Nerve Conduction Studies from A to Z TABLE
OF CONTENTS
Self-Study
Training for the EDT
TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS.............................................................................................................. vii
RESOURCES................................................................................................................................. viii
LIST OF FIGURES......................................................................................................................... ix
INTRODUCTION........................................................................................................................... 1
Scope................................................................................................................................... 1
Systematic Approach to Training............................................................................................ 2
Using the Manual................................................................................................................... 3
The Authors.......................................................................................................................... 3
BASIC ELECTRICAL THEORY..................................................................................................... 7
Chapter Summary.................................................................................................................. 7
Learning Objectives............................................................................................................... 7
Atomic Structure................................................................................................................... 8
Current.................................................................................................................................. 9
Voltage............................................................................................................................... 10
Resistance........................................................................................................................... 10
AC/DC............................................................................................................................... 11
Ohm’s Law......................................................................................................................... 11
Electrical Interference.......................................................................................................... 12
Self-Study Exercises............................................................................................................ 15
Self-Study Exercise Answers............................................................................................... 17
INSTRUMENTATION.................................................................................................................. 19
Chapter Summary................................................................................................................ 19
Learning Objectives............................................................................................................. 19
Systems Overview............................................................................................................... 21
Stimulation System............................................................................................................... 21
Recording System................................................................................................................ 22
Amplification System........................................................................................................... 22
Oscilloscope........................................................................................................................ 24
Filters.................................................................................................................................. 26
Printers................................................................................................................................ 26
Instrumentation Variations and Terminology.......................................................................... 27
Instrument Calibration.......................................................................................................... 27
Instrumentation Safety.......................................................................................................... 27
Self-Study Exercises............................................................................................................ 29
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TABLE OF CONTENTS Nerve
Conduction Studies from A to Z
Self-Study
Training for the EDT
INSTRUMENTATION (Cont.)
Self-Study Exercise Answers............................................................................................... 32
NCS ANATOMY.......................................................................................................................... 35
Chapter Summary................................................................................................................ 35
Learning Objectives............................................................................................................. 35
Terms.................................................................................................................................. 38
The Brain............................................................................................................................ 39
Cranial Nerves.................................................................................................................... 40
Spinal Column..................................................................................................................... 41
Brachial Plexus.................................................................................................................... 43
Nerves Derived Above or Outside the Brachial Plexus......................................................... 45
Spinal Accessory Nerve.......................................................................................... 45
Phrenic Nerve......................................................................................................... 45
Dorsal Scapular Nerve............................................................................................ 46
Suprascapular Nerve............................................................................................... 46
Long Thoracic Nerve............................................................................................... 46
Nerves Derived From the Brachial Plexus............................................................................ 47
Musculocutaneous Nerve......................................................................................... 47
Lateral Antebrachial Cutaneous Nerve..................................................................... 47
Medial Antebrachial Cutaneous Nerve..................................................................... 48
Axillary Nerve......................................................................................................... 48
Radial Nerve........................................................................................................... 49
Median Nerve......................................................................................................... 50
Ulnar Nerve............................................................................................................ 51
Dorsal Ulnar Nerve................................................................................................. 51
Lumbosacral Plexus............................................................................................................. 52
Femoral Nerve........................................................................................................ 53
Lateral Femoral Cutaneous Nerve............................................................................ 54
Saphenous Nerve.................................................................................................... 54
Sciatic Nerve........................................................................................................... 55
Peroneal Nerve....................................................................................................... 56
Deep Peroneal Nerve.............................................................................................. 56
Superficial Peroneal Nerve....................................................................................... 57
Posterior Tibial Nerve.............................................................................................. 57
Medial and Lateral Plantar Nerves........................................................................... 58
Sural Nerve............................................................................................................. 58
Self-Study Exercises............................................................................................................ 59
Self-Study Exercise Answers............................................................................................... 63
NCS PHYSIOLOGY..................................................................................................................... 67
Chapter Summary................................................................................................................ 67
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Nerve Conduction Studies from A to Z TABLE
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Self-Study
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NCS PHYSIOLOGY (Cont.)
Learning Objectives............................................................................................................. 67
Terms.................................................................................................................................. 69
Peripheral Nerves................................................................................................................ 70
Nerve Fiber Types.............................................................................................................. 71
Axons................................................................................................................................. 72
Nerve Impulse Propagation.................................................................................................. 72
Myelinated Nerves.............................................................................................................. 73
Sensory Nerve Units............................................................................................................ 74
Motor Nerve Units.............................................................................................................. 75
Synapses............................................................................................................................. 75
Neuromuscular Junction....................................................................................................... 75
Self-Study Exercises............................................................................................................ 77
Self-Study Exercise Answers............................................................................................... 81
NCS BASICS................................................................................................................................ 85
Chapter Summary................................................................................................................ 85
Learning Objectives............................................................................................................. 85
Normal Values.................................................................................................................... 87
Nerve Conduction Study Parameters................................................................................... 88
Latency................................................................................................................... 88
Amplitude................................................................................................................ 89
Conduction Velocity................................................................................................ 90
Duration and Morphology........................................................................................ 92
Technical Considerations..................................................................................................... 92
Stimulation............................................................................................................... 92
Recording................................................................................................................ 93
Grounding............................................................................................................... 94
Instrument Settings................................................................................................... 94
Biological Considerations..................................................................................................... 94
Temperature............................................................................................................ 94
Physical Abnormalities............................................................................................. 95
Skin Condition......................................................................................................... 95
Age......................................................................................................................... 95
Height of the Patient................................................................................................. 95
Flexion of the Extremity........................................................................................... 95
Anomalous Innervation............................................................................................ 95
Artifact................................................................................................................................ 96
EMG Needle Examination................................................................................................... 96
Self-Study Exercises............................................................................................................ 98
Self-Study Exercise Answers............................................................................................. 102
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COMMON STUDIES.................................................................................................................. 107
Chapter Summary.............................................................................................................. 107
Learning Objectives........................................................................................................... 107
Median Nerve Palmar Sensory Study................................................................................. 109
Median Nerve Palmar Sensory Study 2.............................................................................. 110
Median Nerve Digital Sensory Study.................................................................................. 111
Median Nerve Motor Study............................................................................................... 112
Median Nerve - Abnormal Study 1........................................................................ 113
Median Nerve - Abnormal Study 2........................................................................ 113
Median Nerve - Abnormal Study 3........................................................................ 114
Median Nerve - Unusual Morphology.................................................................... 114
Normal Variants.................................................................................................... 115
Ulnar Nerve Sensory Study Palmar.................................................................................... 120
Ulnar Nerve Sensory Study Palmar 2................................................................................. 121
Ulnar Nerve Sensory Study Digital..................................................................................... 122
Ulnar Nerve Motor Study Segmental................................................................................. 123
Ulnar Nerve Motor Study Segmental 2 (Recording at the FDI)........................................... 125
Ulnar Motor Study - Above and Below Elbow................................................................... 126
Radial Nerve..................................................................................................................... 127
Radial Nerve Sensory Study.............................................................................................. 127
Radial Nerve Sensory Study 2........................................................................................... 128
Radial Motor Study........................................................................................................... 129
Sural Nerve Sensory Study................................................................................................ 130
Sural Nerve Sensory Study 2............................................................................................. 131
Superficial Peroneal Nerve Sensory Study.......................................................................... 132
Peroneal Nerve Motor Study............................................................................................. 133
Peroneal Nerve Motor Study 2.......................................................................................... 134
Accessory Peroneal Nerve................................................................................................ 135
Posterior Tibial Nerve Motor Study................................................................................... 136
Posterior Tibial Nerve Motor Study 2................................................................................ 137
H-Reflex Study.................................................................................................................. 138
Technical Considerations....................................................................................... 138
F-Wave Study................................................................................................................... 140
Technical Considerations....................................................................................... 140
A-Wave............................................................................................................................ 143
Self-Study Exercises.......................................................................................................... 144
Self-Study Exercise Answers............................................................................................. 149
UNCOMMON STUDIES............................................................................................................ 151
Chapter Summary.............................................................................................................. 151
Learning Objectives........................................................................................................... 151
Dorsal
Ulnar Cutaneous Nerve Sensory Study................................................................... 153
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Nerve Conduction Studies from A to Z TABLE
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UNCOMMON STUDIES (Cont.)
Medial Antebrachial Cutaneous Nerve Sensory Study........................................................ 154
Lateral Antebrachial Cutaneous Nerve Sensory Study........................................................ 155
Suprascapular Nerve Motor Study..................................................................................... 156
Musculocutaneous Nerve Motor Study.............................................................................. 157
Axillary Nerve Motor Study............................................................................................... 157
Phrenic Nerve Motor Study............................................................................................... 158
Spinal Accessory Nerve Motor Study................................................................................ 158
First Dorsal Interosseous - Ulnar Nerve Motor Study......................................................... 159
Lateral Femoral Cutaneous Nerve Sensory Study............................................................... 160
Saphenous Nerve (Femoral) Sensory Study....................................................................... 160
Femoral Nerve Motor Study.............................................................................................. 161
Medial and Lateral Plantar Nerves Sensory Study.............................................................. 162
Blink Reflex Study............................................................................................................. 163
Transmission Disorder Repetitive Studies........................................................................... 165
Self-Study Exercises.......................................................................................................... 169
Self-Study Exercise Answers............................................................................................. 171
DISEASES & DISORDERS OF THE PNS.................................................................................. 173
Chapter Summary.............................................................................................................. 173
Learning Objectives........................................................................................................... 173
Terms................................................................................................................................ 174
Overview.......................................................................................................................... 175
Axonal Neuropathies......................................................................................................... 176
Demyelinating Neuropathies............................................................................................... 177
Acquired Demyelinating Neuropathies.................................................................... 177
Hereditary Motor and Sensory Neuropathy (HMSN)............................................. 178
Mixed Neuropathies.......................................................................................................... 178
Entrapments...................................................................................................................... 179
Carpal Tunnel Syndrome....................................................................................... 179
Cubital Tunnel Syndrome....................................................................................... 179
Tardy Ulnar Palsy.................................................................................................. 180
Radial Nerve Palsy................................................................................................ 180
Peroneal Palsy....................................................................................................... 180
Tarsal Tunnel Syndrome........................................................................................ 181
Neuromuscular Junction (NMJ) Disorders.......................................................................... 181
Self-Study Exercises.......................................................................................................... 182
Self-Study Exercise Answers............................................................................................. 184
PROTOCOL................................................................................................................................ 187
Chapter Summary.............................................................................................................. 187
Learning Objectives........................................................................................................... 187
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PROTOCOL (Cont.)
Overview.......................................................................................................................... 188
Mononeuropathies............................................................................................................. 188
Carpal Tunnel Syndrome....................................................................................... 189
Median Nerve Lesions........................................................................................... 190
Ulnar Nerve Lesions.............................................................................................. 191
Radial Nerve Lesions............................................................................................. 191
Sensory Mononeuropathies.................................................................................... 191
Peroneal Nerve Lesions......................................................................................... 191
Tibial Nerve Lesions.............................................................................................. 192
Polyneuropathies............................................................................................................... 192
Hereditary Neuropathies........................................................................................ 193
Guillain-Barre Syndrome........................................................................................ 193
Chronic Inflammatory Demyelinating Polyneuropathy.............................................. 193
Radiculopathies................................................................................................................. 193
Self-Study Exercises.......................................................................................................... 194
Self-Study Exercise Answers............................................................................................. 196
RESPONSIBILITIES OF THE TECHNOLOGIST...................................................................... 199
Chapter Summary.............................................................................................................. 199
Learning Objectives........................................................................................................... 199
Overview.......................................................................................................................... 200
The Laboratory................................................................................................................. 201
The Patient........................................................................................................................ 201
The Study.......................................................................................................................... 202
Continuing Education......................................................................................................... 203
The Code of Ethics for the AAET...................................................................................... 204
Self-Study Exercises.......................................................................................................... 205
Self-Study Exercise Answers............................................................................................. 208
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