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Electromyography

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Electromyography

Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph to produce a record called an electromyogram. An electromyograph detects the electric potential generated by muscle cells when these cells are electrically or neurologically activated. The signals can be analyzed to detect abnormalities, activation level, or recruitment order, or to analyze the biomechanics of human or animal movement. Needle EMG is an electrodiagnostic medicine technique commonly used by neurologists. Surface EMG is a non-medical procedure used to assess muscle activation by several professionals, including physiotherapists, kinesiologists and biomedical engineers. In computer science, EMG is also used as middleware in gesture recognition towards allowing the input of physical action to a computer as a form of human-computer interaction.

EMG testing has a variety of clinical and biomedical applications. Needle EMG is used as a diagnostics tool for identifying neuromuscular diseases, or as a research tool for studying kinesiology, and disorders of motor control. EMG signals are sometimes used to guide botulinum toxin or phenol injections into muscles. Surface EMG is used for functional diagnosis and during instrumental motion analysis. EMG signals are also used as a control signal for prosthetic devices such as prosthetic hands, arms and lower limbs.[citation needed]

An acceleromyograph may be used for neuromuscular monitoring in general anesthesia with neuromuscular-blocking drugs, in order to avoid postoperative residual curarization.

Except in the case of some purely primary myopathic conditions EMG is usually performed with another electrodiagnostic medicine test that measures the conducting function of nerves. This is called nerve conduction study (NCS). Needle EMG and NCSs are typically indicated when there is pain in the limbs, weakness from spinal nerve compression, or concern about some other neurologic injury or disorder. Spinal nerve injury does not cause neck, mid back pain or low back pain, and for this reason, evidence has not shown EMG or NCS to be helpful in diagnosing causes of axial lumbar pain, thoracic pain, or cervical spine pain. Needle EMG may aid with the diagnosis of nerve compression or injury (such as carpal tunnel syndrome), nerve root injury (such as sciatica), and with other problems of the muscles or nerves. Less common medical conditions include amyotrophic lateral sclerosis, myasthenia gravis, and muscular dystrophy.[citation needed]

The first step before insertion of the needle electrode is skin preparation. This typically involves simply cleaning the skin with an alcohol pad.[citation needed]

The actual placement of the needle electrode can be difficult and depends on a number of factors, such as specific muscle selection and the size of that muscle. Proper needle EMG placement is very important for accurate representation of the muscle of interest, although EMG is more effective on superficial muscles as it is unable to bypass the action potentials of superficial muscles and detect deeper muscles. Also, the more body fat an individual has, the weaker the EMG signal. When placing the EMG sensor, the ideal location is at the belly of the muscle: the longitudinal midline. The belly of the muscle can also be thought of as in-between the motor point (middle) of the muscle and the tendonus insertion point.[citation needed]

Cardiac pacemakers and implanted cardiac defibrillators (ICDs) are used increasingly in clinical practice, and no evidence exists indicating that performing routine electrodiagnostic studies on patients with these devices pose a safety hazard. However, there are theoretical concerns that electrical impulses of nerve conduction studies (NCS) could be erroneously sensed by devices and result in unintended inhibition or triggering of output or reprogramming of the device. In general, the closer the stimulation site is to the pacemaker and pacing leads, the greater the chance for inducing a voltage of sufficient amplitude to inhibit the pacemaker. Despite such concerns, no immediate or delayed adverse effects have been reported with routine NCS.[citation needed]

No known contraindications exist for performing needle EMG or NCS on pregnant patients. Additionally, no complications from these procedures have been reported in the literature. Evoked potential testing, likewise, has not been reported to cause any problems when it is performed during pregnancy.

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