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What is an electromyogram?
An electromyogram (EMG) is a test that is used to record the electrical activity of muscles. When muscles are active, they produce an electrical current. This current is usually proportional to the level of the muscle activity. An EMG is also referred to as a myogram.
EMGs can be used to detect abnormal electrical activity of muscle that can occur in many diseases and conditions, including muscular dystrophy, inflammation of muscles, pinched nerves, peripheral nerve damage (damage to nerves in the arms and legs), amyotrophic lateral sclerosis (ALS), myasthenia gravis, disc herniation, and others.
Why is an EMG test done?
An EMG is often performed when patients have unexplained muscle weakness. The EMG helps to distinguish between muscle conditions in which the problem begins in the muscle and muscle weakness due to nerve disorders. The EMG can also be used to detect true weakness, as opposed to weakness from reduced use because of pain or lack of motivation. EMGs can also be used to isolate the level of nerve irritation or injury.
How is an intramuscular EMG done?
A needle is inserted through the skin into the muscle. The electrical activity is detected by this needle (which serves as an electrode). The activity is displayed visually on an oscilloscope and may also be detected audibly with a speaker.
Since skeletal muscles are often large, several needle electrodes may need to be placed at various locations to obtain an informative EMG.
After placement of the electrode(s), the patient may be asked to contract the muscle (for example, to bend the leg).
The presence, size, and shape of the wave form (the action potential) produced on the oscilloscope provide information about the ability of the muscle to respond to nervous stimulation. Each muscle fiber that contracts produces an action potential. The size of the muscle fiber affects the rate (how frequently an action potential occurs) and the size (the amplitude) of the action potential.
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How do you prepare for an intramuscular EMG?
For adults, no special preparation is needed. For infants and children, the physical and psychological preparation depends on the child's age, behavior, and prior experience. (For instance, has the child been traumatized by another medical or dental procedure?)
Does an EMG hurt?
Yes. There is some discomfort at the time the needle electrodes are inserted. They feel like shots (intramuscular injections), although nothing is injected during an EMG. Afterwards, the muscle may feel a little sore for up to a few days.
What other test is done during an intramuscular EMG?
A nerve conduction velocity (NCV) test is often done at the same time as an EMG. In this test, the nerve is electrically stimulated while a second electrode detects the electrical impulse 'down-stream' from the first. This is usually done with surface patch electrodes (they are similar to those used for an electrocardiogram) that are placed on the skin over the nerve at various locations. One electrode stimulates the nerve with a very mild electrical impulse. The resulting electrical activity is recorded by the other electrodes. The distance between electrodes and the time it takes for electrical impulses to travel between electrodes are used to calculate the speed of impulse transmission (nerve conduction velocity). A decreased speed of transmission indicates nerve disease.
The NCV test can be used to detect true nerve disorders (such as neuropathy) or conditions whereby muscles are affected by nerve injury (such as carpal tunnel syndrome). Normal body temperature must be maintained for the NCV test, because low body temperatures slow nerve conduction.
Previous contributing authors and editors: Medical Author: Frederick Hecht, MD, FAAP, FACMG
Medical Editor: Barbara K. Hecht, Ph.D.
Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery
"Electromyography." Institutes of Health. Updated July 27, 2014.
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"Electromyography." Institutes of Health. Updated July 27, 2014.
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Amyotrophic Lateral SclerosisAmyotrophic lateral sclerosis (ALS, Lou Gehrig's disease) is a neurological disease that progresses rapidly. The disease attacks the nerve cells responsible for the control of voluntary muscles. Early symptoms include cramping, twitching, or stiffness of the muscles; slurred nasal speech; difficulty swallowing or chewing, and muscle weakness in an arm or leg. Currently, the cause of ALS is not known. ALS is a fatal disease. No cure has been found for ALS, however, the drug riluzole (Rilutek) is FDA approved, and this drug reduces the damage to motor neurons by decreasing the release of glutamate.
Carpal Tunnel SyndromeCarpal tunnel syndrome is a condition in which irritation of the wrist's median nerve causes tingling and numbness of the thumb, index, and the middle fingers. Treatment of carpal tunnel syndrome depends on the severity of the symptoms and the nature of any disease that might be causing the symptoms.
Carpal Tunnel QuizWho is more affected by carpal tunnel syndrome: Men or women? Take the Carpal Tunnel Quiz to learn the causes, symptoms, and treatments for this common hand condition.
DystoniaDystonia disorders cause involuntary movements and prolonged muscle contraction, resulting in twisting body motions, tremor, and abnormal posture. There are many forms of dystonia. Some types of dystonia respond to dopamine, or can be controlled with dedative-type medications, or surgery.
Low Back PainThere are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Minimally Invasive Lumbar Spinal FusionLower back pain is one of the most common reasons for a visit to the doctor. Lumbar spinal fusion is a surgery where the goal is to have two or more vertebrae fuse together solidly. Minimally invasive spinal fusion is an operation similar to lumbar spinal fusion, however, it a less invasive procedure. There are advantages and disadvantages of the minimally invasive spinal fusion operation.
Myasthenia GravisMyasthenia gravis, a chronic autoimmune neuromuscular disease. Varying degrees of weakness of the voluntary muscles of the body are the main characteristics. A defect in the transmission of nerve impulses ot the muscles is the cause of myasthenia gravis. Symptoms include weakness of th eye muscles, facial expression, and difficulty swallowing. Treatment of myasthenia gravis are medical therapies to control the symptoms of the disease.
Nerve Conduction Velocity TestA nerve conduction velocity test is an electrical test that detects nerve injury in conditions such as:
- peripheral neuropathy,
- mononeuritis multiplex, and
- compression injuries such as carpal tunnel syndrome and compression neuropathy.
Peripheral NeuropathyPeripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
PolymyositisPolymyositis is a disease of the muscle featuring inflammation of the muscle fibers. It results in weakness of the muscles which can be severe and when associated with skin rash, is referred to as dermatomyositis. Although the cause of this disease is unknown, diagnosis includes physical examination of muscle strength, blood tests for muscle enzymes, electrical tests of muscle and nerves, and conformation by a muscle biopsy. Treatment of polymyositis and dermatomyositis includes high doses of cortisone-related medications, immune suppression, and physical therapy.
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Urodynamic TestingUrodynamic testing evaluates the ability of the urethra, sphincters, and bladder to hold and expel urine. The following are urodynamic tests: electromyography, pressure flow study, cystometric testing, uroflowmetry, postvoid residual measurement, leak point pressure measurement, and video urodynamic tests.