Technique of

Electromyography and
Normal EMG
Electromyography

 Needle electromyography refers to methods of

studying the electrical activity of muscle
 It serves as additional aid to neurological
examination in clinical practice for identifying and
characterising disorders of motor unit, including
anterior horn cells, peripheral nerves, NM
junctions and muscles
 It requires Knowledge and skill
 Motor unit

 A single motor neuron with all the

muscle fibres innervated by it
constitutes a motor unit
 It is the functional unit of Motor
component of peripheral nervous
system
 There are 2 different types of motor
units –slow firing fatigue resistant
and fast firing fatigable units
Action potential generation in
Skeletal muscle fibre
 Once the Action potential is generated at the End
Plate, a depolarising wave travels all along the length
of muscle fibre
 Small segment of the muscle fibre act as dipole with
positive charge at the advancing end negative charge
at the other end resulting an electrical field through
the surrounding connective tissue
 The strength of the current decreases in proportion to
the square of the distance from the dipole in the
skeletal muscle fibre.
 When two electrodes are placed apart in
interstitium, due to difference in the distance from
the dipole the field strength varies at the two
electrodes there by generating a potential difference
b/w them

Equipment
 Electrodes
 Amplifier
 Filter
 Display method
 Electrodes
For clinical Electromyography following Needle electrodes are used

Needle
electrode

Macro
Bipolar Monopolar Single Fibre
electrode

Concentric
Bipolar

Coaxial Bipolar
Types of Electrodes
Concentric Bipolar Needle
•This electrode consists of a cannula with 2 wires within
it
•It records the potential difference b/w the two wires, as
one acts as active and other as reference
•It records from a very localised area, activity from only
few muscle fibres is picked up
•Amplitudes of MUPs are reduced due to reduced area
Monopolar electrode
 Electrode inserted into muscle acts as active
electrode, reference electrode is placed over
the surface
 Due to wide separation of the electrodes the
resolution of the low amplitude signals is
better, how ever the noise also gets amplified
Single fibre EMG needle
•It has smaller leading edge to record from single muscle
fibre rather than motor unit
•Like concentric bipolar needle it has a cannula with a wire
inside it but the wire is bent towards the side of the
cannula few mm behind the tip

Macro electrode
•It is suited for recording both from the single fibre and
motor unit
Amplifiers
•Bioelectrical potentials recorded will be in the range of
1μV to 1mV these signals need to be amplified by
1million to thousand times for deflection of 1cm in 1v/cm
recording
•Differential amplifiers increases the amplitude of the
desired response while rejecting unwanted noise
•Amplifiers ability to reject common signals is known as
its common mode rejection ratio (CMRR). The higher the
CMRR, the better the rejection
Gain
•Amplifier gain describes the extent to which the input signal is
increased in voltage.

Display sensitivity
•Describes the visible waveform and is expressed as volts per
division or volts per centimeter •Usually kept at 50-200μV/cm

Filters
•They are used to selectively attenuate the noise preserving the
signal •Band pass filters extending from 10HZ to 10KHZ is
commonly used
Display
•Once the wave form is recorded and processed
it is displayed for visual analysis
•As the EMG potentials have distinct auditory
characteristics presenting them as audible
sounds also helps in differentiating various
response
Preparing the patient
•Prior to the test Patient should be briefly explained about the procedure
and insertion of needle would cause some discomfort
•Wipe the skin over the each puncture site with spirit before needle is
inserted
•Though most patients tolerate the pain some may require oral
analgesic

Selecting the muscle

•It is done on the basis of clinical indication
•Ideally muscle selected should be superficial, easily palpated, Located
away from major blood vessels and nerve trunks
Abductor pollices brevis
Needle insertion:at mid point
of
1st metacarpel

Abductor digiti minimi

Needle insertion at mid
point of 5th metacarpel
First dorsal interossei Needle
insertion: mid point b/w 1st and
2nd MCP joints

First dorsal interossei Needle

insertion: mid point b/w 1st and
2nd MCP joints
 Vastus lateralis
Needle insertion: lateral thigh 4 finger
breadths proximal to lateral part of knee

Tibialis anterior
Needle insertion: just lateral to tibial shin at
junction of proximal 1/3rd and distal 2/3rd of
tibia
Needle insertion
 Prior to needle insertion the muscle should be palpated during
intermittent contraction to localise its borders
 Skin over the puncture site is made taut and needle is inserted
smoothly into superficial layers of the muscle
 When testing the small muscles needle should be inserted obliquely
to increase the needles path

Needle movement
•Needle is moved along a straight line in to the muscle in short steps of
0.5-1mm as large movements are more painful
•Needle is advanced in 5-30 such steps with brief pause b/w each step
 Once the diameter of the muscle is traversed needle is withdrawn
till subcutaneous plain and reinserted from a different angle at
same location
 All the 4 quadrants should be sampled for achieving good recording

Precautions
•For patient with bleeding disorders or those on anticoagulants INR
should be 20,000
•Caution should be taken in patients with skin infection, cellulitis
•Patient s with prosthetic heart valves may have risk of infective
endocarditis
Findings in Normal EMG

Insertional activity
 Burst of high frequency positive or negative spikes occurring during
the movement of the needle electrode
 It occurs due to stimulation of muscle fibres due to mechanical
irritation/injury by the penetrating needle
 The level of response depends on magnitude and speed of needle
movement
 It lasts for about few hundred milliseconds
 Though it is a normal response exaggeration/attenuation of this
response may suggest pathology
End plate noise
•It is frequent irregular low amplitude (10-50μv )
negative waveform with duration of 1-2ms
•It correspond to miniature end plate potential
•It occurs with the release of acetylcholin due to
irritation of intramuscular nerve terminals by the needle
tip at the end plate region •Sounds like seashell held to
the ear
•Following botulinum inj analysis of end plate noise
helps to evaluate the neuromuscular transmission
End plate spike
•It is irregular high amplitude(100-200μv)negative
waveform with duration of 3-4ms
•It occurs due to stimulation of the single muscle fibre
by the tip of the needle at the end plate Small
irregular positive discharges may also occur at the end
plate particularly with concentric needles, these are
considered to be normal
Fibrillation potentials
•These are spontaneous action potentials that arise
from single muscle fibre.
•Oscillations in resting membrane potential triggering
action potential result in fibrillation
• Occasionally they may occur in normal healthy
muscle
•They have regular firing pattern with freq 1-30Hz
•Amp litude:20-500μv, Duration of 1-5ms
•Pathologically significant when detected in at least
three separate sites within the muscle being examined.
FASCICULATION POTENTIALS
•They are similar to motor unit action Potentials occurs due to
spontaneous activation of the muscle fibres of individual motor
units. •Stimulus can originate at any level from anterior horn
cell to axon terminal
•About 77% of normal individuals can have fasciculations
•Association with fibrillations, positive sharp waves suggest
pathological fasciculations
•Generally Benign fasciculations fire at higher frequency(1-2Hz)
than pathological fasciculations (<1Hhz), however it is difficult
to differentiate benign from pathological
Motor Unit Action Potential(MUAP)
The motor unit action potential is a compound potential representing the
sum of the individual action potentials generated in the few muscle fibres
of the unit that are within the pick-up range of the recording electrode

Components:
•Amplitude
•Duration
•Rise time
•Phases
•Area
Amplitude:
•It is measured between the greatest positive and the greatest
negative deflections of the potentials.
•When recorded by a concentric needle electrode, it is usually
between 200 μV and 3 mV

Factors influencing the Amplitude of MUP

•Predominantly determined by the action potentials of fibres that lie
close to the recording electrode
•Slight movement of the electrode has significant effect on amplitude
•Temporal dispersion of the individual action potentials also affects to
some extent
Rise time of MUP
•It is the time lag from the initial positive peak to the subsequent negative peak of
the MUP.
• It reflects the distance between the recording electrode and the muscle fibres of
the motor unit
•Rise time less than 500μs indicate appropriate position of the electrode within
the motor unit territory

Duration of MUP
Measured from the initial deflection from the base line to the final return to the
base line
•It indicate the synchrony among various fibres of a motor unit
•It is influenced by fibres in the recording region that may extend to about 2-
2.5mm radius from the needle
•Normally varies from 5-15ms
Area of the MUP
•It depends on the number of muscle fibres with in
2mm radius of the recording electrode
•Movement of the electrode has significant effect on
area
•Ratio of amplitude to area is stable and less affected
by electrode movement
•Helps to differentiate neuropathy from myopathy
Phases of MUP
It is determined by counting the number of base line
crossings of MUP plus one
•It indicates the synchrony among the individual
muscle fibres of a motor unit
•Usually MUP has 2-4 phases, when >4 it is called
polyphasic
•In normal limb muscles about 12 percent may have
five or more phases (polyphasic)
Satellite potential
•It is a late spike distinct from main potential, that is
time locked to the main potential
•Generated by muscle fibre in a motor unit that has
long nerve terminal, distant end plate region
•Latency can rage from 8-32ms
•It can occur in both pathologic and normal muscle
Pick up area within a motor unit territory
Motor unit potentials
Physiologic Factors Influencing MUPs
•Patient age,
Increasing age from infancy to adulthood there is an
increase in the mean duration of motor unit action
potentials in limb muscles
•Intramuscular temperature,
As temperature declines Mean duration of motor unit
potentials and the number of polyphasic potentials
also increase
• The site of the recording electrode within the
muscle, and Particular muscle under examination
MOTOR UNIT DISCHARGE PATTERN
Recruitment
•As the force of contraction increases, first the firing rate of
the particular active unit increases until it reaches a certain
frequency when additional units are recruited
•Normal ratio of firing frequency to the number of motor units
is 5:1 •Maximum firing rate of a motor unit is about 30-50HZ
•The order of recruitment depends on Diameter of neuron,
synaptic density, Threshold of recruitment, type of motor units
•It depends on patients effort, input from cortex, number of
active motor units available
Interference
•During the maximum contraction of muscle several
motor units get activated simultaneously resulting
in the over lap of MUPs creating an interference
pattern
•It gives a simple measure of number of firing units
at maximum effort
•It is influenced by factors that alter recruitment
Mechanical artefacts during EMG
Electrode noise:
•It occurs due to generation of potentials by the
active metals of electrodes at junction of needle tip
and interstitial fluid
•This can distort the signal that is being recorded
•Using inert metals –stainless steel, platinum this can
be minimized
Electrostatic and Electromagnetic interference
This occurs from electric appliances- Fans, lamps due
to use of AC current
Interference occurs at 50-60Hz
It can be minimised by bundling wires of the recording
and ground electrode, relocating the wires of
appliances, shielding the recording area

Mobile phone use at the recording area also produces

artefacts that resemble complex repetitive discharges
Conclusion
•EMG is an important additional aid in evaluating
patients with peripheral neuromuscular disorder
•It has great sensitivity and specificity
•Good recording of various waveforms require high
technical skills •Knowledge about various normal and
abnormal findings is required for proper
interpretation and application of test results
Thank You