exam. An easy-to-read writing style, abundant case studies, and learning features online help you master the electrodiagnostic evaluation and improve safety and accuracy . Helps you diagnose neuromuscular disorders more quickly and accurately , and correlate electromyographic and clinical findings. Explains complex subject matter in an easy-to-understand, user-friendly manner. Includes dozens of detailed, cross-sectional anatomy drawings to ensure correct EMG needle placement and avoid neurovascular injuries. Features new chapters on Neuromuscular Ultrasound , as well as incorporating neuromuscular ultrasound in the evaluation of clinical neuromuscular disorders along with electrodiagnostic studies in many of the clinical chapters. Provides up-to-date information on iatrogenic complications of electrodiagnostic studies and newly defined genetic neuromuscular conditions. Includes online access to more than 70 videos that allow you to see and hear the EMG waveforms discussed in the text, as well as a convenient "Test Your Knowledge" module. Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic-Ultrasound Correlations......Page 2 Copyright......Page 3 Foreword......Page 4 Preface to the Fourth Edition......Page 5 Preface to the Third Edition......Page 7 Preface to the Second Edition......Page 8 Preface to the First Edition......Page 10 Dedication......Page 11 Acknowledgments......Page 12 1 - Approach to Nerve Conduction Studies, Electromyography, and Neuromuscular Ultrasound......Page 13 LOCALIZATION OF THE DISORDER IS THE MAJOR AIM OF THE ELECTRODIAGNOSTIC STUDY......Page 14 Assessing the Degree of Axonal Loss Versus Demyelination has Implications for Severity and Prognosis......Page 15 Neuromuscular Junction Localization......Page 16 CARDINAL RULES OF NERVE CONDUCTION STUDIES AND ELECTROMYOGRAPHY......Page 17 NEUROMUSCULAR ULTRASOUND......Page 19 Motor Neuron Disease......Page 20 CARDINAL RULES OF NEUROMUSCULAR ULTRASOUND......Page 21 ANATOMY......Page 23 PHYSIOLOGY......Page 26 CLASSIFICATION......Page 31 RECORDING......Page 32 MOTOR CONDUCTION STUDIES......Page 35 Duration......Page 36 Conduction Velocity......Page 37 Peak Latency......Page 38 Conduction Velocity......Page 39 Lesions Proximal to the Dorsal Root ­Ganglion Result in Normal Sensory Nerve Action Potentials......Page 40 Proximal Stimulation: Normal Temporal Dispersion and Phase Cancellation......Page 42 Use Supramaximal Stimulation......Page 44 Axonal Loss......Page 45 Demyelination......Page 47 Conduction Block......Page 48 Myopathy......Page 50 Neuromuscular Junction Disorders......Page 51 4 - Late Responses......Page 53 F RESPONSE......Page 54 F Response Procedure......Page 55 The F Estimate......Page 56 H REFLEX......Page 58 AXON REFLEX......Page 61 BLINK REFLEX PROCEDURE......Page 64 PATTERNS OF ABNORMALITIES......Page 66 NORMAL NEUROMUSCULAR JUNCTION PHYSIOLOGY......Page 69 Modeling Slow Repetitive Nerve Stimulation......Page 70 REPETITIVE NERVE STIMULATION IN THE ELECTROMYOGRAPHY LABORATORY......Page 72 Exercise Testing in the Electromyography Laboratory......Page 73 Temperature Must Be Controlled......Page 74 Nerve Selection......Page 75 Decrement and Increment Calculation......Page 76 Repetitive Nerve Stimulation Protocol......Page 77 Routine Ulnar Conduction Study: Pseudo–Conduction Block Between the Wrist and Below-­Elbow Sites......Page 79 Ulnar Conduction Study: Proximal Martin-­Gruber Anastomosis and Pseudo–Conduction Block Between the Below-­Elbow and Above-­Elbo.........Page 80 Ulnar Conduction Study Recording the First Dorsal Interosseous: Pseudo-­Conduction Block Between the Wrist and Below-­Elbow Site.........Page 81 Routine Median Motor Study: Increased Compound Muscle Action Potential Amplitude Proximally......Page 83 Martin-­Gruber Anastomosis and Carpal Tunnel Syndrome: Positive Proximal Deflection (“Dip”) and Factitiously Fast Conduction Vel.........Page 84 ACCESSORY PERONEAL NERVE......Page 85 Miscellaneous Anatomic Variations......Page 86 Temperature......Page 90 Age......Page 92 Electrode Impedance and Noise......Page 93 Filters......Page 95 Stimulus Artifact......Page 96 Cathode Position: Reversing Stimulator Polarity......Page 98 Supramaximal Stimulation......Page 99 Co-­Stimulation of Adjacent Nerves......Page 100 Electrode Placement for Motor Studies......Page 102 Antidromic Versus Orthodromic Recording......Page 103 Distance Between Recording Electrodes and Nerve......Page 105 Limb Position and Distance Measurements......Page 106 Limb Position and Waveform Morphology......Page 107 Latency Measurements: Sweep Speed and Sensitivity......Page 109 9 - Basic Statistics for Electrodiagnostic Studies......Page 111 BAYES’ THEOREM AND THE PREDICTIVE VALUE OF A POSITIVE TEST......Page 114 LIKELIHOOD RATIOS......Page 116 MULTIPLE TESTS AND THE INCREASING RISK OF FALSE POSITIVES......Page 117 Key Points......Page 119 Distal Distance......Page 120 Key Points......Page 121 Key Points......Page 122 Distal Distance......Page 123 Key Points......Page 124 Key Points......Page 125 Stimulation Site......Page 126 Key Points......Page 127 Distal Distance......Page 129 Recording Sites......Page 130 Recording Site......Page 131 Stimulation Site......Page 132 Key Points......Page 133 Upper Extremity......Page 134 Craniobulbar......Page 135 Key Points......Page 136 Recording Site......Page 137 Key Points......Page 138 Key Points......Page 140 Stimulation Site......Page 141 Key Points......Page 142 Recording Site......Page 143 Key Points......Page 144 Nerve Conduction Studies of the Lower Extremity: Normal Adult Values......Page 145 EQUIPMENT......Page 146 TYPICAL NEEDLE EMG EXAMINATION (BOX 12.1)......Page 148 Cross-­Section Anatomy Key Points......Page 150 Cross-­Section Anatomy Key Points......Page 153 Cross-­Section Anatomy Key Points......Page 157 Cross-­Section Anatomy Key Points......Page 160 Cross-­Section Anatomy Key Points......Page 163 Cross-­Section Anatomy Key Points......Page 166 Cross-­Section Anatomy Key Points......Page 169 Cross-­Section Anatomy Key Points......Page 173 Cross-­Section Anatomy Key Points......Page 176 Cross-­Section Anatomy Key Points......Page 179 Cross-­Section Anatomy Key Points......Page 182 Cross-­Section Anatomy Key Points......Page 185 Cross-­Section Anatomy Key Points......Page 188 Cross-­Section Anatomy Key Points......Page 191 Cross-­Section Anatomy Key Points......Page 195 Cross-­Section Anatomy Key Points......Page 199 Cross-­Section Anatomy Key Points......Page 202 Cross-­Section Anatomy Key Points......Page 206 Cross-­Section Anatomy Key Points......Page 209 Cross-­Section Anatomy Key Points......Page 212 Cross-­Section Anatomy Key Points......Page 215 Cross-­Section Anatomy Key Points......Page 218 Cross-­Section Anatomy Key Points......Page 221 Cross-­Section Anatomy Key Points......Page 225 Cross-­Section Anatomy Key Points......Page 230 Cross-­Section Anatomy Key Points......Page 234 Cross-­Section Anatomy Key Points......Page 238 Morphology......Page 241 INSERTIONAL ACTIVITY......Page 244 SPONTANEOUS ACTIVITY: ABNORMAL MUSCLE FIBER POTENTIALS......Page 245 Positive Sharp Waves......Page 246 Complex Repetitive Discharges......Page 248 Fasciculation Potentials......Page 250 Doublets, Triplets, and Multiplets......Page 251 Myokymic Discharges......Page 252 Neuromyotonic Discharges......Page 253 Rest Tremor......Page 254 PHYSIOLOGY......Page 257 MORPHOLOGY......Page 258 Duration......Page 259 Amplitude......Page 260 STABILITY......Page 261 FIRING PATTERN (ACTIVATION, RECRUITMENT, INTERFERENCE PATTERN)......Page 262 Chronic Axonal Loss......Page 267 Acute......Page 268 Central Nervous System Disorders......Page 269 Axonal Loss Lesions......Page 272 Demyelinating Lesions......Page 273 IMPORTANT NEUROPATHIC PATTERNS......Page 274 Axonal Loss: Acute......Page 275 Demyelination (Slowing and Conduction Block): Single Proximal Lesion......Page 276 Demyelination (Slowing and Conduction Block): Single Distal Lesion......Page 277 MYOPATHIC LESIONS......Page 278 NEUROMUSCULAR JUNCTION LESIONS......Page 279 Upper Motor Neuron Lesion......Page 280 Mononeuropathy: Localizing......Page 281 Chronic Demyelinating Polyneuropathy With Secondary Axonal Changes: Uniform Slowing......Page 282 Radiculopathy......Page 283 Neuromuscular Junction: Postsynaptic Disorders......Page 284 Myopathy With Denervating Features......Page 285 Pure Motor Loss on Nerve Conduction Studies......Page 286 Localizing a Mononeuropathy by Needle EMG: Issues and Limitations......Page 287 NEUROMUSCULAR ULTRASOUND HISTORY......Page 290 BASIC PHYSICS OF ULTRASOUND......Page 291 OPTIMIZING THE IMAGE......Page 294 Tendon......Page 298 Arteries and Veins......Page 299 Skin and Subcutaneous Tissue......Page 300 Cartilage......Page 301 Anisotropy......Page 302 Posterior Acoustic Enhancement......Page 303 Reverberation Artifact......Page 304 ULTRASOUND LIMITATIONS......Page 305 18 - Neuromuscular Ultrasound of Mononeuropathies......Page 307 APPEARANCE OF NORMAL NERVE......Page 308 Measurements......Page 309 Ganglion Cysts......Page 314 Bone Fragments and Callus......Page 315 Tenosynovitis and Synovial Hypertrophy......Page 317 Tumor......Page 318 Hematomas and Blood Vessel Abnormalities......Page 321 Patterns of Muscle Denervation......Page 323 DEMYELINATING POLYNEUROPATHIES......Page 325 Charcot-­Marie-­Tooth Polyneuropathy......Page 326 Chronic Acquired Demyelinating Polyneuropathies......Page 327 Acute-­Onset Chronic Inflammatory Demyelinating Polyneuropathy......Page 328 DIABETIC POLYNEUROPATHY......Page 329 MOTOR NEURON DISEASE......Page 330 MYOPATHY......Page 331 ANATOMY......Page 335 CLINICAL......Page 337 DIFFERENTIAL DIAGNOSIS......Page 339 Nerve Conduction Studies......Page 340 Median-­Versus-­Ulnar Palm-­to-­Wrist Mixed Nerve Studies......Page 341 Median Second Lumbrical-­Versus-­Ulnar Interossei Distal Motor Latencies......Page 342 Wrist-­to-­Palm Versus Palm-­to-­Digit Sensory Conduction Velocity (Segmental Sensory Conduction Studies Across the Wrist)......Page 343 Inching Across the Wrist and Palmar Stimulation......Page 344 Electromyographic Approach......Page 347 Special Situation: EDX Studies After Carpal Tunnel Release......Page 348 ULTRASOUND CORRELATIONS......Page 349 Nonlocalizing Median Neuropathy......Page 353 Persistent Symptoms or Recurrent Symptoms After Carpal Tunnel Release Surgery......Page 354 COMMON ANOMALIES......Page 355 Ganglion Cyst......Page 356 Neuroma in Continuity......Page 357 Tumors......Page 358 Thickened Epineurium and Intraneural Scar......Page 359 DETAILED ANATOMY AT THE ANTECUBITAL FOSSA......Page 370 Ligament of Struthers Entrapment......Page 371 ANTERIOR INTEROSSEOUS NERVE SYNDROME......Page 372 Nerve Conduction Studies......Page 373 Proximal Median Nerve......Page 374 Anterior Interosseous Nerve......Page 378 ANATOMY......Page 384 CLINICAL......Page 385 DIFFERENTIAL DIAGNOSIS......Page 386 Differential Slowing: Flexed Versus Extended Elbow Conduction Techniques......Page 388 Short Segment Incremental Studies (“Inching”)......Page 391 Mixed and Sensory Nerve Conductions......Page 392 Dorsal Ulnar Cutaneous Sensory Study......Page 393 Nerve Conduction Study Pitfalls......Page 395 ULTRASOUND CORRELATIONS......Page 397 CLINICAL......Page 414 DIFFERENTIAL DIAGNOSIS......Page 416 Ulnar Motor Studies Recording the First Dorsal Interosseous......Page 417 Short Segment Incremental Studies......Page 418 Comparison of the Various Electrophysiologic Tests in Ulnar Neuropathy at the Wrist......Page 419 Electromyographic Approach......Page 420 ULTRASOUND CORRELATIONS......Page 422 ANATOMY......Page 429 Deep Branch......Page 431 Posterior Interosseous Neuropathy......Page 432 DIFFERENTIAL DIAGNOSIS......Page 433 ELECTROPHYSIOLOGIC EVALUATION......Page 434 Nerve Conduction Studies......Page 435 Anatomic Considerations of Some Radial-­Innervated Muscles on Needle EMG......Page 437 ULTRASOUND CORRELATIONS......Page 438 ANATOMY......Page 453 Peroneal Neuropathy at the Fibular Neck......Page 455 ETIOLOGY......Page 456 Nerve Conduction Studies......Page 457 Electromyographic Approach......Page 458 ULTRASOUND CORRELATIONS......Page 460 CLINICAL......Page 471 DIFFERENTIAL DIAGNOSIS......Page 472 Nerve Conduction Studies......Page 473 ULTRASOUND CORRELATIONS......Page 474 CLINICAL......Page 480 Nerve Conduction Studies......Page 481 Electromyographic Approach......Page 482 ULTRASOUND CORRELATIONS......Page 483 Trigeminal Nerve......Page 490 Facial Neuropathy......Page 492 Trigeminal Neuropathy......Page 493 Nerve Conduction Studies......Page 494 Nerve Conduction Studies and Blink Reflex......Page 495 Electromyographic Approach......Page 496 CLINICAL......Page 502 Key Question No. 2: Which Fiber Types Are Involved (Motor, Large Sensory, Small Sensory, Autonomic)?......Page 503 Key Question No. 5: Is There a Family History of Polyneuropathy?......Page 505 Special Situations in Axonal Polyneuropathy: The Use of the Sural/Radial Amplitude Ratio in Mild Polyneuropathy......Page 507 Diabetes......Page 508 DEMYELINATING POLYNEUROPATHY......Page 509 Guillain-­Barré Syndrome (GBS)......Page 510 Electrophysiology......Page 511 Charcot-­Marie-­Tooth Neuropathy......Page 512 Electrophysiology......Page 513 Prognosis......Page 514 Electrophysiology......Page 515 Nerve Conduction Studies......Page 516 Electromyographic Approach......Page 517 ULTRASOUND CORRELATIONS......Page 518 Classic Amyotrophic Lateral Sclerosis......Page 537 Primary Lateral Sclerosis......Page 538 Cervical/Lumbar Stenosis......Page 539 Inclusion Body Myositis......Page 540 Mimics of Primary Lateral Sclerosis......Page 541 Nerve Conduction Studies......Page 542 Electromyographic Approach......Page 545 ULTRASOUND CORRELATIONS......Page 546 31 - Atypical and Inherited Motor ­Neuron Disorders......Page 552 Paralytic Poliomyelitis and Postpolio Syndrome......Page 553 Retrovirus-­Associated Motor Neuron Disorders......Page 554 X-­Linked Bulbospinal Muscular Atrophy (Kennedy Disease)......Page 555 Adult-­Onset Hexosaminidase A Deficiency (Late-­Onset Tay-­Sachs Disease)......Page 556 Monomelic Amyotrophy......Page 557 Delayed Radiation-­Induced Motor Neuron Syndrome......Page 559 Nerve Conduction Studies......Page 560 Electromyographic Approach......Page 561 ETIOLOGY......Page 569 Nerve Conduction Studies......Page 570 Superficial Peroneal SNAP and L5 Radiculopathy: The Rare Exception......Page 573 Electromyographic Approach......Page 574 TIME COURSE IN RADICULOPATHY......Page 576 ABERRANT REINNERVATION AND THE “BREATHING ARM”......Page 577 It May Be Difficult to Localize a Radiculopathy to a Single Root Level......Page 578 If the Sensory Nerve Root Is Predominantly Affected, the Electromyographic Study Will Be Normal......Page 579 Abnormal Paraspinal Muscles Are Useful in Identifying a Radiculopathy but Not the Segmental Level of the Lesion......Page 581 There May Be Few or No Electromyographic Abnormalities in Spinal Stenosis......Page 582 Fibrillation Potentials in the Paraspinal Muscles Do Not Necessarily Imply Radiculopathy......Page 583 ANATOMY......Page 589 CLINICAL......Page 590 Lateral Cord Plexopathy......Page 591 Neuralgic Amyotrophy......Page 592 Postoperative Brachial Plexopathy......Page 593 Thoracic Outlet Syndrome......Page 594 Nerve Conduction Studies......Page 595 Electromyographic Approach......Page 598 Neurogenic Thoracic Outlet Syndrome......Page 599 Neuralgic Amyotrophy......Page 600 Brachial Plexopathy......Page 602 Neuralgic Amyotrophy......Page 607 Clinical......Page 618 Clinical......Page 621 Electrodiagnosis......Page 622 Electrodiagnosis......Page 623 Electrodiagnosis......Page 624 Clinical......Page 625 Electrodiagnosis......Page 626 ULTRASOUND CORRELATIONS......Page 627 Special Considerations: Musculocutaneous, Suprascapular, and Spinal Accessory Nerves......Page 628 Obturator Nerve......Page 634 CLINICAL......Page 635 Retroperitoneal Hemorrhage......Page 636 Postpartum Plexopathy......Page 639 Diabetic Amyotrophy......Page 640 Electrophysiologic Evaluation......Page 641 Nerve Conduction Studies......Page 642 Electromyographic Approach......Page 643 ULTRASOUND CORRELATIONS......Page 644 CLINICAL......Page 653 ETIOLOGY......Page 655 Piriformis Syndrome......Page 656 Nerve Conduction Studies......Page 657 Special Studies on Suspected Piriformis Syndrome......Page 658 Electromyographic Approach......Page 659 ULTRASOUND CORRELATIONS......Page 660 Example: Sciatic Neuropathy Secondary to a Bone Fragment......Page 661 MYASTHENIA GRAVIS......Page 666 Clinical......Page 667 Nerve Conduction Studies......Page 668 Repetitive Nerve Stimulation......Page 669 Single-­Fiber Electromyography......Page 670 Clinical......Page 673 Electrophysiologic Evaluation......Page 674 Clinical......Page 675 CONGENITAL MYASTHENIC SYNDROMES......Page 676 38 - Myopathy......Page 687 CLINICAL......Page 688 Nerve Conduction Studies......Page 689 Spontaneous Activity in Myopathies......Page 690 Motor Unit Action Potential Analysis in Myopathies......Page 691 Polymyositis and Dermatomyositis......Page 693 Inclusion Body Myositis......Page 694 Late-­Onset Acid Maltase Deficiency (Pompe Disease)......Page 695 ULTRASOUND CORRELATIONS......Page 696 39 - Myotonic Muscle Disorders and Periodic Paralysis Syndromes......Page 705 Prolonged Exercise Test......Page 706 Myotonic Dystrophy......Page 708 Clinical......Page 709 Electrophysiologic Evaluation......Page 711 Electrophysiologic Evaluation......Page 712 Electrophysiologic Examination......Page 713 Paramyotonia Congenita......Page 714 Clinical......Page 715 Clinical......Page 716 Electrophysiologic Examination......Page 717 OTHER CONDITIONS ASSOCIATED WITH MYOTONIA AND PERIODIC PARALYSIS......Page 718 DIFFERENTIAL DIAGNOSIS OF NEUROLOGIC WEAKNESS IN THE ICU......Page 725 ELECTRODIAGNOSTIC STUDIES IN THE ICU: TECHNICAL ISSUES......Page 727 Low or Absent Motor Responses With Normal Sensory Responses......Page 729 Decreased Activation......Page 731 NERVE CONDUCTION AND ELECTROMYOGRAPHIC PROTOCOL IN THE INTENSIVE CARE UNIT......Page 732 ULTRASOUND CORRELATIONS......Page 733 MATURATION ISSUES......Page 741 TECHNICAL ISSUES......Page 743 APPROACH TO THE CHILD AS A PATIENT......Page 744 ULTRASOUND CORRELATIONS......Page 746 BASICS OF ELECTRICITY......Page 749 Ohm’s Law......Page 750 Kirchhoff’s Laws......Page 751 Resistors in Parallel......Page 752 Direct Current and Alternating Current......Page 753 Capacitance......Page 754 Inductance......Page 756 WAVEFORMS, FREQUENCY ANALYSIS, AND FILTERING......Page 757 Low-­Frequency (High-­Pass) Filters......Page 758 High-­Frequency (Low-­Pass) Filters......Page 759 PRACTICAL IMPLICATIONS FOR ELECTRODIAGNOSTIC STUDIES......Page 760 ELECTRICAL ISSUES......Page 763 Central Lines and Electrical Wires......Page 765 Implanted Pacemakers and Cardioverter-­Defibrillators......Page 766 PNEUMOTHORAX......Page 767 BLEEDING......Page 768 Coexistent Medical Conditions......Page 769 Needle Electromyography and Patients at Risk of Bleeding......Page 770 INFECTION......Page 771 ULTRASOUND CORRELATIONS......Page 772 SUMMARY......Page 773 Palmar Mixed Nerve Studies......Page 775 Phrenic Motor Studya......Page 776 Motor Studies......Page 777 Late Responsesa......Page 778 Mean Motor Unit Action Potential Duration Based on Age and Muscle Group......Page 779 Pediatric Normalsa......Page 780 Successfully correlate electrodiagnostic findings and neuromuscular ultrasound with key clinical findings with Electromyography and Neuromuscular Disorders, 4th Edition. This popular text is the go-to resource for clinicians at all levels of experience who have an interest in neuromuscular medicine, including those studying for the AANEM board exam. An easy-to-read writing style, abundant case studies, and learning features online help you master the electrodiagnostic evaluation and improve safety and accuracy. Helps you diagnose neuromuscular disorders more quickly and accurately, and correlate electromyographic and clinical findings. Explains complex subject matter in an easy-to-understand, user-friendly manner. Includes dozens of detailed, cross-sectional anatomy drawings to ensure correct EMG needle placement and avoid neurovascular injuries. Features new chapters on Neuromuscular Ultrasound, as well as incorporating neuromuscular ultrasound in the evaluation of clinical neuromuscular disorders along with electrodiagnostic studies in many of the clinical chapters. Provides up-to-date information on iatrogenic complications of electrodiagnostic studies and newly defined genetic neuromuscular conditions. Includes online access to more than 70 videos that allow you to see and hear the EMG waveforms discussed in the text, as well as a convenient "Test Your Knowledge" module. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices