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Interpreting Electrodiagnostic Studies for the Management of Nerve Injuries

LECTURE Interpreting Electrodiagnostic Studies for the Management of Nerve Injuries Authors: Mackinnon SE1, Yee A1 Published: September 22, 2021 Author Information 1Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri Standard Edition (201012.201012) Extended Edition (201012.201012) ABSTRACT The accurate interpretation of electrodiagnostic studies (EDX) for nerve injuries is critical for determining appropriate management and achieving optimal outcomes. In this lecture, we build the foundations for understanding nerve classification of nerve injuries and review nerve conduction studies and electromyography. Furthermore, the concept of time-related changes to electrodiagnostic findings from the degree and timing of nerve injuries is presented with case studies. KEYWORDS Nerve classification, nerve injuries, electrodiagnostic studies, nerve conduction studies, electromyography TABLE OF CONTENTS 00:00 Introduction 00:23 Classification of Nerve Injuries 03:38 Rate of Recovery from Ischemic, Demyelination, Axonal, and Mixed Injuries 06:04 Referring EDX Reports 07:11 Electrodiagnostic Studies 07:30 Nerve Conduction Studies 07:40 Conduction Velocity 08:01 Amplitude 08:27 Conduction Block 10:25 Electromyography (EMG) 10:45 Spontaneous Activity 11:18 Fibrillations and Positive Sharp Waves 14:03 Insertional Activity 14:46 Motor Unit Action Potentials (MUPs) 16:50 Normal MUPs 17:01 Acute MUPs (Collateral Sprouting vs. Nascent Axonal Regeneration) 19:21 Chronic MUPs 19:43 EMG Findings for Complete and Mixed Fascicular Injuries 21:04 Percent Denervation for Functional Loss 22:25 Concept of Supercharge Nerve Transfers for Mixed Injuries 23:22 Surgical Management for Classification of Nerve Injuries 24:40 Management Review of Neurapraxia, Axonotmesis, and Neurotmesis Injuries 25:54 EDX Case Studies of Compression Neuropathy 26:00 Types of Conduction Blocks 27:36 Cubital Tunnel Syndrome with Conduction Slowing and Block 31:28 Compression of Radial Nerve at Spiral Groove with Conduction Block 31:46 Severe Carpal Tunnel Syndrome with Conduction Block 32:23 Clinical Correlations and Time-Related Electrodiagnostic Changes 33:26 CMAP Amplitude 33:53 Immediate Considerations of CMAP and SNAP Amplitudes 34:34 Fibrillations and Positive Sharp Waves 35:20 Collateral Sprouting MUPs 35:58 Nascent MUPs 36:16 Chronic MUPs 36:52 Case Study of Collateral Sprouting MUPs and Axonotmetic Injury 38:21 Case Study of Nascent Maturing to Chronic MUPs 41:00 Case Study of Neurotmetic Injury 41:31 Reference of EMG and Neuromuscular Disorders 41:40 Credits