Title EMG Lesion Localization and Characterization
Subtitle A Case Studies Approach
Author Mark A. Ferrante, Bryan E. Tsao
ISBN 9780826148643
List price USD 99.00
Price outside India Available on Request
Original price
Binding Paperback
No of pages 448
Book size 216 x 279 mm
Publishing year 2020
Original publisher Demos Medical Publishing
Published in India by .
Exclusive distributors .
Sales territory Bangladesh, India, Pakistan, Sri Lanka
Status New Arrival
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EMG Lesion Localization and Characterization: A Case Studies Approach takes a unique approach to electrodiagnostic (EDX) medicine, using case studies and exercises to teach clinical reasoning and build technical skills. The first section presents basic principles, reviewing pertinent nerve and muscle anatomy, physiology, and pathophysiology along with study techniques, measurements, and pitfalls. The second section emphasizes how to most effectively utilize the book’s featured case studies, followed by 60 cases covering the range of disorders encountered in the EMG lab and organized by regional and multiregional disorders of the upper and lower extremities, brachial plexopathies, generalized disorders, and challenging cases.

Through the EDX case studies, lesion localization and characterization are demonstrated and discussed step-by-step using a floating text box that tracks the findings for each case. Cases begin with the clinical features, which dictate the initial EDX studies performed. The results of those studies drive the next round of testing, which continues until the abnormality has been localized and characterized and a diagnosis is made. In this manner, the dynamic nature of electrodiagnostic testing and process of sequential study analysis is reinforced, just as it would be in the EMG laboratory.

Authored by two leading experts in neurology and electrodiagnostic medicine, all aspects of lesion localization and characterization are extensively covered, including calculations of lesion severity for demyelinating conduction block and axon loss lesions and calculations of various types of motor unit action potential recruitment frequencies. The book features a large number of anatomical drawings, charts, and EDX images in order to illustrate the skills of lesion localization and characterization comprehensively. By conveying the “cognitive approach” to EDX medicine, EMG Lesion Localization and Characterization merges clinical knowledge with real-life cases to better instruct residents, fellows, technicians, and neuromuscular providers in the field of electrodiagnostic medicine.


Key Features:

  • Includes 60 cases covering all major neuromuscular disorders
  • Presents basic and advanced anatomic, physiologic, pathophysiologic, and temporal principles and concepts pertinent to EDX medicine
  • EDX studies are evaluated as they are collected, providing insight into the principles underlying electrodiagnostic medicine
  • Through sequential step-by-step analysis of findings, the decision-making process required in the EMG laboratory is simulated





Part I. The Fundamental Neuroscience Underlying Electrodiagnostic Medicine

Chapter 1. Pertinent Anatomy, Physiology, and Pathology (Mark A. Ferrante)Introductory Comments • The Goals of Electrodiagnostic Examination • The EDX Examination Is an Independent Study • Basic Anatomy and Organization of the Peripheral Neuromuscular System • Plexus Anatomy • Nerve Anatomy • Anatomy and Physiology of the Membrane • The Transmembrane Potential • Action Potential Generation • Action Potential Propagation • Connective Tissue Elements of the Nerve • Anatomy and Physiology of the Neuromuscular Junction • Presynaptic Region • Synaptic Space • Postsynaptic Region • Anatomy and Physiology of Muscle • Excitation–Contraction Coupling • Neural Control of Muscle • Motor Units, Muscle Fibers, and Force • Motor Unit Types • Muscle Fiber Types • Motor Unit Force Generation • References

Chapter 2. Nerve Conduction Studies (Mark A. Ferrante)Basic Concepts • Electrodes • Surface Recording ElectrodesBipolar Versus Monopolar (Referential) Recording Montages • The Surface Stimulating Electrodes • The Ground Electrode • The Basic Technique • Volume Conduction • Orthodromic Versus Antidromic Techniques • Motor Nerve Conduction Studies • Belly–Tendon Method • E1 and E2 Electrode Placement • Physiologic Temporal Dispersion • What We Measure and What It Means • Amplitude • Negative Area-Under-the-Curve • Distal Latency • Conduction Velocity • Negative Phase Duration • The Value of the Motor Response • Sensory Nerve Conduction Studies • Technique Measurements • Amplitude • The Effect of Technique (Orthodromic vs. Antidromic) on Amplitude • Latency • Peak Latencies Versus Onset Latencies • Fixed Distances Versus Landmark-Based Distances • Conduction Velocity Value Calculated From the Latency Value • Mixed Nerve Conduction Studies • The NCS Manifestations of Pathology • Introduction • How Focal Demyelination Affects Action Potential Propagation • How Focal Axon Loss Affects Action Potential Propagation • Motor NCS Manifestations • Focal Demyelinating Conduction Slowing • Uniform Demyelinating Conduction Slowing • Nonuniform Demyelinating Conduction Slowing • Focal Demyelinating Conduction Block • Lesion Localization Distal to the Two Stimulation Sites • Lesion Localization Between the Two Stimulation Sites • Lesion Localization Proximal to the Two Stimulation Sites • Conduction Failure • Advantages and Disadvantages of the Motor NCS • Sensory NCS Manifestations • Advantages and Disadvantages of the Sensory NCS • The Timing of NCS Manifestations • References

Chapter 3. Repetitive Nerve Stimulation Studies (Mark A. Ferrante)Introductory Comments • Low Frequency RNS • Postexercise Facilitation and Postexercise Exhaustion • High Frequency RNS • References

Chapter 4. The Needle EMG Examination (Mark A. Ferrante)Introductory Comments • Motor Unit Anatomy and Physiology Pertinent to Needle EMG • The Importance of the MUAP Duration • Motor Unit Recruitment • Needle EMG Technique • Needle EMG Measurements and Their Meanings • Insertional Phase • Insertional Activity • Snap-Crackle-Pop • Weichers–Johnson Syndrome • Resting Phase • Endplate Activity • Activation Phase • MUAP Amplitude • MUAP Duration • Intrinsic MUAP Morphology—Phases and Turns • MUAP Stability • References 56

Chapter 5. Needle EMG Examination Abnormalities (Mark A. Ferrante)Introductory Comments • Insertional Phase • Decreased Insertional Activity • “Increased” Insertional Activity • Resting Phase • Fibrillation Potentials, Positive Sharp Waves, and Insertional Positive Sharp Waves • Morphology • Auditory Characteristics and Firing Frequency • Quantification • Insertional Positive Sharp Waves • Fasciculation Potentials and Cramp Potentials • Myotonic Potentials • Neuromyotonia Grouped Repetitive Discharges and Myokymia • Complex Repetitive Discharges • Activation Phase • MUAP Morphology • Duration • MUAP Amplitude • Phases and Turns • MUAP Recruitment • Neurogenic Recruitment • Upper Motor Neuron Recruitment • Early Recruitment • MUAP Stability • References

Chapter 6. Peripheral Nerve Injuries (Mark A. Ferrante)Introductory Comments • Nerve Injury Classification • The Seddon Classification System • The Sunderland Classification System • Nerve Injury Type • Stretch Injuries • Compression Injuries • Transection Injuries • Correlations Between Pathophysiology and Clinical Features Correlations Between Pathophysiology and Lesion Acuteness • References

Chapter 7. Assessing Lesion Severity (Mark A. Ferrante)Introductory Comments • Clinical Grading • Electrodiagnostic Grading • The EDX Study Manifestations • EDX Manifestations Based on Severity • EDX Manifestations Based on the Timing of the Study • The Utility of the Motor Response in Lesion Severity Assessment • The Utility of the Sensory Response in Lesion Severity Assessment • The Utility of the Needle EMG in Lesion Severity Assessment • Fibrillation Potentials • Motor Unit Action Potentials • Recruitment • Duration • Mechanisms of Reinnervation • Collateral Sprouting • Proximodistal Axon Regeneration • Determining the Potential for Reinnervation • References

Chapter 8. Lesion Localization and Characterization (Mark A. Ferrante)Lesion Localization • Nerve Conduction Studies • The Cell Bodies of Origin of the Sensory and Motor Axons • Nerve Conduction Studies and Needle EMG Study • An Example of Lesion Localization • Lesion Characterization • Example 1—Calculating Axon Loss and Demyelinating Conduction Block Severity Using the Motor Responses • Determinations Required • Solution • The Percentage of Fibers Affected by Axon Loss • The Percentage of Fibers Affected by Demyelinating Conduction Block • The Percentage of Fibers Unaffected • Example 2—Sample EDX Case and Terminology • Clinical Impression • Initial Set of Sensory NCS • Sensory Nerve Conduction Studies • Motor Nerve Conduction Studies • The Needle EMG Study • EDX Study Conclusion • Left Ulnar Neuropathy at the Elbow Segment • The Calculations Determining These Pathophysiologies • Motor Nerve Fibers to the ADM Muscle • Final Comments • Example 3—Using Deductive Reasoning to Identify a Proximal Demyelinating Conduction Block • MUAP Waveform Analysis • MUAP Measurements and Stability • MUAP Recruitment Pattern Analysis • References


Part II. Case Studies in Electrodiagnostic Medicine

Chapter 9. Case Studies (Mark A. Ferrante and Bryan E. Tsao)Introductory Comments • EDX Case Study Organization • The Case-Box • Table Descriptors • MUAP Recruitment Descriptors • MUAP Morphology Descriptors • When the Needle EMG Findings Vary • Abbreviations Used • Sensory Ncs • Motor Ncs • Needle Emg • Upper Extremity • Lower Extremity • EDX Case Studies • Introduction • Regional Disorders of the Upper and Lower Extremities (Cases 1 through 19) • Multiregional Disorders of the Upper and Lower Extremities (Cases 20 through 30) • Brachial Plexopathies (Cases 31 through 39) • Generalized Disorders (Cases 40 through 56) • Challenging EDX Cases (57 through 60)



About the Authors:

Mark A. Ferrante, MD, is Professor of Neurology, Co-Director of the Neurophysiology Fellowship, and Associate Director of the Residency Training Program at the University of Tennessee Health Science Center. He also serves as the Chief of Neurology, the Section Chief of Neurophysiology, the Director of the EMG Laboratory, and the Director of the ALS Clinic at the VAMC-Memphis. He is board-certified by the ABPN in Neurology, Added Qualifications in Neurophysiology, and Clinical Neuromuscular Medicine, and by the ABEM in Electrodiagnostic Medicine.

Bryan E. Tsao, MD, is a Chair and Professor of Neurology at Loma Linda University School of Medicine. He serves as Director of the EMG Laboratory, the Director of the Rehabilitation, Orthopedics, and Neuroscience Institute (RONI), and is a Vice-President of the Faculty Medical Group, the faculty practice corporation at Loma Linda University Health. He is board-certified by the ABPN in Neurology, Added Qualifications in Neurophysiology, and Clinical Neuromuscular Medicine, and by the ABEM in Electrodiagnostic Medicine.


Target Audience:

This book is for neuromuscular providers in the field of electrodiagnostic medicine.


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