https://www.youtube.com/watch?v=k8OX8j3Dqn4 12.

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http://clinicalgate.com/nerve-conduction-studies-and-electromyography/ 13.19
http://clinicalgate.com/the-electrodiagnostic-examination/ 13.27
13.31

Motor NCS assess the integrity of anterior horn cells (in the anterior region of the
spinal cord), their axonal projections within pure motor or mixed nerve trunks,
arborizations into individual motor nerve fibers, the neuromuscular junctions,
and attached muscle fibers.

Motor studies

Motor studies involve stimulating the motor nerve at distal and proximal sites and
recording the muscle action potentials (Fig. 1b). The amplitude of the muscle response
(compound muscle action potential, CMAP) to supramaximal nerve stimulation can be
measured. The time from the distal site of stimulation to the onset of the CMAP is the
terminal or distal motor latency. This measure includes components of nerve conduction,
neuromuscular transmission and muscle activation times. The difference in time to CMAP
between the two sites of stimulation and the distance between is used to measure
conduction velocity.

Interpretation of nerve conduction studies

There are two types of abnormality detected by nerve conduction studies:

1. Slowing due to demyelination.

2. Reduction in amplitude of response due to loss of axons.

A survey of appropriate nerves can establish the pattern of peripheral nerve

involvement. This can be:

Focal: where a single nerve is affected, e.g. the median nerve at the wrist in carpal
tunnel syndrome.

Multifocal: where there are multiple focal areas of abnormality. If this affects named
nerves, it is mononeuritis multiplex; if not, it is a multifocal neuropathy.

Generalized neuropathy:

Motor Nerve Conduction Studies

For motor NCS, the recording electrode is placed over the muscle belly, and the reference electrode is
affixed over the tendon. The nerve supplying that muscle is stimulated, and the resulting motor nerve
response is a compound muscle action potential (CMAP), a biphasic waveform that represents
summated muscle fiber action potentials (Fig. 132). In routine motor NCS, small muscles of the
hand and feet serve as recording muscles, and the nerves supplying them are stimulated at two
separate points along their course. For the upper extremity, the wrist (distal) and elbow (proximal) are
used as stimulation sites, and for the lower extremity, the ankle (distal) and knee (proximal) are used
as stimulation sites.

FIGURE 132 Various components of motor nerve conduction study. (The median nerve is being
assessed.)

(Modified from Isley M, Krauss G, Levin K, et al: Electromyography/Electroencephalography. Redford, WA,

Spacelabs Medical, 1993, p 40.)

Numerous parameters are assessed with each CMAP obtained, including amplitude, latency,
and conduction velocity (Fig. 133). The CMAP amplitude represents the number of nerve fibers
that responded to the stimulus and are capable of conducting impulses to the recorded muscle. 1,2 It
is measured from baseline to negative peak (negative being up) and reported in millivolts.
The latency is the time interval between the instant the nerve was stimulated and the onset of
CMAPs; these are reported in milliseconds. The conduction velocity is the speed of transmission
over the fastest conducting nerve fibers assessed and is reported in meters per second. Conduction
velocities are calculated by dividing the distance traveled along a nerve segment (as determined by
surface measurements) by the latency difference between the responses to proximal and distal
stimulation. Normal conduction velocity in the upper limb is greater than 50 m/sec; in the lower limb, it
is greater than 40 m/sec.
FIGURE 133 Compound muscle action potential (CMAP). Distal latency is measured from
stimulus to onset of negative response. Amplitude is measured from baseline to negative peak.