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I have always tried to find ways to make the EMG/NCS test more comfortable for patients. Years ago, I saw an orthopedist using Ethyl Chloride spray before he would do his injections in the office. Ethyl chloride gives the skin a quick freeze, so it makes the needle injection more comfortable for the patient.
When I went into my own private practice, I started using it for the EMG needle exam. I spray it on the skin and then insert the EMG needle into the muscle. Patients seem to have much more comfort with the EMG test using the spray. I'm just curious if anyone else has used this technique or perhaps something else to make the needle exam more comfortable for patients.
I work at a county hospital that wants me to present to them a bullet point list of duties that are needed for management of an electrodiagnostic lab. I work with a very talented technician. We have developed policies and procedures that are quite extensive for her. However, I was hoping not to have to reinvent the wheel for an extensive inclusive list of duties. I couldn't find much in the accreditation section of the AANEM site. Do any of you already have a list of admin duties for running a lab? Or if you just have any random ideas to put on the list, I would be grateful. Thank you in advance.
I cannot understand why the Martin-Gruber, or any other two-nerve connection, is called "anastomosis.” This word, from Latin, is used when two tubes, such as a colon with air inside, are connected. Joao Aris Kouyoumdjian, MD, PhD - Brazil.
Thank you to the entire AANEM community for making our 25th presentation of EMG talk a success!
Although Bill and I have had the pleasure and honor of leading EMG Talk since 1995, in reality we are only the facilitators. Each EMG Talk show is uniquely co-created by our entire AANEM community. It is both unpredictable and inspirational. It can be educational, but it can also highlight areas to be further explored, such as how we describe severity and chronicity.
Great presentations from our guest stars further engage our whole community –limericks from Sandra Hearn, waveforms from Devon Rubin and ultrasound images from Jeff Strakowski. We even enjoyed being handcuffed by “FBI agent” Peter Grant! Entries on AANEM Connect have inspired our shows. The AANEM staff have been wonderful in setting the stage for our shows and our loyal sponsors have been consistently supportive over many years.
Most importantly we appreciate the comments and contributions from the audience who have consistently brought humor, curiosity, playfulness and wisdom to the show. As an added benefit, we raised $1,200 for our foundation (ANF) through the hat auction this year.
Thank you for making this another great show and we look forward to co-creating future EMG Talk shows with our AANEM family.
Is there research on the effect of nerve conduction with respect to torsion and tension on nerves?
I have had a string of patients with rapid weight loss with compressive neuropathies. Aside from entrapment sites, I am wondering what is the effect of excessive tissue or fatty tissue has on the nerves. When I think of the effect of weight, I usually think of joints mainly. However, if the nerves have 20-50 pounds of weight hanging from them, can this be a source of tension or compressive neuropathy?
As the EMG Talk brothers (Spike and Wave) are preparing their annual EMG Talk show, we want to know what term you see or hear commonly in electrodiagnosis that just irritates you the most.
For one of us, it’s "peroneal nerve". Everyone knows, or should know, that it’s now called fibular nerve – that’s the nerve the courses around the peroneal head to supply the dorsiflexors and evertors of the foot!
For the other of us, it’s "chronic". The misuse, or maybe more correctly the misunderstanding, of the word chronic is acutely chronic and it is chronically used as an obfuscating description in EMG reports.
Let us know what term gets your blood boiling and we may discuss it at EMG Talk in Phoenix.
Congratulations to these 2 doctors... Dr. Bassam and Dr. Kincaid!
I'm always so thrilled when my favorite doctors are awarded AANEM awards.
Dr. Bassam and Dr. Kincaid are certainly 2 of my favorite doctors. So many others who are my favorites have also been awarded, and I'm always thankful for the kindness and support for us-techs, no matter what it is--answer to my AANEM connect funky NCS questions, giving advice or instruction when I've needed it, talks/workshops at AANEM, talks for our tech societies, and in general sharing y'all's knowledge. I'm honored and humbled.
I would be grateful for any advice please from those of you with experience in the Gulf of Mexico.
I have just seen a 58 yo male who was walking in the sea off the coast of Cuba 2 years ago. He cut the lateral border of his left ankle, just below the lat malleolus on what he assumes was a rock. Following this he developed painful sensory loss in the left lateral foot extending up the left lower antero-lateral leg and a "scab-like" lesion over a patch on the shin which coincides with a red patch on a tattoo. This lasted a few weeks and after it settled the hairs of this part of the leg turned white and have remained white since. His strength is normal, but his left ankle jerk is absent.
Neurophysiologically the only abnormality is the left sural SNAP is 14uV, whilst it is 26uV on the right. Superficial peroneal (fibular) nerves and motor responses are normal.
Here in the UK we can get a painful neuropathy from standing on a weaver fish, but I have not heard of anything matching this description of events. Any ideas as to aetiology? Is there any useful advice as to management?
Our Neurosurgeon is evaluating pediatric patients for Selective Dorsal Rhizotomy. My partner and I are looking for training in the Neuromonitoring portion, EMG set up and interpretation of stimulation , for the surgery. We will also be evaluating patients in clinic , monitoring during surgery and following post operative.
Does anyone know of training for physicians for the neuromonitoring, interpretation and reporting for this type of surgery?
Opportunity to support genetic counseling student research! As a practicing neurologist or neuromuscular physician, you are invited to participate in a research study that is seeking to better understand the current landscape of genetic testing for neuromuscular disease in neurological patient care.
Please consider completing this 10-15 minute survey. All participants who complete the survey will have the option to enter a drawing to win one of several $25 Amazon gift cards. Participants that choose to do a single follow-up interview over Zoom to elaborate on the themes addressed in the survey will be entered into an additional drawing for more $25 Amazon gift cards.
This project is approved by VCU’s IRB. If you have any questions or concerns about your participation in this research, please reach out to the lead student investigator Ashley Smith at firstname.lastname@example.org.
This may be a silly question, but I can't find much information on it, so I figured I would ask my EDX colleagues here. I know of the safety regarding performing NCS with ICDs and internal pacemakers and am aware of the AANEM position statement on this, but I am curious on the safety of NCS for patients with LVADs. Any reason that this would be a contraindication, or any special safety procedures for performing NCS/EMG studies on patients with LVADs? Thanks for any guidance or discussion here.
NIV is CPAP and BiPAP not used for noninvasive ventilatory support (NVS), NVS settings are PIPs of about 20 cm H2O and no EPAP/PEEP. Since we have ALS patients iwth 90% of normal VC who are 24/7 NVS dependent and others with 7% of VC with normal blood gases and asymptomatic without vents, nasal NIV recommendations for VC under 80% or 50% are inappropriate and should normally be based on supine VC anyway and not the sitting VC of PFTs. Most of our MND patients become NVS dependent without ARF or even going to a hospital, not to mention our 18 with SMA1 between 18-30 years old with 0 ml VC and no trach and many DMDs over age 50 who have never been to a hospital. Use NVS not polysomnographic titrations that don't adequately rest muscles during sleep.
Disclaimer: I have asked the site administrator and been told I can post this. This is NOT a job offer and I am NOT trying to hire anyone to work for me.
I live in Durango, CO. It's nice here. I have a solo PM&R practice and have an office with 3 exam rooms. I have room in my office for 1 (possibly more) providers to share on a full or part time basis. We have the following resources in town:
-5 physiatrists, heavy in spine. 4 of us do EMG, 1 is very skilled in neuromuscular u/s. I'm trying to be more general spine/msk, EMG and work comp
-1 full time neurologist who is neuromuscular specialized at the local Mercy hospital. He's super busy and hard to access.
-1 newer neurologist who just started a cash only practice. He may or may not get busy but with the model he has excluded the vast majority of potential patients
-not enough rheumatologists
-we have a full-service regional hospital, a smaller surgical hospital, infusion center, 3 facilities with MRI including a 3-tesla unit
If there is anyone interested (or you know anyone) in discussing a move to Durango and setting up your own practice within my space, please let me know. After working in groups for about 12 years, I opened my own practice 4 years ago and it's the best thing I've ever done, and easier than I thought. Overhead is very low and modern EMR systems are a game changer.
A general neurologist would be instantly busy, as would any of the above list that are willing to take insurance. Given the number of us who alredy do EMG, a neurologist who isn't interested in EMG would be a better fit.
I am writing to let you know that we are actively recruiting a neuromuscular medicine fellow to begin this summer, July 2024, at Rush University in Chicago.
We are a newer fellowship program currently training our first NM fellow. However, we have a strong track record of education, mentorship, and a well-established neurophysiology/EMG fellowship. Our program includes outstanding clinical exposure with multidisciplinary clinics in ALS, CMT, muscular dystrophy and nerve injuries. Our trainees also get strong exposure to EMG throughout their training. Rush is a top notch, well-run medical center with outstanding, new facilities as well.
Our program is ACGME-approved. We can recruit fellows who are graduates of US neurology or PM&R residencies. This position went unfilled in the 2023 AANEM match which we will participate in again this coming year.
More and more we are having patients referred who are upwards of 500-600#. Is it acceptable for patients who exceed the weight limit of our table to perform the examination in a wood chair? is there any risk in using an aluminum chair? What about wheelchair dependent patients who are unable to transfer to the bed? Is it acceptable to do the EMG in the wheelchair? Do you have any equipment recommendations for positioning these patients for the test. I currently have a NCT who is 7 months pregnant and struggling to do the occasional chair patients when it is lower extremities in a chair when the exceeed out table weight limit. I wasn’t sure what options there were or what other clinics were doing.
I recently saw a 13 y/o young lady who somehow managed to fall backward off of a moving golf cart. She had a mTBI and painful right shoulder. She now can voluntarily dislocate the right shoulder. There is right scapular inferior angle winging. EMG of the serratus anterior, upper trapezius and rhomboid major were normal. My question is how do you produce non neurological scapular winging.
It is difficult to miss the serratus anterior on EMG in the mid axillary line since the serratus is the only muscle there, once you touch the rib periosteum with the EMG needle.. There are some oddities on examination. Forward flexion is strong but winging increases especially as she lowers the arm. The inferior angle rotates laterally and the scapula abducts on forward flexion like normal. With a SA palsy forward flexion should be weak, and scapular rotation and abduction reduced.
Abduction of the shoulder laterally reduces the winging. Shoulder retraction is strong.
I would like to say something more specific than "probably related to the ligament injuries that destabilized the gleno-humeral joint" but haven't found anything in the literature to help.
Over the years I have seen a number of patients with scapular winging, without shoulder dislocation, in whom EMG of the appropriate muscles was normal. On some occasions I could not find the serratus and assumed it had completely atrophied. So this young lady was not an isolated case.
How do you produce scapular winging without neurological, i.e. nerve, injury ?
I have a non-academic, business related question. I hope it is ok to post on this forum, but feel free to remove if this is the wrong place to ask. For those that work in wRVU model systems, do you know of any information on average $ per wRVU for NCS/EMG? I don't see that it is broken down granularly with MGMA, etc. specifically for Electromyographers. Any guidance as to where one could find this type of data? Thanks for any help
I was hoping the practice improvement requirement for ABPMR would go away, but it has not. I am looking at the options available through AANEM. I would appreciate any advice regarding the three options available report writing, carpal tunnel syndrome, cubital tunnel syndrome. I would like to make the best of this board requiremnt
In discussion with a fellow recently-graduated trainee, we were discussing anesthetic nerve blocks and the immediate effect on EDX. Hypothetically, if a person got their proximal median nerve blocked with lidocaine above the elbow, what would the effect be on the median antidromic sensory NCS to digit 2, the median motor NCS to APB, and the needle EMG of APB or pronator teres be?
I would assume, for the EMG, that you would have no spontaneous activity, no neurogenic changes, but (if truly blocked) you would have no activation of median-innervated muscles distal to the block, correct?
For the NCS, would a proximal median nerve block with lidocaine above the elbow appear like a severe post-ganglionic injury (like a brachial plexus injury), resulting in an absent SNAP? Or, conversely would the portion stimulated at the wrist and recorded at digit 2 be intact? Thoughts on CMAP?
I enjoy participating in the AANEM Connect Forum for a number of reasons. There are very fundamental questions posed on a frequent basis that cause me to pause and ask myself, ‘Why didn’t I think of that?’ Also, I continue to learn
new things when others contribute their thoughts and experiences. Connect is an excellent opportunity for members to interact and to address any topic, including those that may not be discussed
at an annual meeting or journal article.