Needle Examination

Perform 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, examine one or two additional muscles innervated by the suspected roots and different peripheral nerves.  Perform needle exam on the asymptomatic limb muscles for comparison as needed.

Nerve            Recording Sites        Stimulation Sites           F-Waves

Sural (s) bilat        ankle                calf
Sup Peron (s) bilat    ankle                lat leg
Peroneal (m)    bilat    EDB                ankle and above knee    ankle
Tibial (m) bilat    AH                ankle and knee        ankle
Peroneal (m) bilat    TA                below and above knee
H-Reflex bilat        soleus                knee

Needle Examination

Perform needle exam on the affected limb.