study guide for r.ncs.t. written exam - aset6 4. node of ranvier preston d, shapiro b. (1998)...

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Study Guide for

R.NCS.T. Written Exam

Published By the American Society of Electroneurodiagnostic Technologists

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This study guide for board preparation for the Nerve Conduction Studies written exam was

developed and collectively compiled by the ASET NCS Study Guide Task Force. Those

serving on the task force are the following registered nerve conduction study technologists:

Carrie E. Ford, R. EP T., R.NCS.T. (editor)

Kim Bunch, R.NCS.T. (contributor)

Michelle Coleman, R.NCS.T. (contributor)

Britt Wallace, R.NCS.T. (contributor)

Jerry Morris, MA, R.NCS.T. (contributor)

Loreen Ingram-Moore, R.NCS.T. (contributor)

Meledy Kise, R.NCS.T. (contributor)

This study guide is intended to assist technologists as they study for the NCS boards by

providing references for the topics listed in the written exam content outline as published in the

AAET National Registry Examination for Nerve Conduction Studies – Written Handbook for

Candidates. This study guide is a compilation of study books from, but not limited to, Kimura,

Oh, Dumitru, Crout, Brown, Tan and the Internet. Use of this guide does not insure passing of

the exam boards.

The content outline in this study guide is published with the permission of the American

Association of Electrodiagnostic Technologists (AAET). It has been expanded to include

appropriate references. This study guide is offered to ASET members free of charge.

Additional information about the AAET NCS credentialing exam can be found online by

visiting www.aaet.info. Candidates may download the complete Handbook for Candidates for

free by visiting http://www.ptcny.com/PDF/AAET2009.pdf.

Copyright © 2009 by the American Society of Electroneurodiagnostic Technologists, Inc. All

rights reserved.

I. Basic Electronics and Nerve Conduction Velocity Calculations 4%

II. Physiology 9%

III. Instrumentation and Stimulation 7%

IV. Plexus and Cutaneous Distributions 11%

V. Neuromuscular Junction Transmission and Nerve Conduction Velocity Techniques 18%

VI. Nerve Conduction Velocity Concepts and Wallerian Degeneration 21%

VII. Terminology and Case Histories 18%

VIII. Temperature and Anomalies 12%

http://www.ptcny.com/PDF/AAET2009.pdf

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I. BASIC ELECTRONICS AND NERVE CONDUCTION VELOCITY

CALCULATIONS

A. Basic Electronics

1. Ohms Law

http://www.the12volt.com/ohm/ohmslaw.asp

Crout B, Flicek C. (1997) Nerve conduction studies from A to Z. Basic electrical Theory

chapter. American Society of Electrodiagnostic Technologists, Iowa.

Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 6

2. Circuit Theory

a. Samples Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc.

Philadelphia. Pages 98-114. Appendix

b. Resistors

1. Parallel Dumitru D. (2002) Electrodiagnostic Medicine 2

nd edition. Hanley

and Belfus, Inc. Philadelphia. Pages 98-114. Appendix

2. Series Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and

Belfus, Inc. Philadelphia. Chapter 3

Crout B, Flicek C. (1997) Nerve conduction studies from A to Z. Basic

electrical Theory chapter. American Society of Electrodiagnostic

Technologists, Iowa.

B. Calculations

1. Fiber Diameter

Crout B, Flicek C. (2004) Nerve Conduction Studies from A to Z: A Self-Study Training Manual

for the EDT. Kansas City: American Society of Electroneurodiagnostic Technologists, Inc.

Kimura J. (1989) Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice, Ed

2. F.A. Davis Company Philadelphia. Chapter 4, Anatomy and Physiology of the Peripheral

nerve. Introduction, Anatomy of Peripheral Nerve, Physiological of nerve conduction

2. Degree of Myelination

Oh S. (1993) Clinical Electromyography: Nerve Conduction Studies, Second Edition. Williams

and Wilkins. Baltimore. Chapter 1, Anatomical/Physiology Basis for EMG studies.

3. Temperature

Preston D, Shapiro B. (1998) Electromyography and Neuromuscular Disorders: Clinical-

Electrophysiological Correlations. Butterworth-Heinemann, Newton, MA. Section Three.

Anomalous Innervations, Artifacts, and Technical Factors, 8. Artifacts and Technical Factors.


2. F.A. Davis Company Philadelphia. Chapter 5, Section 6 Principles of Nerve conduction

studies

http://www.the12volt.com/ohm/ohmslaw.asp

4


Electrophysiological Correlations. Butterworth-Heinemann, Newton, MA. Section Three.

Anomalous Innervations, Artifacts, and Technical Factors, 8. Artifacts and Technical Factors.

Oh S. (1993) Clinical Electromyography: Nerve Conduction Studies, Second Edition. Williams

and Wilkins. Baltimore. Part II Advanced section: Physiological Factors Affecting Nerve

Conduction


4. Internode Length

Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. ASET. NCS Physiology.

5

II. PHYSIOLOGY

A. Nerve Physiology

1. Structure

a. Fascicles Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus, Inc., Philadelphia,

PA. Chapter 4: Nerve Conduction Studies

b. Perineurium ibid. Dumitru Chapter 4: Nerve conduction studies

Preston D, Shapiro B. (1998) Electromyography and Neuromuscular Disorders:

Clinical-Electrophysiological Correlations. Butterworth-Heinemann, Newton, MA.

Chapter 2


c. Epineurium

ibid Dumitru Chapter 4: Nerve conduction studies

Tan FC (2004). EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 3

d. Fiber Types

Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. ASET. Chapter 5:

NCS Physiology

Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc.

Philadelphia. Chapter 5


B. Propagation of Potentials

1. Propagation of Potentials - Saltatory Conduction


Electrophysiological Correlations. Butterworth-Heinemann, Newton, MA. Chapter 2

Aminoff M. (1998) Electromyography in clinical practice, 3rd edition, Chapter 2: Aspects of

muscle and nerve physiology. Churchill Livingstone, Inc, NY


2. Myelinated Axons

Preston D. Shapiro B. (1998) Electromyography and Neuromuscular Disorders: Clinical-


Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd edition, Chapter 1:

Anatomical and physiological basis for electromyographic studies. Lippincott Williams and

Wilkins, Philadelphia.

3. Schwann Cells


nerve and muscle physiology. Churchill Livingstone, Inc, NY.



6

4. Node of Ranvier




nerve and muscle physiology. Churchill Livingstone, Inc, NY.

Crout B, Flicek C. (1997) Nerve conduction studies from A to Z. Chapter 5: NCS physiology.

American Society of Electrodiagnostic Technologists, Iowa.

Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd edition. Chapter 24:

Traumatic peripheral nerve injuries. Lippincott Williams and Wilkins, Philadelphia.

C. Fiber Diameter

Crout B, Flicek C. (2004) Nerve Conduction Studies from A to Z: A Self-Study Training Manual for the

EDT. Kansas City: American Society of Electroneurodiagnostic Technologists, Inc.

Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc. Philadelphia. Chapter 2

D. All or None Response


Kimura J. (2001). Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. Edition 3.

New York: Oxford University Press, Inc. p. 30

E. Resting Potential




Kimura J. (2001) Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. Edition 3.

New York: Oxford University Press, Inc. p. 913

http://bcs.whfreeman.com/thelifewire/content/chp44/4401s.swf

F. Unmyelinated Axons

1. Local Circuit Conduction

Siegel GJ, Agranoff BW, Fisher SK, Albers RW, Uhler MD. (1999) Basic Neurochemistry:

Molecular, Cellular and Medical Aspects. Sixth Edition. Philadelphia: Lippincott–Raven

Publishers.

Dumitru D. (2002). Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc. Philadelphia.

Chapter 2

2. Autonomic Nervous System

Kimura J. (2001) Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice.

Edition 3. New York: Oxford University Press, Inc. p. 69

3. Muscle Physiology


2. F.A. Davis Company Philadelphia. Chapter 2 and 4

Kimura J. (2001) Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice.

Edition 3. New York: Oxford University Press, Inc. p. 69

http://bcs.whfreeman.com/thelifewire/content/chp44/4401s.swf

7

G. Muscle Physiology

1. Histological and Molecular Structure

a. Myofibril Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc.


Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd edition.

Lippincott Williams and Wilkins, Philadelphia. Chapter 1

b. Sarcomere





c. H, A, I, and Z Bands





Kimura J. (1989) Electrodiagnosis in Diseases of Nerve and Muscle: Principles and

Practice, Ed 2. F.A. Davis Company Philadelphia. Chapter 11

Preston D, Shapiro,B. (1998) Electromyography and Neuromuscular Disorders:


Chapter 2

Levin KH, Luders HO. Comprehensive Clinical Neurophysiology Chapter 9 There is a

picture of the muscle structure on page 85.

2. Fiber Types

a. I, IIA, IIB



Tan FC. (2004). EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 3

b. Local Circuit Conduction



3. Mechanism of Contraction

a. Myosin Filaments



b. Actin Filaments



c. Roll of Calcium



d. Sarcoplasmic Reticulum

8





Chapter 2

Levin KH, Luders HO. Comprehensive Clinical Neurophysiology Chapter 9 There is a

picture of the muscle structure on page 85.

H. Basic Physiology

1. Basics

a. Ions

Brown L. (1981) Chemistry, The Central Science. Prentice Hall, Englewood Cliff, NJ.

Chapter 2

Crout B, Flicek C. (1997). Nerve conduction studies from A to Z. Chapter 5: NCS

physiology. American Society of Electroneurodiagnostic Technologists, Iowa.

b. Protons


Chapter 2

Crout, B, Flicek, C. (1997). Nerve conduction studies from A to Z. Chapter 5: NCS


c. Neutrons

Crout B, Flicek C. (1997). Nerve conduction studies from A to Z. Chapter 5: NCS



Chapter 2

2. Physiologic Principles

a. Propagation of Action Potentials http://www.blackwellpublishing.com/matthews/actionp.html

1. Depolarization

http://outreach.mcb.harvard.edu/animations/actionpotential.swfF

Preston D, Shapiro B. (1998) Electromyography and Neuromuscular

Disorders: Clinical-Electrophysiological Correlations. Butterworth-

Heinemann, Newton, MA. Chapter 2

Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and


2. Repolarization http://www.blackwellpublishing.com/matthews/channel.html




Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition., Hanley and


3. Silent Period

AANEM Glossary of Terms Dumitru. (2002) Electrodiagnostic Medicine 2nd

edition. Hanley and Belfus, Inc. Philadelphia

http://www.blackwellpublishing.com/matthews/actionp.html

http://outreach.mcb.harvard.edu/animations/actionpotential.swfF

http://www.blackwellpublishing.com/matthews/channel.html

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4. Sodium Potassium Pump http://outreach.mcb.harvard.edu/animations/actionpotental.swf




http://outreach.mcb.harvard.edu/animations/actionpotential.swf

Aminoff M. (1998) Electromyography in clinical practice, 3rd edition,

Chapter 2: Aspects of nerve and muscle physiology. Churchill Livingstone,

Inc, NY.

Crout B, Flicek C. (1997). Nerve conduction studies from A to Z. Chapter 5:

NCS physiology. American Society of Electrodiagnostic Technologists, Iowa.

Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd

edition, Chapter 1: Anatomical and physiological basis for

electromyographic studies. Lippincott Williams and Wilkins, Philadelphia.

b. Resting Potential http://intro.bio.umb.edu/111-112/112s99Lect/neuro_anims/restingpotential.html


1. Polarity

2. All or None Response

Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd

edition, Chapter 1: Anatomical and physiological basis for

electromyographic studies. Lippincott Williams and Wilkins, Philadelphia

Kimura J. (2001) Electrodiagnosis in Diseases of Nerve and Muscle:

Principles and Practice. Edition 3. New York: Oxford University Press, Inc.

p. 30

http://highered.mcgraw-

hill.com/sites/0072495855/student_view0/chapter14/animation__the_nerve_i

mpulse.html




http://intro.bio.umb.edu/111-112/112s99Lect/neuro_anims/restingpotential.html


http://highered.mcgraw-hill.com/sites/0072495855/student_view0/chapter14/animation__the_nerve_impulse.html



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III. INSTRUMENTATION AND STIMULATION

A. Instrumentation

1. Differential Amplifiers—see below references for a-g

a. Analog to Digital Conversion

b. Vertical Resolution

c. Horizontal Resolution

d. Data Points

e. Averaging

f. Filtering Effects

g. Phase Cancellation

All of the above a-g are referenced to: Chiappa K. (1990) Evoked Potentials in Clinical Medicine, 2nd edition. Raven Press. NY, NY.

Chapter 1

Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 6 and 17

Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc. Philadelphia.

Chapter 3

Misulis K. (1994). Spehlmann’s Evoked Potential Primer. Butterworth-Heinemann. Newton,

Mass. Chapters 2 and 3

B. Stimulators

1. Constant Current-

Kimura J. (1989) Principles of Nerve conduction studies Electrodiagnosis in Diseases of Nerve

and Muscle: Principles and Practice. Chapter 5

2. Volume Conduction

ibid - Kimura Chapter 2: Electrical Properties of Nerve and Muscle


3. Anodal Block


Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus, Inc. Philadelphia, PA. Chapter

11: Pitfalls

4. Parameters

ibid Kimura Chapter 5: Principles of Nerve Conduction studies

a. Intensity


b. Duration


c. Polarity



11

5. Artifact

Dumitru D. (1995) ) Electrodiagnostic Medicine. Hanley & Belfus, Inc. Philadelphia, PA

Chapter 3: Instrumentation

C. Stimulation

1. Parameters

a. Intensity



Clinical-Electrophysiological Correlations. Butterworth-Heinemann, Newton, MA

Chapter 3

b. Duration




Chapter 3

c. Polarity




Chapter 3

2. Concepts and Pitfalls

a. Anodal Block Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 7 and 5


Practice. Edition 3. New York: Oxford University Press, Inc. p. 913

b. Volume Conduction

Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 7 and 5


Practice. Edition 3. New York: Oxford University Press, Inc. p. 919

c. Stimulus Jumping Kimura J. (2006) Handbook of Clinical Neurophysiology: Peripheral Nerve Diseases.

Amsterdam. Elsevier Health Sciences. p. 148

d. Stimulus Artifact Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc.




Chapter 8

3. Excessive Stimulation

Aminoff M. (1998) Electromyography in clinical practice, 3rd edition. Chapter 7: Nerve

conduction studies: basic principles and pathologic correlations. Churchill Livingstone, Inc, NY

12

4. Stimulus Artifact

Crout B, Flicek C. (1997). Nerve conduction studies from A to Z. Chapter 6: NCS basics.

American Society of Electroneurodiagnostic Technologists, Iowa.

Kimura J. (1989) Electrodiagnosis in diseases of nerve and muscle; principles and practice, 2nd

edition. Chapter 5: Principles of nerve conduction studies. FA Davis Company, Philadelphia

13

IV.PLEXUS AND CUTANEOUS DISTRIBUTIONS

A. Brachial Plexus

1. Spinal Roots


2. Anterior and Posterior Rami


3. Brachial Plexus


Electrophysiological Correlations. Elsevier Butterworth Heinemann, Philadelphia, PA. Section 1.

Overview of Nerve Conduction Studies and Electromyography. Chapter 2. Anatomy and

Physiology

Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd edition.. Lippincott

Williams and Wilkins, Philadelphia. Chapter 5

a. Trunks Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 1

b. Divisions Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 1

c. Cords Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 1

d. Peripheral Nerves Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 1

e. Myotomes Preston D, Shapiro B. (2005) Electromyography and Neuromuscular Disorders:

Clinical-Electrophysiological Correlations. Elsevier Butterworth Heinemann,

Philadelphia, PA. Section 1. Overview of Nerve Conduction Studies and

Electromyography. Chapter 2. Anatomy and Physiology


Practice, Ed. 2. EA Davis, Co. Philadelphia, PA. Chapter 1. Anatomic Basis for

Localization. Sections 3 and 4.


B. Cutaneous Distributions

1. Dermatomes

CIBA—Collection of Medical Illustrations. Volume 1. Nervous System. Page 55 a. Upper

Extremity


Chapter 18


a. Lower Extremity




14

CIBA—Collection of Medical Illustrations. Volume 1. Nervous System Page 55

2. Sensory Nerves

a. Upper Extremity

Oh S. (2003). Clinical electromyography: nerve conduction studies, 3rd edition.

Lippincott Williams and Wilkins, Philadelphia. Chapter 5.

b. Lower Extremity


Lippincott Williams and Wilkins, Philadelphia Chapter 5

Crout B, Flicek C. (2005) Nerve Conduction Studies from A to Z, A Self-Study

Training Manual for the EDT. The American Society of Electroneurodiagnostic

Technologists, Inc., Chapter- NCS Anatomy.

C. Cranial Nerves I-XII

1. Anatomy

a. Innervations

CIBA—Collection of Medical Illustrations.Volume 1. Nervous System Pages 42-43

b. Cutaneous Sensation


Practice, Ed. 2. EA Davis, Co., Philadelphia, PA. Chapter 1. Anatomic Basis for

Localization. Section 2.

ASET. Fundamentals of Nerve Conduction Studies. 2007. Basic Anatomy of the

Peripheral Nervous System. Kansas City, MO

2. Testing

a. Blink Reflex Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 15

b. Facial Nerve Preston D, Shapiro B. (2005) Electromyography and Neuromuscular Disorders:


Philadelphia, PA. Chapter 22

c. Electrophysiologic Testing Kimura J. (1989) Electrodiagnosis in Diseases of Nerve and Muscle: Principles and

Practice. Part 5.Tests for Less Accessible Regions of the Nervous System. Chapter 16.

The Blink Reflex.


Clinical-Electrophysiological Correlations. Section 2. Fundamentals of Nerve

Conduction Studies. Chapter 5 AND Section 4. Detailed Nerve Conduction Studies,

Chapter 10.

Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. ASET, Chapter 8.

Uncommon Studies.

D. Neuromuscular Junction Disorders

1. Presynaptic

a. Lambert-Eaton Syndrome

b. Botulism

15

a & b can be found in these references:

Dumitru D. (1995) Electrodiagnostic Medicine. Neuromuscular Junction Disorders.

Hanley & Belfus, Inc/Philadelphia. Chapter 19

Aminoff M. (1998) Electromyography in clinical practice, 3rd edition, Chapter 16:

Neuromuscular transmission and its disorders. Churchill Livingstone, Inc, NY.


Chapter 1: Anatomical and physiological basis for electromyography studies.

Lippincott Williams and Wilkins, Philadelphia.



Chapter 30


Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd edition,


2. Postsynaptic

a. Myasthenia Gravis Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. Diseases &

Disorders of the PNS. ASET.

Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus, Inc/Philadelphia.

Chapter 19 Neuromuscular Junction Disorders.




Chapter 1: Anatomical and physiological basis for electromyography studies.


3. Repetitive Stimulation Testing

a. Decremental Aminoff M. (1998). Electromyography in clinical practice, 3rd edition, Chapter 16:

Neuromuscular transmission and its disorders. Churchill Livingstone, Inc, NY

.


Kimura J. (1989). Electrodiagnosis in diseases of nerve and muscle; principles and

practice, 2nd edition, Chapter 9: Techniques of repetitive stimulation. FA Davis

Company, Philadelphia.

b. Incremental Oh S. (2003) Clinical Electromyography Nerve Conduction Studies, Third Edition.

Lippincott Williams & Wilkins Philadelphia, PA. Chapter 2, General Concepts of

Electrodiagnostic Studies In Neuromuscular Disease



Kimura J. (1989) Electrodiagnosis in diseases of nerve and muscle; principles and

practice, 2nd edition, Chapter 9: Techniques of repetitive stimulation. FA Davis


Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus, Inc., Philadelphia,

PA. Chapter 19, Neuromuscular Junction Disorders


16



Philadelphia, PA.Chapter 30

4. Abnormalities:



Kimura J. (1989) Electrodiagnosis in diseases of nerve and muscle; principles and practice, 2nd

edition. Chapter 24: Myasthenia gravis and other disorders of neuromuscular transmission. FA

Davis Company, Philadelphia.

5. Post Activation

a. Facilitation

Kimura J. (1989) Electrodiagnosis in diseases of nerve and muscle; principles and

practice, 2nd edition. AAEE Glossary of terms in clinical electromyography. FA Davis






b. Exhaustion

Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus, Inc., Philadelphia,

PA. Chapter 19, Neuromuscular Junction Disorders


17

V. NEUROMUSCULAR JUNCTION TRANSMISSION AND NERVE

CONDUCTION VELOCITY TECHNIQUES

A. Late Responses

1. F-waves

a. Origin Dumitru D. (1995) Electrodiagnostic Medicine. Chapter 5Special Nerve Conduction

Techniques, specifically pages 191-196. Hanley & Belfus, Inc/Philadelphia

Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. Chapter 7 Common

Studies. ASET.


b. Applications

1. Technical Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and



2. Clinical Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 11






c. Relationship to M wave and Habituation—see above references

B. Transmission of Repetitive Nerve Stimulation Studies

Oh S. (1988) Electromyography. Neuromuscular Transmission Studies. Williams and Wilkins. Chapter 4

1. Technical Set Up

a. Electrode Stabilization—see 1b 1 and 2 (below)

b. Stimulation Parameters

1. Low Frequency


and Chapter 17

2. High Frequency

Kimura J. (1989). Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice.

Chapter 9. Techniques of Repetitive Stimulation.

Preston D, Shapiro B. (2005) Electromyography and Neuromuscular Disorders: Clinical

Electrophysiological Correlations. Section 2. Fundamentals of Nerve Conduction Studies.

Chapter 6 AND Section 3. Sources of Error: Anomalies, Artifacts, Technical Factors, and

Statistics. Chapter 9.


18

3. Evaluation

a. Incremental Studies Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 12

b. Decremental Studies Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 12

c. Facilitation Preston D, Shapiro B. (2005) Electromyography and Neuromuscular Disorders:



d. Abnormalities

1. Pre-Synaptic Preston D, Shapiro B. (2005) Electromyography and Neuromuscular

Disorders: Clinical-Electrophysiological Correlations. Elsevier Butterworth

Heinemann, Philadelphia, PA. Chapter 30

2. Post-Synaptic Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd

edition, Lippincott Williams and Wilkins, Philadelphia Chapter 4





Crout B, Flicek C. (1997). Nerve conduction studies from A to Z. Chapter 8:

Uncommon studies. Diseases & Disorders of the PNS. American Society of

Electrodiagnostic Technologists, Iowa.

Dumitru D. (1995) Electrodiagnostic Medicine. Neuromuscular Junction

Disorders. Hanley & Belfus, Inc/Philadelphia. Chapter 19

19

VI. NERVE CONDUCTION VELOCITY CONCEPTS AND WALLERIAN

DEGENERATION

A. Nerve Conduction

1. Anatomy

a. Pre and Post Ganglionic Lesions

1. Localization—see reference below

2. Effects—see reference below

Brown W. (1993) Clinical Electromyography, 2nd edition. Butterworth and

Heinemann, Boston. Chapter 7

b. Neurapraxic Lesions Stimulation

1. Distal Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and


Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 7-9

2. Proximal Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 3

and Chapter 7-9

Kimura J. (1989) Electrodiagnosis in Diseases of Nerveand Muscle:

Principles and Practice, Ed 2. F.A. Davis Company Philadelphia. Chapter 4

c. Nerve Conduction Studies

1. Focal Lesions

Kimura J. (1989). Electrodiagnosis in Diseases of Nerve and Muscle;

Principles and Practice, 2nd edition, Chapter 4: Anatomy and physiology of

the peripheral nerve. FA Davis Company, Philadelphia.

Oh S. (2003). Clinical electromyography: nerve conduction studies, 3rd

edition, Chapter 19: Magnetic and HVLI electrical stimulation tests.



2. Diffuse Processes

Crout B, Flicek C. (1997) Nerve conduction studies from A to Z. Chapter 9: Diseases and

disorders of the PNS. American Society of Electroneurodiagnostic Technologists, Iowa.


3. Multifocal Disorders

Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd edition, Chapter 23:

Nerve conduction in polyneuropathies. Lippincott Williams and Wilkins, Philadelphia.

4. Waveform Evaluation

1. Temporal Dispersion

a. Normal Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 27

20

b. Abnormal Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd

edition. Lippincott Williams and Wilkins, Philadelphia. Chapter 20


c. Amplitude Drop Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 27


Disorders: Clinical-Electrophysiological Correlations. Section 2.

Fundamentals of Nerve Conduction Studies. Chapter 3

d. Stimulation Concepts


Disorders: Clinical-Electrophysiological Correlations. Elsevier Butterworth

Heinemann, Philadelphia, PA. Chapter 3

2. Parameters

a. Nerve Conduction Parameters

1. Latency Preston D, Shapiro B. (2005) Electromyography and

Neuromuscular Disorders: Clinical-Electrophysiological

Correlations. Elsevier Butterworth Heinemann, Philadelphia, PA.

Chapter 3

Crout B, Flicek C. (2004) Nerve Conduction Studies from A to Z.

Chapter 6: NCS Basics

2. Amplitude Preston D, Shapiro B. (2005) Electromyography and



Chapter 3

Crout B, Flicek C. (2004) Nerve Conduction Studies from A to Z.

Chapter 6: NCS Basics

3. Area Preston D, Shapiro B. (2005) Electromyography and



Chapter 3

Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus,

Inc/Philadelphia. Chapter 4: Nerve Conduction Studies

4. Duration Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus,


Preston D, Shapiro B. (2005) Electromyography and



Chapter 3

5. Rise Time Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus,


21




Chapter 3

6. Normal Values

Crout B and Flicek C. (1997) Nerve Conduction Studies from A to

Z. ASET. Nerve conduction parameters sections 1-6; Chapter 5:

NCS Physiology




Chapter 3


Inc/Philadelphia. Chapter 4: Nerve Conduction Studies starting on

page 124.

3. Volume Conduction


Volume Conduction Chapter 2

Crout, B. and Flicek, C. (2004) Nerve Conduction Studies from A to Z. ASET. NCS

Basics.

Tan FC. (2004).EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 5

4. Anodal Block

Dumitru, D (1995) Electrodiagnostic Medicine. Hanley & Belfus, Inc/Philadelphia.

Pages 60, 135, 424/425, 1172.

Crout B, Flicek C. (2004) Nerve Conduction Studies from A to Z. ASET. NCS Basics.

5. Stimulus Jumping

http://www.ncbi.nlm.nih.gov/pubmed/7664514


Kimura J. (2006) Handbook of Clinical Neurophysiology: Peripheral Nerve Diseases.

Amsterdam. Elsevier Health Sciences. p. 148


Clinical-Electrophysiological Correlations. Section 2. Fundamentals of Nerve

Conduction Studies. Chapters 2 and 3

6. Late Responses

a. Clinical Utility


b. Physiologic Origin


Disorders: Clinical-Electrophysiological Correlations. Section 2.

Fundamentals of Nerve Conduction Studies. Chapter 4.

Thompson LL. (1981) The Electromyographer’s Handbook. Little, Brown,

and Co. Boston, MA. Chapters 15 and 16


http://www.ncbi.nlm.nih.gov/pubmed/7664514

22

7. Pediatric Nerve Conduction

a. Maturation

Dyck, P. (1993). Peripheral Neuropathy. Volume 1. W.B. Saunders

Company, Philadelphia. Page 605

b. Technical Considerations

a and b above referenced to: Jones, Jr., Royden H., Bolton CF., Harper Jr., C. Michel C. (1996) Pediatric

Clinical Electromyography. Lippincott-Raven, Philadelphia, PA. Chapter 1,

An approach to Pediatric Electromyography


B. Wallerian Degeneration

1. Neuropraxia


Chapter 4

2. Axonotmesis


Chapter 4

3. Neurotmesis


Chapter 4

Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd edition, Lippincott

Williams and Wilkins, Philadelphia. Chapter 23


Brown W. (1993) Clinical Electromyography, 2nd edition. Butterworth and Heinemann, Boston.

Chapter 13


2. F.A. Davis Company Philadelphia. Chapter 4

23

VII. TERMINOLOGY AND CASE HISTORIES

A. Neuroanatomy

1. Upper Extremity

a. Median Nerve

1. Anterior Interosseous Nerve Preston D, Shapiro B. (1998) Electromyography and Neuromuscular



2. Carpal Tunnel Preston D, Shapiro B. (1998) Electromyography and Neuromuscular



3. Palmar Cutaneous Branch Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 28

and 29






Tan FC. (2004. EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 28

b. Ulnar Nerve

1. Dorsal Ulnar Cutaneous Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and


2. Ulnar Neuropathies

a. Condylar Groove Dumitru D. (2002). Electrodiagnostic Medicine 2nd edition. Hanley

and Belfus, Inc. Philadelphia. Chapter 24

b. Cubital Tunnel Dumitru D. (2002). Electrodiagnostic Medicine 2nd edition. Hanley


c. Guyons Canal Dumitru D. (2002). Electrodiagnostic Medicine 2nd edition. Hanley


d. Tardy Ulnar Palsy Dumitru D. (2002). Electrodiagnostic Medicine 2nd edition. Hanley




Correlations. Butterworth-Heinemann, Newton, MA. Chapter 17

Brown W. (1993) Clinical Electromyography, 2nd edition.

Butterworth and Heinemann, Boston. Chapter 10

24

Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia.

Chapter 28

c. Radial Nerve

1. Posterior Interosseous Nerve Oh S. (2003) Clinical Electromyography Nerve Conduction Studies, Third

Edition. Lippincott Williams & Wilkins Philadelphia, PA. Chapter 22, Nerve

Conduction in Focal Neuropathies.

Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus, Inc.,

Philadelphia, PA. Chapter 18, Focal Peripheral Neuropathies.

Dumitru D. (2002). Electrodiagnostic Medicine 2nd edition. Hanley and


2. Superficial Radial Nerve Oh S. (2003) Clinical Electromyography Nerve Conduction Studies, Third


Conduction in Focal Neuropathies.

Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus, Inc.,

Philadelphia, PA. Chapter 18,Focal Peripheral Neuropathies.

3. Saturday Night Palsy Oh S. (2003) Clinical Electromyography Nerve Conduction Studies, Third


Conductio in Focal Neuropathies.


Philadelphia, PA. Chapter 18, Focal Peripheral Neuropathies.








d. Musculocutaneous Nerve/Lateral Antebrachial Preston D, Shapiro B. (1998) Electromyography and Neuromuscular Disorders:


Chapter 27



2. Lower Extremity

a. Lumbrosacral Plexus Brown W. (1993) Clinical Electromyography, 2nd edition. Butterworth and Heinemann,

Boston. Chapter 7




b. Saphenous Nerve Brown W. (1993) Clinical Electromyography, 2nd edition. Butterworth and Heinemann,

Boston. Chapter 12

25

Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition., Hanley and Belfus, Inc.


c. Obturator Nerve Brown W. (1993) Clinical Electromyography, 2nd edition. Butterworth and Heinemann,

Boston. Chapter 7

d. Lateral Femoral Cutaneous

all above: Preston D, Shapiro B. (1998) Electromyography and Neuromuscular Disorders:


Chapter 28

e. Sciatic Nerve

1. Common Peroneal Dumitru D. (2002). Electrodiagnostic Medicine 2nd edition. Hanley and


a. Deep Dumitru D. (2002). Electrodiagnostic Medicine 2nd edition. Hanley





Chapter 19

b. Superficial Oh SJ. (2003) Clinical Electromyography Nerve Conduction

Studies, Ed. 3. Lippincott Williams & Wilkins. Philadelphia, PA.

Chapter 22, Nerve Conduction in Focal Neuropathies.

2. Posterior Tibial Nerve



3. Sural Nerve Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and


3. Cranial Nerves I-XII

ASET. (2007) Fundamentals of Nerve Conduction Studies. 2007. Kansas City, MO. Basic

Anatomy of the Peripheral Nervous System.

CIBA—Collection of Medical Illustrations. Volume 1. Nervous System

4. Other Nerves

a. Phrenic Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc.

Philadelphia. Chapter 5 and 22

b. Suprascapular Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc.


c. Long Thoracic Preston D, Shapiro B. (2005). Electromyography and Neuromuscular Disorders:

Clinical-Electrophysiological Correlations. Section 4. Detailed Nerve Conduction

Studies. Chapter 10.

26


Practice. Part 1. Chapter 1. Anatomic Basis for Localization. Section 4

Crout B, Flicek C. (2004) Nerve Conduction Studies from A to Z. ASET. Chapter 8.

Uncommon Studies.



B. Clinical Syndromes

1. Motor Neuron

Aminoff M. (1998) Electromyography in clinical practice, 3rd edition, Chapter 12: Motor neuron

disorders. Churchill Livingstone, Inc, NY.

a. Syringomyelia Kimura J. (1989) Electrodiagnosis in diseases of nerve and muscle; principles and

practice, 2nd edition. Chapter 13: Types of abnormality, and Chapter 20: Diseases of

the motor neuron. FA Davis Company, Philadelphia.



b. Amyotrophic Lateral Sclerosis


Motor neuron disorders. Churchill Livingstone, Inc, NY.

Oh S. (2003) Clinical electromyography: nerve conduction studies, 3rd edition,

Chapter 23: Nerve conduction in polyneuropathies. Lippincott Williams and Wilkins,

Philadelphia.

c. Poliomyelitis





d. Spinal Muscular Atrophy



2. Dorsal Root Ganglion

a. Friedrich’s Ataxia



Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. ASET. P. 178

Dyck, P. (1993). Peripheral Neuropathy. Volume 1 . W.B. Saunders Company,

Philadelphia. Page 677

b. Sjogren’s Neuropathy Brown W. (1993) Clinical Electromyography, 2nd edition. Butterworth and Heinemann,

Boston. Chapter 15

3. Root

a. Radiculopathy Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus, Inc/Philadelphia.

Chapter 13 Radiculopathies.

27

Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. ASET. Chapter 10






Brown W. (1993) Clinical Electromyography, 2nd edition. Butterworth and Heinemann,

Boston. Chapter 8

b. Polyradiculopathy

Dumitru, D. (1995) Electrodiagnostic Medicine. Hanley & Belfus, Inc., Philadelphia. p

773



c. Root Avulsion


Boston. Chapter 8




Chapter 14, specifically pages 587, 595, 596

4. Plexus Lesions

a. Erb’s Palsy




b. Neurogenic Thoracic Outlet Syndrome Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc.


c. Parsonage Turner

Kimura J. (1989) Electrodiagnosis of Nerve and Muscle: Principles and Practice.

Chapter 21. Diseases of the Root and Plexus.

Preston D, Shapiro B. (2005). Electromyography and Neuromuscular Disorders:

Clinical-Electrophysiological Correlations. Section 6. Clinical Electrophysiological

Correlations. Chapter30.

5. Mononeuropathies

a. Common Sites of Entrapment Preston D, Shapiro B. (2005) Electromyography and Neuromuscular Disorders:


Philadelphia, PA. Chapters 16-22

b. Clinical Syndromes


Philadelphia Chapter 24

Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z ASET. Pages 178-

181

28

c. Mononeuropathy Multiplex



6. Peripheral Polyneuropathies

a. Hereditary

1. Diffusely Demyelinating



Dyck, P. (1993). Peripheral Neuropathy. Volume 2. W.B. Saunders

Company, Philadelphia. Chapter 57

2. Axonal Dyck, P. (1993). Peripheral Neuropathy. Volume 2. W.B. Saunders

Company, Philadelphia. Chapter 57

b. Acquired Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc.


Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. ASET. Pages 177-

178

1. Demyelinating—see references above and below

a. AIDP Brown W. (1993) Clinical Electromyography, 2nd edition.


Dyck, P. (1993). Peripheral Neuropathy. Volume 2.

W.B. Saunders Company, Philadelphia. Chapter 80

b. CIDP Brown W. (1993) Clinical Electromyography, 2nd edition.




2. Axonal

a. Toxic

Crout B, Flicek C. (1997) Nerve Conduction Studies

from A to Z. ASET. Page 176



b. Metabolic

Kimura J. (1989) Electrodiagnosis in Diseases of Nerve

and Muscle: Principles and Practice, Edition 2. F.A.

Davis Company Salem, MA. Chapter 22,

Polyneuropathies.

Aminoff M. (1999) Electrodiagnosis In Clinical

Neurology, Fourth Edition. Churchill Livingstone

Philadelphia, PA. Chapter 17, Evaluation of the

Autonomic Nerve System and Chapter 33,

Electrophysiologic Techniques in the Evaluation of

Patients with Suspected Neurotoxic Disorders.

29

7. Muscle

a. Muscular Dystrophy


Chapter 20, specifically pages 1067-1083.

b. Myopathies


Chapter 20.



Chapter 31

c. Polymyocitis


Boston. Chapter 24





Chapter 20, specifically pages 1054-1056.

30

VIII. TEMPERATURE AND ANOMALIES

A. Temperature

1. Effects on Latency and Velocity

a. Amplitude



Chapter 8




b. Correction Factors



Chapter 8

2. Effects on Repetitive Stimulation Factors


2.F.A. Davis Company, Philadelphia. Chapter 9, Techniques of Repetitive Stimulation

Oh SJ. (2003) Clinical Electromyography Nerve Conduction Studies, Ed. 3. Lippincott Williams

& Wilkins Philadelphia, PA. Chapter 13, Physiological Factors Affecting Nerve Conduction.


B. Anomalies

1. Martin Gruber Anastomosis

Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. ASET. Pages 115-119

Oh S. (2003) Clinical Electromyography Nerve Conduction Studies, Third Edition. Lippincott

Williams & Wilkins Philadelphia, PA. Chapter 14, Anomalous Innervation


a. Hypothenar—see above

b. First Dorsal Interosseous—see above

c. Thenar—see above

2. Riches-Cannieu Anastomosis


Williams & Wilkins Philadelphia, PA. Chapter 14, Anomalous Innervation



Chapter 15

3. Accessory Peroneal


Chapter 15

31


Williams & Wilkins Philadelphia, PA. Chapter 14, Anomalous Innervation.


Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. ASET. Page 135

C. Infection Control

1. 1994 Guidelines

a. Infection Transmission

b. Modes of Transmission

c. Disaffection and Decontamination http://www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html

2. Transmissible Diseases/Standard (Universal) Precautions

a. HIV

b. Hepatitis

c. Jakob Creutzfeldt http://www.cdc.gov/ncidod/dhqp/bp_universal_precautions.html

D. Electrical Safety

1. Ground Loops

Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. ASET Kansas City, MO.

Chapter 3, Instrumentation.

Dumitru D. (2002) Electrodiagnostic Medicine 2nd edition. Hanley and Belfus, Inc. Philadelphia

Chapter 2

Kimura J. (1989) Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice,

Edition 2. F.A. Davis Company Salem, MA. Appendix 3, Electrical Safety.

2. Leakage Current

Crout B, Flicek C. (2004) Nerve Conduction Studies from A to Z. ASET Kansas City, MO.

Chapter 3, Instrumentation.



Aminoff M. (1999) Electrodiagnosis In Clinical Neurology, Fourth Edition. Churchill

Livingstone Philadelphia, PA. Chapter 2, Electrophysiologic Equipment and Electrical Safety.


Chapter 2

3. Electrically Sensitive Patients



Crout B, Flicek C. (1997) Nerve Conduction Studies from A to Z. ASET. Page 87

http://www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html

http://www.cdc.gov/ncidod/dhqp/bp_universal_precautions.html

32

E. Physiologic Factors

1. Temperature


& Wilkins Philadelphia, PA Chapter 13: Physiological Factors Affecting Nerve Conduction


Chapter 5

2. Age




Chapter 5

3. Body Length




Chapter 5

4. Anomalous Innervation


& Wilkins Philadelphia, PA Chapter 14: Anomalous Innervation


Chapter 5


Electrophysiological Correlations. Butterworth-Heinemann, Newton, MA. Chapter 7-8

F. Other Factors

1. Technical

All of the below can be found at: Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 7


Chapter 3



Dumitru D. (1995) Electrodiagnostic Medicine. Hanley & Belfus, Inc., Philadelphia. Chapter 11.

Crout B, Flicek C. (2004) Nerve Conduction Studies from A to Z. ASET. Chapter 6.

a. Electrode Size—see above

b. Electrode Polarity—see above

c. Distance of Reference—see above

d. Recording Electrode Placement—see above

e. Measuring Errors—see above

33

f. Limb Position—see above

g. Antidromic vs Orthodromic—see above

2. Instrumental

a. Equipment Parameters


Philadelphia. Chapter 2-3 and 5

Oh, S. (1993) Clinical Electromyography: Nerve Conduction Studies, Second Edition.

Williams and Wilkins, Baltimore. Chapter 3.



Chapter 3

1. Filter—see above references

2. Sweep Speed—see above references

3. Gain—see above references

4. Cursor Placement—see above references

b. Errors in Stimulation

1. Excessive Stimulation

Kimura J. (2006) Handbook of Clinical Neurophysiology: Peripheral Nerve

Diseases. Amsterdam. Elsevier Health Sciences. p. 148



p. 919



2. Stimulus Artifact Tan FC. (2004) EMG Secrets. Hanley and Belfus, Philadelphia. Chapter 5



p. 47



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