ncs

EMG and Nerve Conduction Studies

We offer full medical consultations followed by electrodiagnostic studies for the evaluation of neuromuscular symptoms. ​As a form of functional testing, this is complimentary to diagnostic imaging, with greater specificity.

Why do Electrodiagnostic Testing?

When disease of the peripheral nervous system is suspected, electrodiagnostics can help determine:

Diagnosis:

CNS, MND, root, plexus, mononeuropathy, polyneuropathy, NMJ, muscle,

Timing of injury:

<1 week, 1-2 weeks, 2-6 weeks, >6 weeks

Severity of injury:

Demyelination or axonal, and percentage loss

When disease of the peripheral nervous system is suspected, electrodiagnostics can help determine:

Estimating prognosis:

Motor unit recruitment demonstrates axonal continuity

Monitoring injury:

Testing at different intervals can demonstrate recovery or worsening

Surgical planning:

Carpal tunnel release, ulnar nerve transposition, nerve transfer/grafts, spinal canal decompression, thoracic outlet decompression

Common Symptoms

"Negative" Symptoms

"Positive" Symptoms

Motor Nerve

  • Weakness
  • Decreased Muscle Tone ("floppy")
  • Decreased Muscle Bulk
  • Orthopedic Deformities
  • Decreased Reflexes
  • Muscle Cramp ( "Charlie Horse" )
  • Increased Muscle tone ("stiffed")
  • Muscle Fasiculations ("twitching")
  • Muscle Fasiculations ("twitching")
  • Restless Legs

Sensory Nerve , Large Fiber

  • Decreased Vibration/Proprioception Sense
  • Decreased Muscle Tone ("floppy")
  • Decreased Reflexes/Proprioception Sense
  • "Tingling"
  • "Burning"

Sensory Nerve , Small fiber

  • Decreased Pin-Prick Sense
  • Decreased Temperature Sense
  • "Shooting"
  • "Burning"

Motor Nerve

Sensory Nerve , Large Fiber

Sensory Nerve , Small fiber

EMG Advantages and Limiting Factors

Advantages

  • • Only laboratory study that directly assesses the physiologic integrity of the roots , thereby providing both diagnostic and prognostic relevance
  • • Objective : May reveal changes consistent with a root lesion in the presence of a normal/unsatisfactory physical exam
  • • The EDX evaluation may be abnormal when all other laboratory procedures, including neuroimaging studies, are unrevealing. EDX is therefore helpful with non-compressive radiculopathies, when imaging is inconclusive
  • • With definite compressive root lesions, EDX can determine the severity of the axon loss, helping to gauge the relevance of any positive imaging findings
  • • EDX can identify extraforaminal lesions e.g. plexopathies, mononeuropathies, polyneuropathies, the symptoms of which are often attributed incorrectly to radiculopathies
  • • When performed by experienced physicians, EDX studies are rarely false positive. In contrast, incidental neuroimaging abnormalities are very common, particularly in the middle-aged or elderly patients without related symptoms. Consequently, EDX studies may be helpful in determining whether the imaging is of clinical significance
  • • EDX studies have a low morbidity

Limiting Factors

  • • Does not detect all compressive radiculopathies. EDX cannot be used to exclude a radiculopathy.
  • • When a radiculopathy is suggested, the etiology cannot be determined.
  • • When a specific root appears to be involved, various anatomic factors may lead to inaccurate localization, so the affected root is not recognized (usually the one adjacent)
  • • Confounding actors: patient age, diabetes mellitus, generalized polyneuropathy, remote poliomyelitis

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755 Queensway East

Mississauga ON L4Y 4C5

REHABILITATION SERVICES

Unit 303: Physiotherapy, Massage Therapy,
Chiropractic, Custom Bracing, DEXA Body Scans

Mon, Wed, Fri : 8 am to 7 pm
Tues, Thurs : 8 am to 5 pm
Sat to Sun : Closed

MEDICAL SERVICES

Unit 303: Rheumatology, Neurology, Psychiatry, Lifestyle Medicine
Unit 304: Physical Medicine, NCS/EMG, US-Guided Injections

Mon to Fri : 8 am to 5 pm
Sat to Sun : Closed
(Hours and availability may vary)

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