Appendix

NERVE CONDUCTION STUDIES: NORMAL ADULT VALUES

UPPER EXTREMITY STUDIES
Motor Studies
Amplitude Conduction Distal Distal
Nerve Record (mV) Velocity (mls) Latency (ms) Distance (cm)

Median Abductor pollicis brevis ~4.O ~49 ~4.4 7

Ulnar Abductor digiti minimi ~6.0 ~49 ~3.3 7
Ulnar First dorsal interosseous ~7.0 ~49 ~4.5 8-12'
Radial Extensor indicis proprius ~2.0 ~49 ~2.9 4-6

oDistance measured with calipers

Antidromic Sensory Studies

Amplitude Conduction Distal Peak Distal
Nerve Record (!IV) Velocity (mls) Latency (ms) Distance (cm)

Median Digit 2 ~20 ~50 ~3.5 13

Ulnar' Digit 5 ~17 ~50 ~3.1 11
Radial Snuffbox ~15 ~50 ~2.9 10
Dorsal ulnar cutaneous t Dorsal D4-D5 webspace ~8 ~50 ~2.5 8
Lateral antebrachial cutaneous t Lateral forearm ~1O ~55 ~3.0 12
Medial antebrachial cutaneous t Medial forearm ~5 ~50 ~3,2 12

In adults older than 60 years, many consider ulnar antidromic sensory amplitudes >10 JlV as normal.
tIn these less commonly performed studies, side- to-side comparisons, especially of amplitude, often are more useful than normal value tables, especially
when symptoms and signs are limited to one side.

Palmar Mixed Nerve Studies

Amplitude Conduction Distal Peak Distance
Nerve (/LV) Velocity (mls) Latency (ms) (cm)

Median mixed ~50 ~50 ~2.2 8

Ulnar mixed ~12 ~50 ~2.2 8

663
664 Appendix

F Responses Major Upper Extremity Motor Latencies from Erb's

Point Stimulation
Nerve Minimum F Latency (ms)
Latency Distance
Median ~31 (ms) (em)
Nerve Muscle
Ulnar ~32
Axillary' Deltoid ~4.9 15-21
'For tall or short patients, F responses must be normalized for height (see
Musculocutaneous' Biceps ~5.7 23-29
Chapter 4).
Suprascapular Supraspinatus ~3.7 7-12
Suprascapular Infraspinatus ~4.3 10--15

Distances measured with calipers.

Median-Ulnar Internal Comparison Studies
Significant Latency
Study'
Median mixed: palm to wrist
Ulnar mixed: palm to wrist
'The axillary and musculocutaneous neIVes can also be stimulated in
the axilla, with typical distal motor latencies 53.3 ms. Both axillary and
Erb's point stimulations often are technically difficult. In patients with
symptoms limited to one side, comparing both latencies and amplitudes
Difference! (ms) side to side is always preferable to using normal value tables.
Source: From GH Kraft. Axillary, musculocutaneous, and suprascapular
nelVe latency studies. Arch Phys Med RehabtlI972;53:382-387, and DP
Currier. Motor conduction velocity of axillary nerve. Phys Ther
~0.4
1971:51:503-509.

Median motor: wrist to second lumbrical

Ulnar motor: wrist to interossei ~0.5

Median sensory: wrist to digit 4

Phrenic Motor Study
Ulnar sensory: wrist to digit 4 ~0.5
Amplitude Distal
'For each paired study, identical distances are used for hoth the median (mV) Latency (ms)
Nerve Record
and ulnar study.
'Values that exceed these cutoffs imply focal slowing and are useful in Phrenic Diaphragm 597 139 !tV 6.3 0.8
electrodiagnosis of median neuropathy across the carpal tunnel and ulnar
neuropathy across Guyon's canal. >320 !tV <8.0

Source: From ON Markand, Kincaid IC, Pourmand RA, et al.

Electrophysiologic evaluation of diaphragm by transcutaneous phrenic
nelVe stimulation. Neurology 1984:34:606-614.

Median-Palmar Stimulation Studies

Significant
Palm-to- Wrist CRANIOBULBARSTUDIES
Study Amplitude Ratio
Motor Studies
Median motor: wrist to abductor
Amplitude Distal
pollicis brevis
Nerve Record (mV) Latency (ms)
Median motor: palm to abductor > 1.2
pollicis brevis Facial Nasalis ~1.0 ~4.2
Facial Orbicularis oculi ~1.0 ~3.1
Median sensory: wrist to digit 2
Median sensory: palm to digit 2 > 1.6

Values that exceed these cutoffs imply some element of conduction

block of the median nelVe across the carpal tunnel.
Blink Reflex Studies
Latency Side-to-Side Latency
Response (ms) Difference (ms)

R1 (ipsilateral) ~13 ~1.2

R2 (ipsilateral) ~41 ~5
R2 (contralateral) ~44 ~7
 Appendix 665

LOWER EXTREMITY STUDIES

Motor Studies
Amplitude Conduction Distal Distal
Nerve Record (mV) Velocity (mls) Latency (ms) Distance (cm)

Peroneal Extensor digitorum brevis 2:2.0 2:44 $6.5 9

Peroneal Tibialis anterior 2:5.0 2:44 $6.7 5-10
Tibial Abductor hallucis brevis 2:4.0 2:41 $5.8 9
Tibial Abductor digit quinti pedis 2:3.0 2:41 $6.3 10"

oDistance measured with calipers.

Antidromic Sensory Studies

Amplitude Conduction Distal Peak Distal
Nerve Record (JIV) Velocity (mls) Latency (ms) Distance (cm)

Sural Posterior ankle 2:6 2:40 $4.4 14

Superficial peroneal Lateral ankle 2:6 2:40 $4.4 14
Saphenous" Medial ankle 2:4 2:40 $4.4 14
Medial plantar" Medial ankle 2:2 2:35 Variable
Lateral plantar" Medial ankle 2:1 2:35 Variable
In some normal individuals without symptoms, especially those older than age 40 years, these responses may be very small, requiring electronic averag
ing, or may be absent. Thus, a low amplitude or absent potential should not necessarily be interpreted as abnormal. Side-ta-side comparisons often are
usefulin this regard.

Plantar Mixed Nerve Studies

Amplitude Conduction Distal Peak Distance
Nerve (JIV) Velocity (mls) Latency (ms) (cm)

Medial plantar" 2:3 2:45 $3.7 14

Lateral plantar" 2:3 2:45 $3.7 14

"In somenormalindividuals\vithoutsymptoms,especiallythoseolder than age 40 years,these responsesmaybe verysmall,requiringelectronicaverag-

ing, or may be absent. Thus, a low amplitude or absent potential should not necessarily be interpreted as abnormal. Side-ta-side comparisons often are use-
fulin this regard.

Late Responses'
Minimum Minimum
Nerve F Latency (ms) H Latency (ms)

Peroneal $56 N/A

Tibial $56 $34

"For tallor shortpatients,F responsesand H reflexesmustbe normalizedfor height(seeChapter 4).

NOTES:

1. All values above assume normal controlled temperature
and standard distances.
2. All motor and sensory amplitudes are measured from
baseline to negative peak.
3. All sensory and mixed neIVe distal latencies are peak
latencies. However, all sensory and mixed-neIVe conduc-
tion velocities are calculated based on the onset latency.
4. Some values may need to be adjusted for extremes of
height or age (see Chapter 8).
5. Comparison between the affected and unaffected limb
often is very useful and may be more useful than nor-
mal value tables.
6. This is one set of normal values; others exist. Ideally, each
laboratory should develop its own set of normal values.
666 Appendix

NERVE CONDUCTION STUDIES: NORMAL PEDIATRIC VALUES

Motor Studies
Median Nerve Peroneal Nerve

Age DML(ms) CV(mls) F(ms) AMP (mV) DML(ms) CV(mls) F(ms) AMP (mV)

7 days-I month 2.23 (0.29)" 25.43 (3.84) 16.12 (1.5) 3.00 (0.31) 2.43 (0.48) 22.43 (1.22) 22.07 (1.46) 3.06 (1.26)
1-6 months 2.21 (0.34) 34.35 (6.61) 16.89 (1.65) 7.37 (3.24) 2.25 (0.48) 35.18 (3.96) 23.11 (1.89) 5.23 (2.37)
6-12 months 2.13 (0.19) 43.57 (4.78) 17.31 (1. 77) 7.67 (4.45) 2.31 (0.62) 43.55 (3.77) 25.86 (1.35) 5.41 (2.01)
1-2 years 2.04 (0.18) 48.23 (4.58) 17.44 (1.29) 8.90 (3.61) 2.29 (0.43) 51.42 (3.02) 25.98 (1.95) 5.80 (2.48)
2-4 years 2.18 (0.43) 53.59 (5.29) 17.91 (1.11) 9.55 (4.34) 2.62 (0.75) 55.73 (4.45) 29.52 (2.15) 6.10 (2.99)
4-6 years 2.27 (0.45) 56.26 (4.61) 19.44 (1.51) 10.37 (3.66) 3.01 (0.43) 56.14 (4.96) 29.98 (2.68) 7.10 (4.76)
6-14 years 2.73 (0.44) 57.32 (3.35) 23.23 (2.57) 12.37 (4.79) 3.25 (0.51) 57.05 (4.54) 34.27 (4.29) 8.15 (4.19)

"All values are reported as mean (standard deviatiou).

AMP, amplitude; CV, conduction velocity; DML, distal motor latency; F, F latency.
Source: Parano E, Uncini A, DeVivo DC, et a1.Electrophysiologic correlates of peripheral nervous system maturation in infancy and childhood. J Child
NeuroI1993;8:336-338.

Antidromic Sensory Studies

Median Nerve Sural Nerve

Age CV (mls) Amp (ILV) CV(mls) Amp (ILV)

7 days-l month 22.31 (2.16)" 6.22 (1.30) 20.26 (1.55) 9.12 (3.02)
1-6 month 35.52 (6.59) 15.86 (5.18) 34.63 (5.43) 11.66 (3.57)
612 month 40.31 (5.23) 16.00 (5.18) 38.18 (5.00) 15.10 (8.22)
1-2 years 46.93 (5.03) 24.00 (7.36) 49.73 (5.53) 15.41 (9.98)
2-4 years 49.51 (3.34) 24.28 (5.49) 52.63 (2.96) 23.27 (6.84)
4-6 years 51.71 (5.16) 25.12 (5.22) 53.83 (4.34) 22.66 (5.42)
6-14 years 53.84 (3.26) 26.72 (9.43) 53.85 (4.19) 26.75 (6.59)

~All values are reported as mean (standard deviation).

AMP, amplitude; CV, conduction velocity.
From Parano E, Uncini A, DeVivo DC, et a1. Electrophysiologic correlates of peripheral nervous system maturation in infancy and childhood. J Child
NeuroI1993;8:336-338.