SHAPIRO EMG PDF
He spent the next 7 years at the Duke University EMG Laboratory to develop Preston D, Shapiro B. Basic electromyography: analysis of motor unit action. EMG. Eric Wisotzky, MD. Associate Director of Cancer Rehabilitation Pocket EMG / Eric Wisotzky, Victor Tseng, Dane Pohlman. .. Preston DC, Shapiro BE. Purchase Electromyography and Neuromuscular Disorders - 3rd Edition. Print Book & E-Book. Authors: David Preston Barbara Shapiro.
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Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic by David C. Preston MD FAAN (Author), Barbara E. Shapiro MD PhD (Author). Fiber type. Pathology. Temporal course. Adapted from fig , Preston and Shapiro Value of NCSs/EMG. • When neuromuscular disease is. (EMG), has been used for the diagnosis of neuromuscular and muscle diseases. .. Katirji B, Kaminski HJ, Ruff RL, Shapiro EB, editors.
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Volume 48 , Issue 2 August Pages Related Information. Email or Customer ID. Forgot password? Old Password. New Password.
Your password has been changed. Returning user. Request Username Can't sign in? The puzzle may be complicated with many pieces or fairly straightforward with few pieces needed to solve it. In medicine, the other puzzle pieces are the history, physical examination, laboratory tests, imaging studies, etc. One of the things that is important to remember is that electrodiagnostic studies represent a physiologic piece of the diagnostic puzzle.
For example, unlike an MRI or an x-ray, which are simply sophisticated photographs, the EMG and NCS provide information in real time about what is occurring physiologically with respect to the nerve and the muscle.
This is not to say that imaging studies are not useful, but rather to explain that these tests complement each other and each has a role in helping to establish the correct diagnosis in neuromuscular disorders. The take-home message is this: Electrodiagnostic studies are sometimes essential in establishing a particular diagnosis and are sometimes not useful at all. As a clinician, it is important to understand when to recommend these studies just as it is important to know when to order an imaging study.
In a practical sense, you can consider electrodiagnostic testing in any of the following circumstances: 1. A patient is complaining of numbness. A patient is complaining of tingling paresthesias.
A patient has pain. A patient has weakness. A patient has a limp. A patient has muscle atrophy.
A patient has depressed deep tendon reflexes. A patient has fatigue. For example, a young woman comes in complaining of arm pain. The differential diagnosis should immediately include trauma as a source of the pain.
Upon questioning you learn that in fact she fell and on physical examination you note a large abrasion that explains her pain. To even consider electrodiagnostic studies in this 5 6 Easy EMG situation is absurd. The point here is that a list of signs and symptoms does not lead you to automatically order electrodiagnostic studies. Rather, these tests can be thought of as an extension of the history and physical examination when someone presents with any one or more of the signs or symptoms listed that cannot be explained by the history and physical examination alone.
Clearly electrodiagnostic studies are useful to establish the correct diagnosis, but they are also useful to determine whether someone should have surgery and are often preferred over imaging studies when certain types of surgery are a consideration. They are also done for prognostic reasons to follow the course of recovery or deterioration from an injury.
In summary, electrodiagnostic studies are used to: 1. Establish the correct diagnosis.
Localize the lesion. Determine treatment even if the diagnosis is already known.
Provide information about the prognosis. Upon questioning he also reveals he has neck pain. The physical examination is inconclusive.
The differential diagnosis includes carpal tunnel syndrome median nerve compression at the wrist and cervical radiculopathy. In the past he was diagnosed with carpal tunnel syndrome and underwent an injection with local corticosteroid into the carpal tunnel that completely alleviated his symptoms for a few months a good response to a corticosteroid injection in the carpal tunnel is both therapeutic and diagnostic for carpal tunnel syndrome.
Now, however, his symptoms are back with a vengeance. In this case of carpal tunnel syndrome, electrodiagnostic studies can be recommended in order to determine the severity of his condition and to help decide whether conservative management or surgery is the most appropriate course of treatment.
Example 3 A third man comes in who had carpal tunnel surgery 3 months ago.
Pediatric Nerve Conduction Studies and EMG
His symptoms are much better, but he is still quite weak. Now, he is a candidate for repeat electrodiagnostic studies to provide information about the prognosis.
The new study can be compared to the old study, and information extrapolated about the current status of the median nerve and predicted future improvement. The Skilled and Compassionate Electrodiagnostician Many patients are afraid to have electrodiagnostic studies.
electromyography and neuromuscular disorders preston shapiro pdf
They may have heard that these tests are extremely painful or they may have a genuine needle phobia. In order to get the 2 Why do Electrodiagnostic Studies? Avoid keeping the patient waiting, as that will only increase his or her anxiety. Before you start, explain to the patient what you are going to do. Explain that these tests will be useful in determining the diagnosis. Reassure the patient that you will stop the test at any point if they request you to do so.
Be sure to honor the request should it occur. Although not typically used, analgesic or sedating medication can be given. During the test, distract the patient with conversation. It is usually easy to distract someone by asking them questions about what they like to do, where they like to go, etc. Assure the patient that you will minimize the length of the exam, doing only what is absolutely necessary to obtain the required information.
Keep the room warm. This serves two purposes. First of all, the patient is generally dressed in a gown and therefore is prone to being cold.
Keeping the room warm will make him or her more comfortable. Special Precautions There are a number of clinical situations that deserve special mention. Care must be taken to ensure that the needle is indeed placed in the appropriate muscle. Extra-long needles may be used. Thin Individuals In very thin patients, it is important not to insert the needle too far as it can injure other tissues e. It may be helpful to have recent laboratory testing for coagulation parameters.Anand and David Chad.
ISBN 13: 9781455726721
Although not typically used, analgesic or sedating medication can be given. Electromyogr Clin Neurophysiol. You get direct information about the muscles in EMG and indirect information about the nerves that supply the muscles you test. They should be cleaned between patients. Current Pediatric Therapy. In order to get the 2 Why do Electrodiagnostic Studies? Curr Opin Pediatr. We are always looking for ways to improve customer experience on Elsevier.
State-of-the-art guidance helps you correlate electromyographic and clinical findings and use the latest EMG techniques to their fullest potential.