ELECTROMYOGRAM

MARIA ISABEL NABOR PHYSIOLOGY 297

ELECTROMYOGRAPHY
The study of muscle function through analysis of the electrical signals emanated during muscular contractions It measures the electrical signal associated with the activation of the muscle.

Contractions

Electrical Signals

MUSCLE FUNCTION

THE MOTOR UNIT

The functional unit of the muscle contraction is a motor unit, which is comprised of a single alpha motor neuron and all the fibers it enervates.
Alpha motor neuron Muscle fibers

This muscle fiber contracts when the action potentials (impulse) of the motor nerve which supplies it reaches a depolarization threshold.

THE MOTOR UNIT

The depolarization generates an electromagnetic field and the potential is measured as a voltage.

Depolarization

EM Field

VOLTAGE

The depolarization, which spreads along the membrane of the muscle, is a muscle action potential.

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- - - - -+ + + -----+++

THE MOTOR UNIT

The motor unit action potential is the spatio and temporal summation of the individual muscle action potentials for all the fibers of a single motor unit.

Motor Unit Action Potential

Therefore, the EMG signal is the algebraic summation of the motor unit action potentials within the pick-up area of the electrode being used.

MOTOR UNIT POTENTIAL

Duration of action potential associated with a twitch of a muscle fiber is about 1-4 ms. Not all contract at exactly the same time, some are delayed. Thus, the electrical potential of all the fibers in the motor unit is prolonged.

T = 2ms

T = 4ms

T = 6ms

T = 8ms

The electrical result of the motor unit twitch is an electrical discharge lasting about 5-8 ms (some until 12ms). Majority of these motor unit potentials have an amplitude of 0.5 mV.

SUMMARY
CNS Alpha Motor Neuron Muscle Fibers Synchronous Discharges Detected by electrodes

Generate Action Potential Dissipated to surrounding tissues

ELECTROMYOGRAPH
A high gain amplifier to which electrodes are connected. It can detect motor unit potentials.
Motor Unit Potential Electrodes Amplified by EMG

The electrodes are placed either on the skin above the muscle or into the muscles using needle or wire electrodes. When the motor unit potentials obtained by electromyography are displayed on a cathode ray oscilloscope, the result is a sharp spike that is most often biphasic

FACTORS
The larger the potential registered the larger the motor unit producing it.
Size of Motor Unit

The distance of the unit from the electrodes and the types of electrodes and equipment used determine the final size and pattern of the individual motor unit potential that is recorded.
Distance from electrodes, type of electrodes and equipment

Furthermore, there are characteristic variations with different normal muscles, e.g., the smallness of potentials in facial muscles as compared to those muscles of the extremity.
Characteristic variations of different muscles

APPLICATION
EMG is most useful for distinguishing nerve from muscle disease. They are obtained

1. at REST, when normally there is no spontaneous activity 2. during SLIGHT MUSCLE CONTRACTION in order to assess the size and duration of activity of motor units, thus enabling differentiation between myopathic and neuropathic diseases 3. during MAXIMAL MUSCLE ACTIVITY in order to determine if there is abnormal recruitment of motor units, which could then differentiate if the problem is myopathic or neuropathic

APPLICATIONS
Find diseases that damage muscle tissue, nerves, or the junctions between nerve and muscle. These problems may include a herniated disk, amyotrophic lateral sclerosis, or myasthenia gravis. Diseases that damage muscle, nerves or NMJs Find the cause of weakness, paralysis, or muscle twitching. Problems in a muscle, the nerves supplying a muscle, the spinal cord, or the area of the brain that controls a muscle can cause these symptoms. The EMG does not show brain or spinal cord diseases. Causes of weakness, paralysis or twitching

INSTRUMENTATION
The concentric or coaxial needle electrode (usually 24 gauge) is a bipolar electrode, one pole of which is formed by the shaft of the needle and the other by a wire threaded by through the shaft, an insulating material being provided between the two. The electrode records the electrical activity only at its tip, thus sampling a restricted area within the muscle.

The activity recorded by the electrodes is amplified and displayed as a visual sign on an oscilloscope, or printed out on paper recorder. Since the frequencies happen to be within the auditory frequency range, it can be displayed as an auditory signal.

PROCEDURE
The skin over the areas to be tested is cleaned. A needle electrode that is attached by wires to a recording machine is inserted into a muscle. When the electrodes are in place, the electrical activity in that muscle is recorded while the muscle is at rest. Then the technologist or doctor asks you to tighten (contract) the muscle slowly and steadily. This electrical activity is recorded. The electrode may be moved a number of times to record the activity in different areas of the muscle or in different muscles. The electrical activity in the muscle is shown as wavy and spiky lines on a video monitor and may also be heard on a loudspeaker as machine gun-like popping sounds when you contract the muscle. The activity may also be recorded on video.

RESULTS
Electromyogram
Normal The EMG recording shows no electrical activity when the muscle is at rest. There is a smooth, wavy line on the recording with each muscle contraction. Electrical activity in a muscle at rest shows that there may be a problem with the nerve supply to the muscle. Abnormal wave lines when a muscle contracts may mean a muscle or nerve problem, such as amyotrophic lateral sclerosis (ALS), post-polio syndrome, inflammation, or other muscle problems.

Abnormal

ELECTROMYOGRAM
The resting muscle in normal subject is electrically silent- no potentials are recorded and a straight line is inscribed. Movement of the needle produces momentary discharges called the insertion activity.

ELECTROMYOGRAM
On muscle contraction, the action potentials of the muscle fibers, called motor unit potentials, are recorded. They are usually biphasic or triphasic potentials, some polyphasic, about 0.5-2.0 mV in amplitude and 5-15 ms in duration.

As an audio signal, they produce, knocking or thumping sound over the loudspeaker.

ELECTROMYOGRAM
During stronger contraction, many motor units are recruited into activity and the potentials run into one another, and the resulting confused tracing is called the interference pattern of the muscle.

RESULTS
Henneman Principle: Under normal conditions, the smaller potentials appear first, with slight contraction. As the force is increased, larger and larger potentials are recruited, this being the normal pattern of recruitment.

This normal pattern is absent in cases of partial paralysis due to injuries or lesions of the lower motor neuron- the small potentials never appear because only the larger motor units have survived.

FIBRILLATION
This is the contraction of single muscle cells which have completely dissociated from nervous control due to destruction of a motor nerve and subsequent degeneration of the distal part of the axon by disease or wilting of the nerve.

Occurs for several weeks and then ceases as the muscle cells atrophy. There is no summation of muscle fibers because the motor unit has been disrupted. Therefore, the potentials must be measured from single muscle cells with the aid of bipolar needle electrodes inserted into the muscle.

FIBRILLATION
Apparently spontanous independent contractions of individual muscle fibers occur which are so minute, they cannot be seen on the skin. EMG shows low voltage, high frequency irregular potentials.

FASCICULATION
This is the contraction of groups of muscle cells integrated by a single axon into a motor unit. This occurs when an anterior motor neuron is destroyed, as in motor neuron disease or the axon is severed. Spontaneous impulses will arise as the distal axon atrophies. Until atrophy is complete, the muscle cells composing the motor unity will contract in response to these spontaneous impulses. These contractions are therefore strong enough to allow measurement of potentials with skin electrodes.

NERVE CONDUCTION STUDIES

MARIA ISABEL NABOR PHYSIOLOGY 297

PRINCIPLE
When a pair of electrodes is placed on the skin and a current passed through them some of the current penetrates deep into the tissues. If this current is sufficiently strong and is in the neighborhood of a nerve then it stimulates some of the nerve fibers. In a motor nerve, the peripherally directed action potentials cause the innervated muscle fibers to contract.

PRINCIPLE
For instance, stimulation of the median nerve at the wrist and then at the elbow causes electrical activity in the thenar muscles of the palm. If the length of the nerve between the two stimulated points and the difference in the latent periods of the two response is known the velocity of the nerve impulse can be calculated.

NERVE CONDUCTION VELOCITY

Nerve conduction velocity is the speed at which an electrical stimulus signal passes through the nervous system. If an electrical stimulus is applied externally to a nerve fiber, a current flows from the positive stimulating electrode to the interior of the neuron and leaves again at the negative electrode. If the change reaches a certain threshold level, then the cells in the nerve depolarize and an action potential is set off.

NERVE CONDUCTION VELOCITY

The speed of this action potential, or nerve velocity, can be measured by recording the time it takes for the charge to travel from the stimulus electrodes to the recording electrodes located somewhere else along the nerve. Given these information, you can then divide the physical distance between the two electrode sites by the length of time to find the velocity.

APPLICATIONS
Information from nerve conduction velocity studies are useful in determining the status of the nervous system and whether or not there are any deficiencies in the conduction of electrical information in the body. It is used to find damage to the peripheral nervous system, which includes all the nerves that lead away from the brain and spinal cord and the smaller nerves that branch out from those nerves.

EQUIPMENT

PROCEDURE
In this test, several flat metal disc electrodes are attached to your skin with tape or a paste. A shock -emitting electrode is placed directly over the nerve, and a recording electrode is placed over the muscles controlled by that nerve. Several quick electrical pulses are given to the nerve, and the time it takes for the muscle to contract in response to the electrical pulse is recorded. The speed of the response is called the conduction velocity. The same nerves on the other side of the body may be studied for comparison. When the test is done, the electrodes are removed.

PROCEDURE

SETUP

RESULTS
Nerve Conduction Studies
Normal The nerves send electrical impulses to the muscles or along the sensory nerves at normal speeds, or conduction velocities. Sensory nerves allow the brain to feel pain, touch, temperature, and vibration. Different nerves have different normal conduction velocities. The speed of nerve impulses is slower than what is normal for that nerve. Slower speeds may be caused by injury to a nerve or group of nerves. Nerve conduction velocities generally get slower as a person gets older.

Abnormal

SAMPLE DATA

WAVEFORM ANALYSIS

EARLY SPIKE Almost instantaneous, determined by the speed of electricity Represents response to the stimulus as it is conducted to the skin point of measurement for POINT OF STIMULUS

WAVEFORM ANALYSIS

SECOND PEAK Occurs at around 5ms Response to the stimulus along the ulnar nerve

WAVEFORM ANALYSIS

TWITCH RESPONSE Large dip between 7-17ms Response of the subjects arm at the time of stimulation

WAVEFORM ANALYSIS

RESPONSE Time between the initial stimulation and the first nerve response peak

DATA ANALYSIS
Measure the external distance that the stimulus traveled (midpoint of the stimulating and midpoint of the recording electrodes) using a tape measure

Divide the distance by the time measurement to determine the speed.

Average nerve conduction velocities are in the range of 4555 m/s.