Electrodiagnostic Testing (EMG, NCV)
There are two kinds of electromyography (EMG) in widespread use: surface EMG and needle (intramuscular) EMG. To perform intramuscular EMG, a needle electrode is inserted through the skin into the muscle tissue. A trained professional (most often a physiatrist, neurologist, physical therapist, or chiropractor) observes the electrical activity while inserting the electrode. The insertional activity provides valuable information about the state of the muscle and its innervating nerve. Normal muscles at rest make certain, normal electrical sounds when the needle is inserted into them. Then the electrical activity when the muscle is at rest is studied. Abnormal spontaneous activity might indicate some nerve and/or muscle damage. Then the patient is asked to contract the muscle smoothly. The shape, size and frequency of the resulting motor unit potentials is judged. Then the electrode is retracted a few millimeters, and again the activity is analyzed until at least 10-20 units have been collected. Each electrode track gives only a very local picture of the activity of the whole muscle. Because skeletal muscles differ in the inner structure, the electrode has to be placed at various locations to obtain an accurate study.
A motor unit is defined as one motor neuron and all of the muscle fibers it innervates. When a motor unit fires, the impulse (called an action potential) is carried down the motor neuron to the muscle. The area where the nerve contacts the muscle is called the neuromuscular junction, or the motor end plate. After the action potential is transmitted across the neuromuscular junction, an action potential is elicited in all of the innervated muscle fibers of that particular motor unit. The sum of all this electrical activity is known as a motor unit action potential (MUAP). This electrophysiologic activity from multiple motor units is the signal typically evaluated during an EMG. The composition of the motor unit, the number of muscle fibres per motor unit, the metabolic type of muscle fibres and many other factors affect the shape of the motor unit potentials in the myogram.
Nerve conduction testing (NCV) is also often done at the same time as an EMG in order to diagnose neurological diseases. A light shock is used to stimulate the nerve to conduct an impulse that is then measured to determine how long it takes to reach the target, as well as whether the nerve conducted the impulse normally. Patients will usually find the procedure mildly or moderately painful while others experience only a small amount of discomfort when the needle is inserted. The muscle or muscles being tested may be slightly sore for a day or two after the procedure. Otherwise the testing is considered to be a very low risk procedure.