Neurography / Electromyography (EMG)

EMG and nerve conduction studies are critical tools in diagnosing nerve and muscle disorders. Our clinic offers these advanced diagnostic tests to detect conditions like neuropathy, radiculopathy, and myopathies. With detailed insights from these tests, we can develop precise treatment plans that address the root cause of your symptoms.

Neurography and Electromyography (NG/EMG) Examinations

Neurography and electromyography are used for diagnosing neurological disorders and assessing disease progression.

Neuropathies

• N. medianus (median nerve) neuropathy – Carpal tunnel syndrome
• N. ulnaris (ulnar nerve) neuropathy – Cubital tunnel syndrome and Guyon’s canal syndrome
• N. radialis (radial nerve) neuropathy
• N. peroneus neuropathy – "Foot drop"
• N. tibialis neuropathy – Tarsal tunnel syndrome
• N. femoralis (femoral nerve) neuropathy
• N. facialis (facial nerve) neuropathy

Other conditions diagnosed include:

• Cervical and lumbar nerve root injuries
• Polyneuropathy
• Nerve plexus injuries
• Tremor analysis
• Myositis/Myopathy
• Motor neuron disease
• Amyotrophic lateral sclerosis (ALS)
• Myasthenic reaction
• Myotonia

If you or your loved one suspects any of these conditions and requires an examination, we are happy to assist. You can schedule a Neurography/Electromyography examination by contacting us via phone or email.

What is the Peripheral Nervous System?

When thinking of the nervous system, most people imagine the brain. However, it is a much more complex structure. The nervous system consists of central and peripheral parts.

The central nervous system includes the brain and spinal cord, while the peripheral nervous system extends from the spinal cord, forming spinal nerve roots. These nerves branch throughout the body, much like tree branches growing from a trunk. The peripheral nervous system serves as a pathway for signals traveling from the brain to the muscles and back. It enables muscle contractions when initiating movement and transmits sensory information—such as pain, touch, and temperature—to the brain.

Each nerve is responsible for a specific innervation zone, covering certain muscles and skin areas. If a nerve’s motor component is affected, weakness and movement impairments occur in specific muscle groups. If the sensory component is damaged, symptoms such as pain and sensory disturbances arise in the affected nerve’s territory.

The extent of symptoms depends on the location and severity of the nerve damage.

Muscle weakness can result from nerve injuries, central nervous system disorders, or muscular diseases, such as inflammation-related damage. It can also stem from neuromuscular junction disorders, which interfere with nerve impulse transmission to the muscle.

Peripheral Nervous System Examination Methods

Electroneuromyography consists of two procedures: neurography and electromyography.

• Neurography records sensory and motor nerve potentials using mild electrical stimulation at various nerve sites, enabling segment-specific analysis.
• Electromyography examines muscles at rest and during movement using a needle electrode to determine potential damage, classify the injury as neural or muscular, and assess whether it is active or chronic.

Applications of Neurography and Electromyography

These procedures assist in diagnosing localized neuropathies, where a single nerve is affected, often due to trauma or compression. Compression can be caused internally (e.g., joint inflammation or cysts) or externally (e.g., prolonged pressure against a hard surface).

Commonly affected nerves:

• Median nerve (compressed in the wrist, leading to carpal tunnel syndrome)
• Ulnar nerve (compressed in the wrist or elbow due to external pressure)
• Radial nerve (often compressed in the upper arm due to external pressure)
• Peroneal nerve (compressed at the knee or ankle)

Polyneuropathies involve multiple nerves deteriorating simultaneously, typically starting in the feet and progressing upwards. Symptoms include pain, numbness, tingling, muscle weakness, gait disturbances, and skin changes. Common causes include diabetes, thyroid dysfunction, infections (e.g., hepatitis, Lyme disease), toxins, medications, autoimmune processes, and genetic disorders. Early detection of polyneuropathy can help diagnose the underlying disease and prevent further nerve damage.

Plexopathies & Radiculopathies

Plexopathies involve injuries to nerve bundles located in the shoulder or pelvis, leading to widespread sensory loss, pain, and muscle weakness. Causes include muscle or bone imbalances, tumors, trauma, or autoimmune inflammation.

Radiculopathy (sciatica) occurs when nerve roots exiting the spine become compressed, often due to disc herniations or degenerative spine changes. Symptoms include pain radiating down the limb, weakness, and sensory disturbances in a specific nerve root’s area. Diagnosis usually involves MRI or CT scans, but electromyography can provide additional insights on nerve function and injury severity.

Other muscle and neuromuscular diseases, such as myopathy, myositis, myasthenia gravis, or motor neuron disorders (e.g., ALS), can also be diagnosed with electroneuromyography.

If you suspect any of these conditions and need an examination, contact us by phone or email to schedule a Neurography/Electromyography test.

Neurography and Electromyography: Additional Applications

In addition to neurography and electromyography, surface electromyography can also be performed. This is a non-invasive method where an electrode is placed on the skin above the muscle to record electrical impulses. It allows for the measurement of muscle contractions, whether voluntary or spontaneous, and is primarily used for tremor assessment.

Who Can Benefit from This Method?

Tremor, or involuntary shaking, can occur due to various diseases or even in healthy individuals, for example, due to strong emotional stress.

Types of Tremors:

• Parkinsonian Tremor – The most well-known type associated with Parkinson’s disease, typically accompanied by slow movements, muscle stiffness, altered gait, and instability. It often begins on one side and later affects both limbs. This tremor is present even at rest but can also occur during activities. Diagnosis is based on clinical symptoms, additional tests, and brain MRI scans.
• Essential Tremor – The second most common tremor, symmetrically affecting the hands and head, appearing primarily during actions with minimal presence at rest. Patients often maintain quality of life for a long time without rapid symptom progression.
• Orthostatic Tremor – A rare disorder in which tremors occur when a person is standing upright. Proper diagnosis allows for effective symptom management.
• Dystonic Tremor – Linked to dystonia, a condition characterized by abnormal muscle tone, resulting in postural changes, involuntary movements, and tremors.
• Physiological or Enhanced Physiological Tremor – Occurs in healthy individuals, triggered by fatigue or anxiety.
• Medication-Induced Tremor – Can result from certain drugs, particularly those affecting the central nervous system.
• Cerebellar Tremor – Develops due to damage to the cerebellum, a brain region responsible for movement coordination. Patients experience severe tremors when approaching a target object.
• Psychogenic Tremor – Arises without neurological abnormalities, often related to psychiatric disorders or intense emotional distress.
• Peripheral Nervous System-Related Tremors – Includes Holmes tremor and other types.

How Do Tremors Differ?

Tremors vary in terms of location (head, hands, legs, trunk), triggers (whether at rest, against gravity, or during action), and frequency. Electromyography can determine tremor frequency, aiding in identifying the tremor type—which is crucial for selecting the best diagnostic plan and treatment.

Neurography and Electromyography: Preparation Guidelines

Keep in mind that the examination can be lengthy, lasting at least an hour, depending on the diagnosis. Since it involves electrical stimulation and needle electrodes, some discomfort may occur. However, the test is entirely safe for children and pregnant women. To ensure optimal effectiveness, it is recommended that the examination follows an assessment by a neurologist, neurosurgeon, or rheumatologist.

To schedule an examination, contact us via phone at 26565299.