Академический Документы
Профессиональный Документы
Культура Документы
Introduction
Active
Uses of EMG
Source generators
Source
Motor neuron Terminal axon NMj Muscle fiber Multiple muscle fiber
Insertional activity
Brief burst for several milliseconds Important for confirmation Increased when
Last
Spontaneous activity
Miniature end plate potential Muscle fiber Multiple muscle fiber Motor unit
Morphology
Spontaneous activity
Stability
Firing charecteristics
Morphology
Spontaneous activity
Stability
Stable unstable
Firing charecteristics
NORMAL ACTIVITY
Miniature end plate potentials Result from spontaneous exocytosis of AcH across NMJ Low amplitude, monophasic, negative potential Irregular at 20-40 Hz Seashell sound
Nerve potentials or muscle fiber action potential (MFAP) due to irritation of terminal nerve leading MFAP Biphasic (triphasic) with initial negative deflection Duration 1-5 ms with low amplitude Irregular at 50 Hz
ABNORMAL ACTIVITY
Fibrillation potential
Extracellular record of single muscle fiber Spontaneous depolarization of muscle fiber Marker of active denervation Duration- 1-5ms Low amplitude- 10-100V (chronic <10V) Regular at 0.5- 10 Hz Sounds like rain on roof Differentiate from end plate spikes
Due to mechanical deformation of muscle fiber and membrane inexcitability. Long duration Amplitude 10-100V Regular at 0.5-10 Hz Sound like dull pop
0- none present +1 - persistent single trains of potential in at least 2 areas +2 - moderate potential in 3 or more areas +3 - many potential in all areas +4 full interference pattern of potential +4 seen in nerve lacerations, vasculitis where all fibers denervate simultaneously
Depolarization of single muscle fiber followed by spread to adjacent denervated muscle fiber i.e. muscle membrane to membrane High frequency 20-150 Hz Perfectly repetitive in nature Machine like sound Common in myopathies along with denervation
Myotonic discharge
Firing rate is 20-150 Hz Waxing and waning of both amplitude and frequency Positive wave or brief spike morphology Revving engine sound Common in myopathies
Differentiate from positive wave and fibrillation potential
Fasciculation potentials
Single, spontaneous, involuntary discharge of individual motor unit Fire slow and irregularly at1-2 Hz Generated from motor neuron or axon Corn popping sound Complex and large in case of reinnervation
MUAP fire in group of two, three or multiples Seen with fibrillation potential Seen in neuropathic conditions, spasms
Myokymic discharge
Grouped, repetitive, rhythmic discharge of same motor unit Firing at 5-60 Hz Due to spontaneous depolarisation along the demylinated segments of nerve Common in radiation injuries (plexopathies), brainstem lesions (MS)
Cramps
Painful, involuntary contraction of muscle Repetitive and irregular firing at 40-75 Hz Associated with benign conditions, neuropathic, metabolic, endocrinologic conditions.
Neuromyotonic discharges
Decrementing, repetitive discharge of single motor unit High frequency- 150-250 Hz Pinging sound Generated by peripheral motor axons
Differentiate from myotonia
Tremors
1. 2. 3. 4. 5.
Extracellular compound potential of the muscle fiber of motor unit Size principle Size of axon Thickness of myelin sheath Conduction velocity of axon Threshold to depolarization Type of muscle fiber
Morphology
MUAP showes normal variability MUAP duration is shorter in proximal muscles Larger in adults Loss of 1% year after third decade
Duration
Time for initial deflection from baseline to final return to baseline. Between 5-15 ms Indicate number of muscle fibers in motor unit and dispersion of their depolarization varies directly with age Inversely with temperature Long duration- dull and thuddy Short duration- crisp like
Polyphasia
Measure of synchrony 5-10% normal (deltoid 25%) High frequency clicking sound Serrations indicate less synchronus firing
Satellite potential
Linked or parasite potential Seen in early reinnervation Small, unmylinated Collateral sprouts having slow conduction time and increased distance After reinnervation it becomes phase of main complex
Amplitude
1.
2.
3.
4.
Greater than 100 V Reflect fibers nearest to the needle (2-12) Factors influencing amplitude Proximity of needle Increased number of muscle fiber Increased diameter synchronisation
Major spike
Largest positive to negative component of MUAP Affected by surrounding tissue MUAP parameter should measured only when needle is very close to motor unit
Stability
MUAPs are usually are stable Unstable MUAP result in NMJ disorder Change in amplitude and number of phases During reinnervation unstable MUAPs are formed due to newly matured, imature NMJ
Firing pattern
Interference pattern
Early recruitment
Due to drop out of muscle fiber from motor unit Motor units become small generating lesser force Hence many motor units fire to generate smaller force.
Neuropathic disorder
Spontaneous activity Acute axonal Chronic axonal N Fibr potn + wave
MUAP morphology Duration Amplitude Phases MUAP interference Activation Recruitment
N N N N
N N N N
N N N N
N N N N N
N N
Myopathic disorders
Spontaneous activity Acute N Fibr potn myotonia N Fibr potn CRD N Fibr potn CRD MUAP morphology
Duration Amplitude Phases
MUAP interference
Activation Recruitment
N/ early
Chronic
N/ early
End stage
NMJ disordes
Spontaneous activity Increased N jitter Fibr potn Intermitt + waves ant block Severe block N MUAP morphology
Duration Amplitude Phases
MUAP interference
Activation Recruitment
N N/ U
N N/ U
N N/ early
N/ U N
Thank you!