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 ANATOMICAL GUIDE FOR
THE ELECTROMYOGRAPHER
The Limbs and Trunk
By

EDWARD F. DELAGI, M.D. ALDO O. PEROTTO, M.D.

JOHN IAZZETTI, M.D. DANIEL MORRISON, M.D.

Fifth Edition by

ALDO O. PEROTTO, M.D.

Associate Professor
Department of Rehabilitation Medicine
Albert Einstein College of Medicine
Former Director of Residency Training Program
New York, New York

Illustrated by
Phyllis B. Hammond
Aldo O. Perotto, M.D.
and
Hugh Thomas
 Published and Distributed Throughout the World by

CHARLES C THOMAS • PUBLISHER, LTD.

2600 South First Street
Springfield, Illinois 62704

This book is protected by copyright. No part of

it may be reproduced in any manner without written
permission from the publisher. All rights reserved.

© 2011 by CHARLES C THOMAS • PUBLISHER, LTD.

ISBN 978-0-398-08648-0 (Hard)

ISBN 978-0-398-08649-7 (Paper)
ISBN 978-0-398-08650-3 (Ebook)

Library of Congress Catalog Card Number: 2011001172

First Edition, 1975

Second Edition, 1980
Third Edition, 1994
Fourth Edition, 2005
Fifth Edition, 2011

With THOMAS BOOKS careful attention is given to all details of manufacturing

and design. It is the Publisher’s desire to present books that are satisfactory as to their
physical qualities and artistic possibilities and appropriate for their particular use.
THOMAS BOOKS will be true to those laws of quality that assure a good name
and good will.

Printed in the United States of America

SM-R-3

Library of Congress Cataloging-in-Publication Data

Perotto, Aldo.
Anatomical guide for the electromyographer : the limbs and trunk / by
Edward F. Delagi . . . [et al.] ; illustrated by Phyllis B. Hammond, Aldo O.
Perotto, and Hugh Thomas. -- 5th ed. / by Aldo O. Perotto.
p. ; cm.
ISBN 978-0-398-08648-0 (hard) -- ISBN 978-0-398-08649-7 (pbk.) -- ISBN
978-0-398-08650-3 (ebook)
1. Electromyography. 2. Extremities (Anatomy). 3. Abdomen--Anatomy. I.
Delagi, Edward F. II. Title.
[DNLM: 1. Electromyography--methods. 2. Extremities--innervation. 3.
Muscles--innervation. WE500]

RC77.5.A5 2011
2011001172
To the memory of my Mentor and friend
Dr. Edward Delagi

And to

My granddaughter Laura Adriana

and to my grandson Martin Alejandro
 PREFACE

T his new edition of the Anatomical Guide for the Electromyographer incorpo-
rates updated information concerning the basic principles of elec-
tromyography. This edition was written at the suggestion of numerous read-
ers who had read the previous edition.
Once again, a vast amount of kinesiological information is included that
gives this book a functional angle for the reader. The extensive information
also provides the electromyographer with a reminder of the functional anato-
my that allows him to understand and analyze the electrical findings.
Great emphasis is placed on describing the insertion of the needle elec-
trode in the intended muscle and to avoid common pitfalls during this phase
of the procedure.
The technique described for the study of the diaphragm is not based on
my own experience, in contrast to the other muscles in this book. The tech-
nique for this muscle was described by Doctor P. Saadeh in 1993. See details
of the technique in the footnote of the diaphragm muscle.
In the Appendix, a drawing of the “Nerves Entrapment in the Upper and
Lower Extremities Appendix” has been added to facilitate the use and com-
prehension of anatomic and electromyographic knowledge. It is hoped this
new edition will help in the development of future generations of elec-
tromyographers.
A.O.P.

BIBLIOGRAPHY

Blair, R. et al. (1978). Laryngeal electromyography: Technique and application.

Otolaryngology Clinic of North America, 11:225.
Hirand, M. et al. (1969). Use of hook-wire electrodes for electromyography of
intrinsic laryngeal muscles. Journal of Speech and Hearing Research, 12:
362–373.

vii
viii Anatomical Guide for the Electromyographer

Moore, K. L. (1992). Clinical oriented anatomy (3rd ed.). Philadelphia, PA: Williams &
Wilkins.
Olson, T. R. (1996). A. D. A. M. Student atlas of anatomy. Philadelphia, PA: Williams
& Wilkins.
Saadeh, P. B., Crisafulli, C. F., Sosner, J., & Wolf, E. (1993). Needle electromyogra-
phy of the diaphragm: A new technique. Muscle and Nerve, 16:15–20.
 INTRODUCTION

T he primary goal of this book is to be able to reach the intended muscle

by using simple techniques. Obtaining distances from easily recogniz-
able anatomical landmarks are sufficient to acquire the target muscle and this
is essential for the interpretation of the electrical findings.
The fact that the muscles, especially in the upper and lower extremities are
in close proximity to each other, and there is more than one nerve supply-
ing the muscles in the limbs, makes this goal extremely important. The prop-
er technique for each muscle was obtained after many anatomical dissec-
tions. These dissections were performed at the Anatomy Laboratory of the
Albert Einstein Collage of Medicine (A.E.C.O.M.) and were shared wit the
residents of the Department of Rehabilitation Medicine and the Electrodiag-
nostic Laboratory at Jacobi Hospital and at the Albert Einstein Hospital. We
arrived at the conclusion that these techniques were very useful.
At the suggestion of many readers of previous editions of this book, we
have decided to incorporate information that describes the essentials of elec-
tromyographic testing. Only needle electromyography will be described.
Nerve conduction techniques will not be described because they are consid-
ered to be outside the scope of the book.

ix
 ACKNOWLEDGMENTS

O nce again, my gratitude to Doctor Edward Delagi for all those years of
teaching and friendship in the sixth anniversary of his death. The vac-
uum left by his passing will never be filled. I dedicate this edition to his mem-
ory.
Special thanks to my wife for her support and encouragement. To my son
Oscar for the editorial work.
My thanks to Doctor B. Nori, Chief of the Department of Rehabilitation
Medicine at Elmhurst Hospital, Bronx, New York for her help in preparing
this revision.

xi
 CONTENTS

Page
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii
BASIC PRINCIPLES IN ELECTROMYOGRAPHY . . . . . . . . . . . . . .3

Section I
HAND
Abductor Digiti Minimi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Abductor Pollicis Brevis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Adductor Pollicis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Dorsal Interossei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Volar Interossei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Lumbricals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Flexor Digiti Minimi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Flexor Pollicis Brevis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
Opponens Digiti Minimi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Opponens Pollicis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Palmaris Brevis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Section II
FOREARM
Abductor Pollicis Longus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Anconeus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Brachioradialis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Extensor Carpi Radialis, Longus and Brevis . . . . . . . . . . . . . . . . . . . . . . . .54
Extensor Carpi Ulnaris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

xiii
xiv Anatomical Guide for the Electromyographer

Extensor Digitorum Communis and Extensor Digiti

Minimi Proprius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
Extensor Indicis Proprius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
Extensor Pollicis Brevis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
Extensor Pollicis Longus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Flexor Carpi Radialis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Flexor Carpi Ulnaris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
Flexor Digitorum Profundus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
Flexor Digitorum Superficialis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
Flexor Pollicis Longus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82
Palmaris Longus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
Pronator Quadratus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
Pronator Teres . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90
Supinator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93

Section III
ARM
Biceps Brachii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
Brachialis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
Coracobrachialis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
Triceps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107
Lateral Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107
Long Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
Medial Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112

Section IV
SHOULDER JOINT
Deltoid, Anterior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117
Deltoid, Middle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119
Deltoid, Posterior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
Infraspinatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124
Latissimus Dorsi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
Pectoralis Major . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130
Supraspinatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
Teres Major . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
Teres Minor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137
 Contents xv

Section V
SHOULDER GIRDLE
Levator Scapulae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141
Pectoralis Minor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
Rhomboideus Major . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
Rhomboideus Minor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148
Serratus Anterior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150

Section VI
FOOT
Abductor Digiti Quinti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155
Abductor Hallucis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
Adductor Hallucis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
Extensor Digitorum Brevis and Extensor Hallucis Brevis . . . . . . . . . . . .164
Flexor Digitorum Brevis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167
Flexor Digiti Quinti Brevis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170
Flexor Hallucis Brevis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173
Interossei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176
Quadratus Plantae (Flexor Digitorum Accessorius) . . . . . . . . . . . . . . . . . .178

Section VII
LEG
Extensor Digitorum Longus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
Extensor Hallucis Longus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .185
Flexor Digitorum Longus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188
Flexor Hallucis Longus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191
Gastrocnemius: Lateral Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .194
Gastrocnemius: Medial Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196
Peroneus Brevis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198
Peroneus Longus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200
Peroneus Tertius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202
Popliteus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205
Soleus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207
Tibialis Anterior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .210
Tibialis Posterior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
xvi Anatomical Guide for the Electromyographer

Section VIII
THIGH
Adductor Brevis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219
Adductor Longus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222
Adductor Magnus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225
Biceps Femoris: Long Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .228
Biceps Femoris: Short Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .230
Gracilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .233
Iliopsoas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
Pectineus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237
Rectus Femoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239
Sartorius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241
Semimembranosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244
Semitendinosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .247
Tensor Fascie Latae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250
Vastus Intermedius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .252
Vastus Lateralis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255
Vastus Medialis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258

Section IX
PELVIS AND HIP JOINT
Gluteus Maximus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .263
Gluteus Medius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .266
Gluteus Minimus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .268
Obturator Internus and Gemelli . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .270
Piriformis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .273
Quadratus Femoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275

Section X
MUSCLES INNERVATED BY CRANIAL NERVES
Facial Nerve (Number 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .280
Retro Auricular or Auricularis Posterior . . . . . . . . . . . . . . . . . . . . . . .282
Orbicularis Oculi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .284
Dilator Naris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .286
Orbicularis Oris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .288
Occipitofrontalis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290
 Contents xvii

Hypoglossal Nerve (Number 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .292

Tongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .293
Spinal Accessory (Number 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .296
Sterno-Cleido-Mastoid (S.C.M.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297
Trapezius, Lower . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .300
Trapezius, Middle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302
Trapezius, Upper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304
Trigeminal Nerve (Number 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .306
A. Temporal Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .307
B. Masseter Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .309
Vagus Nerve (Number 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .311
Cricothyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312
Vocalis or Thyroarytenoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .314

Section XI
MUSCLES OF THE PERINEAL REGION
A. Sphincter Ani Externus (Rectal Sphincter) . . . . . . . . . . . . . . . . . . . . .319
B. Sphincter Urethrea (Urinary Sphincter) . . . . . . . . . . . . . . . . . . . . . . .321
Transversus Perineal Superficialis . . . . . . . . . . . . . . . . . . . . . . . . . . . .324

Section XII
MUSCLES OF THE PARASPINAL REGION
Quadratus Lumborum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .329
Paraspinals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .332

Section XIII
MUSCLES OF THE ABDOMINAL WALL
Rectus Abdominal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .337
External Oblique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .340

Section XIV
INTERCOSTAL AND DIAPHRAGM MUSCLES
Intercostals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .345
Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .348
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .351