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QuickTime compatibility added
The videos in the EMG tutorial can now be viewed on the Apple iPad, iPod touch, and other machines that require QuickTime.
 



Online Course Content



Vasculature of the brain
Vasculature of the BrainA tutorial on the arterial and venous supply of the brain.  Terminology:By the end of this section, make certain that you understand what each of these terms mean, and can apply them appropriately.  If applicable, make sure you can...
 
Venous drainage of the brain
A tutorial on the venous drainage of the brain.
 
Arteries of the brain
A tutorial on the arterial supply of the brain.
 
Primitive Reflexes - Closing Remarks
IN CLOSINGThe long-term prognosis of an infant does not always correlate to the neurologic exam.  It's important to remember that these reflexes can vary with the examiner's experience as well as the alertness of the infant. To determine an abnormal...
 
Primitive Reflexes
Welcome.This is a mini-course written by Lizzy Freeman, M.S. III, and J. Douglas Miles, M.D., Ph.D. , and Dr. Mitzi Payne, all from Marshall University in West Virginia.  This mini-course is a brief tutorial on the primitive reflexes - those reflexes which...
 
Online courses
On FrontalCortex.com, you can create a collection of multimedia resources organized into a coherent structure focused on one topic.This is considered an online course. An example of this is the neuropathology course, or the EMG course. Mixing with Face-to-Face...
 
FrontalCortex.com User Tutorials
Welcome to FrontalCortex.com.This website is a free resource for residents, medical students, electrodiagnostic technologists, and others interested in studying topics in neurology. This is a very useful site.  It may help you to know a little more about it...
 
Topics in Basic Neurology
This course will feature several resources on the basics of neurology, at the level appropriate for a medical student.  A brief tutorial on primitive reflexes can be found here.  A brief module on the peripheral nervous system and the physical exam has recently been added.
 
Nerve Conduction Studies for Electrodiagnostic Technologists
A searchable, illustrated tutorial for nerve conduction studies, by Steven Arbogat, D.O., and J. Douglas Miles, M.D., Ph.D.This tutorial covers a wide array of nerve conduction studies (NCS). We have attempted to organize the tutorial in a logical approach...
 
Upper Extremity Nerve Conduction Studies
MotorAxillary Motor Nerve - recording the Deltoid  Median and Ulnar motor nerves- Recording the 2nd Lumbrical and interossei Median Motor Study - Recording the Abductor Pollicis Brevis Musculocutaneous Motor Nerve - recording the Biceps  Radial Motor Nerve...
 
Motor Nerve Conduction Studies
Axillary Axillary Motor Nerve - recording the DeltoidFacial Facial Motor Nerve – recording the Orbicularis OculiFemoralFemoral Motor Nerve - recording the Rectus FemorisMedian Median Palmar Mixed Nerve (orthodromic) Median Motor Study - Recording the...
 
Special Studies
Blink Blink Reflexes – recording the Orbicularis OculiF-waves F-WavesFacial Facial Motor Nerve – recording the Orbicularis OculiH-ReflexH-Reflex - recording the SoleusPhrenic Motor StudyPhrenic Motor Nerve Conduction StudyRepetitive Stimulation...
 
Nerve Conduction Studies (NCS) Tutorial
All Nerves   Upper Extremity Nerve Conduction Studies Lower Extremity Nerve Conductions  Motor Nerve Conduction Studies Sensory Nerves  Special Studies      These are studies not performed on a regular basis, including facial motor responses, repetitive nerve...
 
Median Sensory Nerve - Recording the middle finger (antidromic)
Median Sensory Nerve - middle (antidromic)Origin:  C7 root, middle trunk and lateral cord of the brachial plexus, median nerveRecording Site:  Middle fingerReference Site:  Middle fingerGround:  Palm or top of handStimulation Site:  WristProcedure:  The recording...
 
Median Sensory Nerve - Recording the thumb (antidromic)
Origin:  C6-C7 root, upper and middle trunk and lateral cord of the brachial plexus, median nerve.Recording Site:  ThumbReference Site:  ThumbGround:  Palm or top of handStimulation Site:  WristProcedure:  The recording electrode is placed on the proximal phalanx of the thumb...
 
Ulnar Sensory Nerve - Recording the little finger (antidromic)
Origin:  C8 root, lower trunk and lateral cord of the brachial plexus, ulnar nerveRecording Site:  Little fingerReference Site:  Little fingerGround:  Palm or top of handStimulation Site:  Wrist Procedure:  The recording electrode is placed on the proximal phalange of the little finger...
 
Dorsal Ulnar Sensory Nerve (antidromic)
Origin:  C8 root, lower trunk and medial cord of the brachial plexusRecording Site:  Top of handReference Site:  Base of 5th fingerGround:  Top of HandStimulation Site:  WristProcedure:  The recording electrode is placed on the dorsum of the hand at the bottom...
 
Radial Sensory Nerve (antidromic)
Origin:  C6-C7 roots, upper or middle trunk and posterior cord of the brachial plexus, radial nerveRecording Site:  Base of the FDI web space between the index finger and thumbReference Site:  Base of thumbGround:  Palm or top of handStimulation Site:  Radius...
 
Median Sensory Nerve - Recording the ring finger (antidromic)
Origin:  C7 roots, middle trunk and lateral cord of the brachial plexus.Recording Site: Ring FingerReference Site:  Ring FingerGround:  Palm or top of handStimulation Site:  Wrist Procedure:  The recording electrode is placed on the proximal phalanx of the ring finger...
 
Ulnar Sensory Nerve - Recording the ring finger (antidromic)
Origin:  C8 root, lower trunk and lateral cord of the brachial plexus.Recording Site:  Ring fingerReference Site:  Ring fingerGround:  Palm or top of handStimulation Site:  WristProcedure:  The recording electrode is placed on the proximal phalange of the fourth finger...
 
Median Palmar Mixed Nerve (orthodromic)
Recording Site:  Wrist over median nerve (bar electrode)Reference Site:  Wrist over median nerve (bar electrode)Ground:  Top of handStimulation Site:  Palm, between the 2nd and 3rd metacarpal bones.Procedure:  The recording and reference electrodes (bar electrode)...
 
Ulnar Palmar Mixed Nerve (orthodromic)
Recording Site:  Wrist over the ulnar nerve (bar electrode)Reference Site:  Wrist over the ulnar nerve (bar electrode)Ground:  Top of handStimulation Site:  Palm, between the 4th and 5th metacarpal bones.Procedure:  The recording and reference electrodes (bar...
 
Lateral Antebrachial Cutaneous Sensory Nerve (antidromic)
Origin:  C6 root, upper trunk and lateral cord of the brachial plexus,       Musculocutaneous nerveRecording Site:  Forearm (bar electrode)Reference Site:  Forearm (bar electrode)Ground:  ForearmStimulation Site:  ElbowProcedure:  The recording and reference...
 
Medial Antebrachial Cutaneous Sensory Nerve - Forearm (antidromic)
Origin:  C8-T1 root, lower trunk and medial cord of the brachial plexusRecording Site:  Forearm (bar electrode)Reference Site:  Forearm (bar electrode)Ground:  ForearmStimulation Site:  ElbowProcedure:  The recording and reference electrodes (bar electrode)...
 
Sensory Nerves
Lateral Antebrachial CutaneousLateral Antebrachial Cutaneous Sensory Nerve - Forearm(antidromic) Lateral Femoral Cutaneous Lateral Femoral Cutaneous Sensory Nerve – recording the lateral thigh (antidromic)Medial Antebrachia; Cutaneous Medial Antebrachial...
 
Lower Extremity Nerve Conductions
SensoryLateral Femoral Cutaneous Sensory Nerve – recording the lateral thigh (antidromic)Saphenous Sensory Nerve – recording anterior to the Medial Malleolus (antidromic)Superficial Peroneal Sensory Nerve - recording anterior to the Lateral Malleolus...
 
All Nerves
A list of all nerves commonly tested in alphabetic order.Axillary Axillary Motor Nerve - recording the DeltoidBlink Blink Reflexes – recording the Orbicularis OculiF-waves F-WavesFacial Facial Motor Nerve – recording the Orbicularis OculiFemoralFemoral...
 
Median Motor Study - Recording the Abductor Pollicis Brevis
Origin:  C8-T1 roots, lower trunk and medial cord of the brachial plexus, median nerve.Recording Site:  Abductor Pollicis Brevis muscle (APB)Reference Site:  Base of thumbGround:  Palm or top of handStimulation Sites:  Wrist and elbowProcedure:  The recording...
 
Ulnar Motor Nerve - Recording the Abductor Digiti Minimi (ADM)
Origin:  C8-T1 roots, lower trunk and medial cord of the brachial plexus, ulnar nerveRecording Site:  Abductor Digiti Minimi muscle (ADM)Reference Site:  Base of little fingerGround:  Palm or top of handStimulation Sites:  Wrist, below elbow and above elbow...
 
Ulnar Motor Nerve - Recording the First Dorsal Interosseous (FDI)
Origin:  C8-T1 roots, lower trunk and medial cord of the brachial plexus, ulnar nerveRecording Site:  First Dorsal Interosseous (FDI or 1st DI)Reference Site:  Base of thumbGround:  Palm or Top of HandStimulation Site:  Wrist, below elbow and above elbow.Procedure: ...
 
Median and Ulnar motor nerves- Recording the 2nd Lumbrical and interossei
Origin:    Median – C8-T1 roots, lower trunk and medial cord of the brachial plexus, median nerve.Ulnar – C8-T1 roots, lower trunk and medial cord of the brachial plexus, ulnar nerve.Recording Site:  Palm, between the 2nd and 3rd metacarpal bones...
 
Radial Motor Nerve - Recording the Extenor Digitorum Communis (EDC)
Origin:  C7-C8 roots, middle and lower trunk and posterior cord of the brachial plexus, radial nerve.Recording Site:  Extensor Digitorum Communis muscle (EDC)Reference Site:  Above the wristGround:  Medial forearmStimulation Sites:  Elbow and arm (below and...
 
Musculocutaneous Motor Nerve - recording the Biceps
Origin:  C5-6 roots, upper trunk and lateral cord of the brachial plexus, Musculocutaneous nerve.Recording Site:  Biceps muscleReference Site:  Distal upper armGround:  Upper armStimulation Site:  Axilla and Erb’s point.Procedure:  The recording electrode...
 
Musculocutaneous Motor Nerve - recording the Biceps
Upper ExtremityLower Extremity Motor NervesSensory Nerves All NervesSpecial Studies
 
Axillary Motor Nerve - recording the Deltoid
Origin:  C5-6 roots, upper trunk and posterior cord of the brachial plexus, axillary nerve.Recording Site:  Deltoid muscleReference Site:  Distal upper armGround:  ShoulderStimulation Sites:  Erb’s PointProcedure:  The recording electrode is placed over...
 
Spinal Accessory Motor Nerve - recording the Trapezius
Origin:  C2-C4 roots, cervical plexus, spinal accessory nerve.Recording Site:  TrapeziusReference Site:  ShoulderGround:  Upper backStimulation Site:  Posterior neckProcedure:  The recording electrode is placed on the belly of the trapezius muscle.  The reference...
 
Sural Sensory Nerve - recording behind the Lateral Malleolus (antidromic)
Sural Sensory Nerve (antidromic)Origin:  S1 root, sacral plexus, sciatic nerve, tibial nerve.Recording Site:  Lateral MalleolusReference Site:  Side of the footGround:  Top of footStimulation Site:  Back of lower legProcedure:  The patient should be lying...
 
Superficial Peroneal Sensory Nerve - recording anterior to the Lateral Malleolus (antidromic)
Origin:  L5 root, sacral plexus, sciatic nerve, peroneal nerve.Recording Site:  Lateral lower leg (bar electrode)Reference Site:  Lateral lower leg (bar electrode)Ground:  Medial lower legStimulation:  Lateral lower legProcedure:  The recording and reference...
 
Saphenous Sensory Nerve – recording anterior to the Medial Malleolus (antidromic)
Origin:  L3-4 roots, lumbar plexus, femoral nerveRecording Site:  Lower calf at ankle (bar electrode)Reference Site:  Lower calf at ankle (bar electrode)Ground:  Lower legStimulation Site:  CalfProcedure:  The recording and reference electrodes (bar electrode)...
 
Lateral Femoral Cutaneous Sensory Nerve - recording the lateral thigh (antidromic)
Origin:  L2-3 roots, lumbar plexusRecording Site:  Anterolateral thigh (bar electrode)Reference Site:  Thigh (bar electrode)Ground Site:  ThighStimulation Site:  Iliac crestProcedure:  The recording and reference electrodes (bar electrode) is placed 12cm down from the iliac crest...
 
Medial and Lateral Plantar Mixed Nerves (orthodromic)
Medial and Lateral Plantar Mixed Nerves (orthodromic)Origin:  S1 root, sacral plexus, sciatic nerve, tibial nerveRecording Site:  Ankle (bar electrode)Reference Site:  Ankle (bar electrode)Ground:  Top of footStimulation Site:                Medial foot (medial...
 
Peroneal Motor Nerve - recording the Extensor Digitorum Brevis
Origin:  L5-S1 roots, sacral plexus, sciatic nerve, peroneal nerveRecording Site:  Extensor Digitorum Brevis muscle (EDB)Reference Site:  Top of foot below the 4th and 5th toesGround:  Top of footStimulation Sites:  Ankle, below fibular neck and kneeProcedure: ...
 
Peroneal Motor Nerve - recording the Tibialis Anterior
Origin:  L4-L5 roots, sacral plexus, sciatic nerve, peroneal nerveRecording Site:  Tibialis Anterior muscle (TA)Reference Site:  Top of AnkleGround:  Medial lower legStimulation Sites:  Below the fibular head and kneeProcedure:  The recording electrode is placed over the belly of the TA...
 
Tibial Motor Nerve - recording the Abductor Hallucis
Origin:  S1-S2 roots, sacral plexus, sciatic nerve, tibial nerve.Recording Site:  Abductor Hallucis muscle (AH)Reference Site:  Base of big toeGround:  Top of footStimulation Sites:  Ankle and kneeProcedure:  The recording electrode is placed over the belly of the AH...
 
Tibial Motor Nerve - recording the Abductor Digiti Quinti Pedis
Origin:  S1-S2 roots, sacral plexus, sciatic nerve, tibial nerveRecording Site:  Abductor Digiti Quinti Pedis muscle (ADQP)Reference Site:  Top of foot below 5th toeGround:  Top of footStimulation Site:  Ankle Procedure:  The recording electrode is placed over the belly of the ADQP...
 
Femoral Motor Nerve - recording the Rectus Femoris.
Origin:  L2-L4 roots, lumbar plexus, femoral nerveRecording Site:  Rectus Femoris muscle (Rec Fem)Reference Site:  Distal thighGround:  Medial thighStimulation Site:  GroinProcedure:  The recording electrode is placed over the belly of the Rec Fem.  The reference...
 
H-Reflex - recording the Soleus
Origin:  S1, sacral plexus, sciatic nerve, tibial nerve.Recording Site:  Soleus Reference Site:  Achilles tendon, just above the ankleGround:  Back of leg, halfway between the knee and recording site Procedure:  The patient should be placed in the prone position...
 
Facial Motor Nerve – recording the Orbicularis Oculi
Origin:  Brainstem facial nucleus, facial nerveRecording Site:  Orbicularis OculiReference Site:  Outer canthusGround:  ForeheadStimulation Site:  Front of Lower ear.Procedure:  The recording electrode is placed over the orbicularis oculi muscles, midpoint, just below the lower lid...
 
Blink Reflexes – recording the Orbicularis Oculi
Origin:  Brainstem nuclei, facial nerves, trigeminal nervesRecording Site:  Orbicularis OculiReference Site:  Lateral orbit or side of noseGround:  ForeheadStimulation Site:  Supraorbital notchProcedure:  The recording electrode is placed over the orbicularis oculi...
 
F-Waves
The most common routine F-wave responses are recorded from the Median (APB), Ulnar (ADM), Peroneal (EDB) and the Tibial (AH) motor nerves.  However, F-waves can be recorded from any motor nerve.  F-waves vary in amplitude and latency and may not be recorded following every stimulation...
 
Repetitive Nerve Stimulation for Myasthenia Gravis (post-synaptic neuromuscular junction defect)
The most common slow repetitive stimulation studies are recorded from the  Median (APB), Ulnar (ADM), Spinal Accessory (Trapezius) and the Facial (Orbicularis Oculi) motor nerves.  However, myasthenia gravis repetitive stimulation studies can be performed on any motor point...
 
Repetitive Stimulation for Lambert-Eaton Syndrome (pre-synaptic neuromuscular junction defect)
The most common rapid repetitive stimulation studies are recorded from the Median (APB) or Ulnar (ADM) motor nerves.  However, rapid repetitive stimulation studies can be performed on any motor nerve.After performing the routine motor nerve conduction study...
 
Normal Value Disclaimer
Please be awere that each lab may have its own normal values. These can vary based upon age, temperature, technique and equipment.Age generally leads to a lower amplitude and a prolonged distal latency.  Temperature has significant effects on nerve conduction studies...
 
Axillary Motor Nerve - Anatomy (image)

 
Brachial Plexus (image)

 
Saphenous Sensory Nerve – recording anterior to the Medial Malleolus (antidromic)
Origin:  L3-4 roots, lumbar plexus, femoral nerveRecording Site:  Lower calf at ankle (bar electrode)Reference Site:  Lower calf at ankle (bar electrode)Ground:  Lower legStimulation Site:  CalfProcedure:  The recording and reference electrodes (bar...
 
EMG Tutorial
A searchable, illustrated tutorial for electrodiagnsotic studies, by Steven Arbogat, D.O., and J. Douglas Miles, M.D., Ph.D.This tutorial covers both nerve conduction studies (NCS) and electromyography (EMG). We have attempted to organize the tutorial in a...
 
Lateral Femoral Cutaneous Sensory Nerve - recording the lateral thigh (antidromic)
Origin:  L2-3 roots, lumbar plexusRecording Site:  Anterolateral thigh (bar electrode)Reference Site:  Thigh (bar electrode)Ground Site:  ThighStimulation Site:  Iliac crestProcedure:  The recording and reference electrodes (bar electrode) is placed 12cm down from the iliac crest...
 
Brachial Plexus (image)

 
Axillary Motor Nerve - Anatomy (image)

 
Facial Mononeuropathy/Bell’s Palsy
Facial Mononeuropathy/Bell’s PalsyNerve            Recording Sites        Stimulation SitesFacial (m) bilat    Orbicularis Oculi        earBlink Reflexes bilat    Orbicularis Oculi        supraorbital notchNeedle ExaminationPerform needle exam on the affected side of the face.
 
Phrenic Mononeuropathy
Phrenic MononeuropathyNerve            Recording Sites        Stimulation SitesPhrenic (m) bilat    xyphoid process        anterior neckNeedle ExaminationNeedle exam is not usually performed.
 
Myopathy
MyopathyNerve             Recording Sites        Stimulation Sites         F-WavesMedian (s)         index                wrist       orRadial (s)         thumb                  forearmMedian (m)        APB                wrist and elbow             wristSural...
 
Peripheral Neuropathy/Motor Neuron Disease
Peripheral Neuropathy/Motor Neuron DiseaseNerve            Recording Sites        Stimulation Sites          F-WavesMedian (s)        index and middle        wristUlnar (s)        5th                wristRadial (s)        thumb                forearmMedian...
 
Lumbosacral Plexopathy
Lumbosacral PlexopathyNerve            Recording Sites        Stimulation Sites           F-WavesSural (s) bilat        ankle                calfSup Peron (s) bilat    ankle                lat legPeroneal (m) bilat    EDB                ankle and above knee  ...
 
Sciatic Mononeuropathy
Needle ExaminationPerform needle exam on the symptomatic limb.  Test the minimum of once muscle innervated by the L2, L3, L4, L5 and S1 spinal roots (see Appendix C).  Test the lumbosacral paraspinal muscles at one or more levels.If abnormalities are detected,...
 
Tarsal Tunnel Syndrome
arsal Tunnel SyndromeNerve            Recording Sites        Stimulation Sites     F-Waves    Sural (s)        ankle                calfSup Peron (s)    ankle                lat legMed Plantar(s) bilat    ankle                soleLat Plantar(s) bilat    ankle  ...
 
Femoral Mononeuropathy
Femoral MononeuropathyNerve            Recording Sites        Stimulation Sites          F-WavesSural (s)        ankle                calfSup Peron (s)    ankle                lat legSaphenous (s) bilat    leg                legPeroneal (m)        EDB      ...
 
Peroneal Mononeuropathy
Peroneal MononeuropathyNerve            Recording Sites        Stimulation Sites                F-WavesSural (s)        ankle                calfSup Peron (s) bilat    ankle                lat legPeroneal (m) bilat    EDB                ankle, bel & above...
 
Routine Lower Extremity Back/Leg Pain and Lumbosacral Root Search
LOWER EXTREMITYRoutine Lower Extremity Back/Leg Pain and Lumbosacral Root SearchNerve            Recording Sites        Stimulation Sites            F-WavesSural (s)        ankle                calf    Sup Peron (s)    ankle                lat legPeroneal...
 
Other Upper Extremity Mononeuropathies (Axillary, Musculocutaneous, Suprascapular, Spinal Accessory, etc…)
Nerve Conductions Studies Median sensory recording the index and middle fingers.Ulnar sensory recording the ring finger. Radial sensory recording the dorsal thumb.Lateral antebrachial cutaneous sensory recording the forearm.Median motor recording the abductor pollicis brevis with F-Waves...
 
Radial Mononeuropathy
Nerve Conductions Studies Median sensory recording the index and middle fingers. Ulnar sensory recording the ring finger.  Radial sensory recording the bilateral dorsal thumbs.Median motor recording the abductor pollicis brevis with F-Waves.Ulnar motor recording...
 
Ulnar Mononeuropathy
Median sensory recording index and middle  fingers.Ulnar sensory recording the llittle  finger.Radial sensory recording the dorsal thumb.Dorsal Ulnar sensory recording the dorsum of the handMedian motor recording the abductor pollicis brevis with F-Waves.Ulnar...
 
All Nerves
A list of all nerves commonly tested in alphabetic order.Axillary Axillary Motor Nerve - recording the DeltoidBlink Blink Reflexes – recording the Orbicularis OculiF-waves F-WavesFacial Facial Motor Nerve – recording the Orbicularis OculiFemoralFemoral...
 
Carpal Tunnel Syndrome
Nerve Conductions StudiesMedian sensory recording the  index and middle  fingers. Ulnar sensory recording the llittle finger.Radial sensory recording the dorsal thumb. Median motor recording the abductor pollicis brevis with F-Waves. Ulnar motormotor recording...
 
Sensory Nerves
Lateral Antebrachial CutaneousLateral Antebrachial Cutaneous Sensory Nerve - Forearm(antidromic) Lateral Femoral Cutaneous Lateral Femoral Cutaneous Sensory Nerve – recording the lateral thigh (antidromic)Medial Antebrachia; Cutaneous Medial Antebrachial...
 
Brachial Plexopathy (including Thoracic Outlet Syndrome)
Brachial Plexopathy (including Thoracic Outlet Syndrome)Median sensory recording the bilateral  index and middle fingers.Median sensory recording the bilateral thumbs.Ulnar sensory recording the bilateral llittle fingers.Radial sensory recording the bilateral dorsal thumbs...
 
Nerve Conduction Studies
All Nerves   Upper Extremity Nerve Conduction Studies Lower Extremity Nerve Conductions  Motor Nerve Conduction Studies Sensory Nerves  Special Studies      These are studies not performed on a regular basis, including facial motor responses, repetitive nerve...
 
Special Studies
Blink Blink Reflexes – recording the Orbicularis OculiF-waves F-WavesFacial Facial Motor Nerve – recording the Orbicularis OculiH-ReflexH-Reflex - recording the SoleusRepetitive Stimulation Repetitive Nerve Stimulation for Myasthenia Gravis (post-synaptic...
 
Upper Extremity Nerve Conduction Studies
MotorAxillary Motor Nerve - recording the Deltoid  Median and Ulnar motor nerves- Recording the 2nd Lumbrical and interossei Median Motor Study - Recording the Abductor Pollicis Brevis Musculocutaneous Motor Nerve - recording the Biceps  Radial Motor Nerve...
 
Lower Extremity Nerve Conductions
SensoryLateral Femoral Cutaneous Sensory Nerve – recording the lateral thigh (antidromic)Saphenous Sensory Nerve – recording anterior to the Medial Malleolus (antidromic)Superficial Peroneal Sensory Nerve - recording anterior to the Lateral Malleolus...
 
Motor Nerve Conduction Studies
Axillary Axillary Motor Nerve - recording the DeltoidFacial Facial Motor Nerve – recording the Orbicularis OculiFemoralFemoral Motor Nerve - recording the Rectus FemorisMedian Median Palmar Mixed Nerve (orthodromic) Median Motor Study - Recording the...
 
Median Sensory Nerve - Recording the middle finger (antidromic)
Median Sensory Nerve - middle (antidromic)Origin:  C7 root, middle trunk and lateral cord of the brachial plexus, median nerveRecording Site:  Middle fingerReference Site:  Middle fingerGround:  Palm or top of handStimulation Site:  WristProcedure:  The recording...
 
Median Sensory Nerve - Recording the thumb (antidromic)
Origin:  C6-C7 root, upper and middle trunk and lateral cord of the brachial plexus, median nerve.Recording Site:  ThumbReference Site:  ThumbGround:  Palm or top of handStimulation Site:  WristProcedure:  The recording electrode is placed on the proximal phalanx of the thumb...
 
Ulnar Sensory Nerve - Recording the little finger (antidromic)
Origin:  C8 root, lower trunk and lateral cord of the brachial plexus, ulnar nerveRecording Site:  Little fingerReference Site:  Little fingerGround:  Palm or top of handStimulation Site:  Wrist Procedure:  The recording electrode is placed on the proximal phalange of the little finger...
 
Normal Value Disclaimer
Please be awere that each lab may have its own normal values. These can vary based upon age, temperature, technique and equipment.Age generally leads to a lower amplitude and a prolonged distal latency.  Temperature has significant effects on nerve conduction studies...
 
Repetitive Stimulation for Lambert-Eaton Syndrome (pre-synaptic neuromuscular junction defect)
The most common rapid repetitive stimulation studies are recorded from the Median (APB) or Ulnar (ADM) motor nerves.  However, rapid repetitive stimulation studies can be performed on any motor nerve.After performing the routine motor nerve conduction study...
 
Repetitive Nerve Stimulation for Myasthenia Gravis (post-synaptic neuromuscular junction defect)
The most common slow repetitive stimulation studies are recorded from the  Median (APB), Ulnar (ADM), Spinal Accessory (Trapezius) and the Facial (Orbicularis Oculi) motor nerves.  However, myasthenia gravis repetitive stimulation studies can be performed on any motor point...
 
F-Waves
The most common routine F-wave responses are recorded from the Median (APB), Ulnar (ADM), Peroneal (EDB) and the Tibial (AH) motor nerves.  However, F-waves can be recorded from any motor nerve.  F-waves vary in amplitude and latency and may not be recorded following every stimulation...
 
Blink Reflexes – recording the Orbicularis Oculi
Origin:  Brainstem nuclei, facial nerves, trigeminal nervesRecording Site:  Orbicularis OculiReference Site:  Lateral orbit or side of noseGround:  ForeheadStimulation Site:  Supraorbital notchProcedure:  The recording electrode is placed over the orbicularis oculi...
 
Facial Motor Nerve – recording the Orbicularis Oculi
Origin:  Brainstem facial nucleus, facial nerveRecording Site:  Orbicularis OculiReference Site:  Outer canthusGround:  ForeheadStimulation Site:  Front of Lower ear.Procedure:  The recording electrode is placed over the orbicularis oculi muscles, midpoint, just below the lower lid...
 
H-Reflex - recording the Soleus
Origin:  S1, sacral plexus, sciatic nerve, tibial nerve.Recording Site:  Soleus Reference Site:  Achilles tendon, just above the ankleGround:  Back of leg, halfway between the knee and recording site Procedure:  The patient should be placed in the prone position...
 
Femoral Motor Nerve - recording the Rectus Femoris.
Origin:  L2-L4 roots, lumbar plexus, femoral nerveRecording Site:  Rectus Femoris muscle (Rec Fem)Reference Site:  Distal thighGround:  Medial thighStimulation Site:  GroinProcedure:  The recording electrode is placed over the belly of the Rec Fem.  The reference...
 
Tibial Motor Nerve - recording the Abductor Digiti Quinti Pedis
Origin:  S1-S2 roots, sacral plexus, sciatic nerve, tibial nerveRecording Site:  Abductor Digiti Quinti Pedis muscle (ADQP)Reference Site:  Top of foot below 5th toeGround:  Top of footStimulation Site:  Ankle Procedure:  The recording electrode is placed over the belly of the ADQP...
 
Tibial Motor Nerve - recording the Abductor Hallucis
Origin:  S1-S2 roots, sacral plexus, sciatic nerve, tibial nerve.Recording Site:  Abductor Hallucis muscle (AH)Reference Site:  Base of big toeGround:  Top of footStimulation Sites:  Ankle and kneeProcedure:  The recording electrode is placed over the belly of the AH...
 
Peroneal Motor Nerve - recording the Tibialis Anterior
Origin:  L4-L5 roots, sacral plexus, sciatic nerve, peroneal nerveRecording Site:  Tibialis Anterior muscle (TA)Reference Site:  Top of AnkleGround:  Medial lower legStimulation Sites:  Below the fibular head and kneeProcedure:  The recording electrode is placed over the belly of the TA...
 
Peroneal Motor Nerve - recording the Extensor Digitorum Brevis
Origin:  L5-S1 roots, sacral plexus, sciatic nerve, peroneal nerveRecording Site:  Extensor Digitorum Brevis muscle (EDB)Reference Site:  Top of foot below the 4th and 5th toesGround:  Top of footStimulation Sites:  Ankle, below fibular neck and kneeProcedure: ...
 
Medial and Lateral Plantar Mixed Nerves (orthodromic)
Medial and Lateral Plantar Mixed Nerves (orthodromic)Origin:  S1 root, sacral plexus, sciatic nerve, tibial nerveRecording Site:  Ankle (bar electrode)Reference Site:  Ankle (bar electrode)Ground:  Top of footStimulation Site:                Medial foot (medial...
 
Saphenous Sensory Nerve – recording anterior to the Medial Malleolus (antidromic)
Origin:  L3-4 roots, lumbar plexus, femoral nerveRecording Site:  Lower calf at ankle (bar electrode)Reference Site:  Lower calf at ankle (bar electrode)Ground:  Lower legStimulation Site:  CalfProcedure:  The recording and reference electrodes (bar...
 
Saphenous Sensory Nerve – recording anterior to the Medial Malleolus (antidromic)
Origin:  L3-4 roots, lumbar plexus, femoral nerveRecording Site:  Lower calf at ankle (bar electrode)Reference Site:  Lower calf at ankle (bar electrode)Ground:  Lower legStimulation Site:  CalfProcedure:  The recording and reference electrodes (bar electrode)...
 
Superficial Peroneal Sensory Nerve - recording anterior to the Lateral Malleolus (antidromic)
Origin:  L5 root, sacral plexus, sciatic nerve, peroneal nerve.Recording Site:  Lateral lower leg (bar electrode)Reference Site:  Lateral lower leg (bar electrode)Ground:  Medial lower legStimulation:  Lateral lower legProcedure:  The recording and reference...
 
Sural Sensory Nerve - recording behind the Lateral Malleolus (antidromic)
Sural Sensory Nerve (antidromic)Origin:  S1 root, sacral plexus, sciatic nerve, tibial nerve.Recording Site:  Lateral MalleolusReference Site:  Side of the footGround:  Top of footStimulation Site:  Back of lower legProcedure:  The patient should be lying...
 
Spinal Accessory Motor Nerve - recording the Trapezius
Origin:  C2-C4 roots, cervical plexus, spinal accessory nerve.Recording Site:  TrapeziusReference Site:  ShoulderGround:  Upper backStimulation Site:  Posterior neckProcedure:  The recording electrode is placed on the belly of the trapezius muscle.  The reference...
 
Axillary Motor Nerve - recording the Deltoid
Origin:  C5-6 roots, upper trunk and posterior cord of the brachial plexus, axillary nerve.Recording Site:  Deltoid muscleReference Site:  Distal upper armGround:  ShoulderStimulation Sites:  Erb’s PointProcedure:  The recording electrode is placed over...
 
Musculocutaneous Motor Nerve - recording the Biceps
Origin:  C5-6 roots, upper trunk and lateral cord of the brachial plexus, Musculocutaneous nerve.Recording Site:  Biceps muscleReference Site:  Distal upper armGround:  Upper armStimulation Site:  Axilla and Erb’s point.Procedure:  The recording electrode...
 
Musculocutaneous Motor Nerve - recording the Biceps
Upper ExtremityLower Extremity Motor NervesSensory Nerves All NervesSpecial Studies
 
Radial Motor Nerve - Recording the Extenor Digitorum Communis (EDC)
Origin:  C7-C8 roots, middle and lower trunk and posterior cord of the brachial plexus, radial nerve.Recording Site:  Extensor Digitorum Communis muscle (EDC)Reference Site:  Above the wristGround:  Medial forearmStimulation Sites:  Elbow and arm (below and...
 
Median and Ulnar motor nerves- Recording the 2nd Lumbrical and interossei
Origin:    Median – C8-T1 roots, lower trunk and medial cord of the brachial plexus, median nerve.Ulnar – C8-T1 roots, lower trunk and medial cord of the brachial plexus, ulnar nerve.Recording Site:  Palm, between the 2nd and 3rd metacarpal bones...
 
Ulnar Motor Nerve - Recording the First Dorsal Interosseous (FDI)
Origin:  C8-T1 roots, lower trunk and medial cord of the brachial plexus, ulnar nerveRecording Site:  First Dorsal Interosseous (FDI or 1st DI)Reference Site:  Base of thumbGround:  Palm or Top of HandStimulation Site:  Wrist, below elbow and above elbow.Procedure: ...
 
Ulnar Motor Nerve - Recording the Abductor Digiti Minimi (ADM)
Origin:  C8-T1 roots, lower trunk and medial cord of the brachial plexus, ulnar nerveRecording Site:  Abductor Digiti Minimi muscle (ADM)Reference Site:  Base of little fingerGround:  Palm or top of handStimulation Sites:  Wrist, below elbow and above elbow...
 
Median Motor Study - Recording the Abductor Pollicis Brevis
Origin:  C8-T1 roots, lower trunk and medial cord of the brachial plexus, median nerve.Recording Site:  Abductor Pollicis Brevis muscle (APB)Reference Site:  Base of thumbGround:  Palm or top of handStimulation Sites:  Wrist and elbowProcedure:  The recording...
 
Recommended approaches to common clinical problems.
This section covers our recommended approaches to common conditions the electromyographer is asked to evaluate. Neck/Arm pain and root search  Carpal Tunnel Syndrome 
 
Medial Antebrachial Cutaneous Sensory Nerve - Forearm (antidromic)
Origin:  C8-T1 root, lower trunk and medial cord of the brachial plexusRecording Site:  Forearm (bar electrode)Reference Site:  Forearm (bar electrode)Ground:  ForearmStimulation Site:  ElbowProcedure:  The recording and reference electrodes (bar electrode)...
 
Ulnar Sensory Nerve - Recording the ring finger (antidromic)
Origin:  C8 root, lower trunk and lateral cord of the brachial plexus.Recording Site:  Ring fingerReference Site:  Ring fingerGround:  Palm or top of handStimulation Site:  WristProcedure:  The recording electrode is placed on the proximal phalange of the fourth finger...
 
Median Sensory Nerve - Recording the ring finger (antidromic)
Origin:  C7 roots, middle trunk and lateral cord of the brachial plexus.Recording Site: Ring FingerReference Site:  Ring FingerGround:  Palm or top of handStimulation Site:  Wrist Procedure:  The recording electrode is placed on the proximal phalanx of the ring finger...
 
Lateral Antebrachial Cutaneous Sensory Nerve (antidromic)
Origin:  C6 root, upper trunk and lateral cord of the brachial plexus,       Musculocutaneous nerveRecording Site:  Forearm (bar electrode)Reference Site:  Forearm (bar electrode)Ground:  ForearmStimulation Site:  ElbowProcedure:  The recording and reference...
 
Ulnar Palmar Mixed Nerve (orthodromic)
Recording Site:  Wrist over the ulnar nerve (bar electrode)Reference Site:  Wrist over the ulnar nerve (bar electrode)Ground:  Top of handStimulation Site:  Palm, between the 4th and 5th metacarpal bones.Procedure:  The recording and reference electrodes (bar...
 
Median Palmar Mixed Nerve (orthodromic)
Recording Site:  Wrist over median nerve (bar electrode)Reference Site:  Wrist over median nerve (bar electrode)Ground:  Top of handStimulation Site:  Palm, between the 2nd and 3rd metacarpal bones.Procedure:  The recording and reference electrodes (bar electrode)...
 
Radial Sensory Nerve (antidromic)
Origin:  C6-C7 roots, upper or middle trunk and posterior cord of the brachial plexus, radial nerveRecording Site:  Base of the FDI web space between the index finger and thumbReference Site:  Base of thumbGround:  Palm or top of handStimulation Site:  Radius...
 
Dorsal Ulnar Sensory Nerve (antidromic)
Origin:  C8 root, lower trunk and medial cord of the brachial plexusRecording Site:  Top of handReference Site:  Base of 5th fingerGround:  Top of HandStimulation Site:  WristProcedure:  The recording electrode is placed on the dorsum of the hand at the bottom...
 
Needle EMG Studies
A searchable, illustrated tutorial for electromyography (EMG). Describes innervation, anatomy, appropriate needle placement, and activation techniques for muscles commonly studied using EMG.
 
EMG Tutorial
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How to use the microscope
A brief and basic review on the use of the microscope.Many medical schools no longer require their students to learn how to use a microscope.  And yet, you may be in a pathology course where you are expected to look at microscope slides.  So here's a very...