Caldwell EMG PDF

Reference Guides
Brachial Plexus
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1427
Sierra Summit Help manual
Brachial Plexus Root Distribution
1428
Reference Guides
Brachial Plexus Studies

Brachial Plexus Protocol
General Approach when Diffuse Plexus Involvement Suspected
Common Studies Additional Considerations
Motor Nerve Median (APB) Perform conduction studies in all nerves

Studies Ulnar (ADM) that have a clinical deficit (any weakness
Radial (EDC) or sensory loss).
Musculocutaneous (Biceps)
Spinal Accessory
(Trapezius)
Sensory Nerve Median (2nd Digit) Consider performing sensory and/or
Studies Ulnar (5th Digit) motor studies on opposite side for
Radial (Thumb) comparison if the findings are borderline.
Lateral Antebrachial
Cutaneous
Needle EMG Cervical Paraspinal (two If weakness in Upper Trunk, test
Studies levels) additional C5-6 muscles:
Biceps (MC, C5-6, both Rhomboid (DSc)
heads) Infraspinatus (SScap)
Triceps (R, C5-6, both lateral Deltoid (Ax)
and medial heads) Brachioradialis (R)
First Dorsal Interosseous (U,
C8-T1) If weakness in Middle Trunk, test
additional C7 muscles:
Pronator Teres (M)
Extensor Carpi Radialis (R)
Extensor Dig Communis (R)
If there is weakness in Lower Trunk, test

additional C8 muscles:
Extensor Carpi Ulnaris (R)
Extensor Indicis Proprius (R)
Flexor Pollicis Longus (M)
Flexor Carpi Ulnaris (U)
Flexor Pollicis Longus (M)
MC = musculocutaneous n., R = radial n., M = median n., U = ulnar n., DSc = dorsal scapular n., SScap –
suprascapular n., Ax = axillary n.
1429
Segments of the Brachial Plexus tested by specific nerve conduction studies

Upper Trunk (C5-6) Middle Trunk (C6-7-8) Lower Trunk (C8-T1)
Suprascapular
(Supraspinatus)
Lateral Lateral Antebrachial Median sensory to 2nd

Cord Cutaneous Digit
Median sensory to Median sensory to 3rd
Thumb Digit
Median sensory to 2nd
Digit
Musculocutaneous motor
(Biceps)
Posterior Radial sensory Radial sensory

Cord Axillary motor (Deltoid) Radial motor (EDC)
Medial Ulnar sensory to 5th

Cord Digit
Dorsal Ulnar
Cutaneous
Medial Antebrachial
Cutaneous
Median motor (APB)
Ulnar motor (ADM,
FDI)
1430
Reference Guides
Brachial Plexus Muscle Innervation

Upper Trunk (C5-6) Middle Trunk (C6-7-8) Lower Trunk (C8-T1)
Supraspinatus (SScap)
Infraspinatus (SScap)
Lateral Biceps (MC) Pronator Teres (M)
Cord Brachialis (MC) Flexor Carpi Radialis
Coracobrachialis (MC) (M)
Posterior Brachioradialis (R) Triceps (R) Extensor Indicis
Cord Supinator (R) Anconenus (R) Proprius (R)
Deltoid (Ax) Extensor Carpi Radialis Extensor Carpi Ulnaris
Teres Minor (Ax) (R) (R)
Triceps (R) Extensor Dig Communis
(R)
Extensor Carpi Ulnaris
(R)
Medial Abductor Pollicis
Cord Brevis (M)
First Dorsal
Interosseous (U)
Abductor Digiti Minimi
(U)
Flexor Carpi Ulnaris
(U)
Flexor Digitorum
Profundus (U)
Flexor Pollicis Longus
(M)
SScap= Suprascapular nerve
MC = Musculocutaneous nerve
Ax = Axillary nerve
R = Radial nerve
M = Median nerve
U = Ulnar nerve
1431
Upper Trunk Assessment

(C5-6)
Nerve Conduction Studies Needle EMG
Abnormal Sensory Normal Sensory Abnormal Normal

Median to 2nd Digit Ulnar to 5th Digit Supraspinatus Rhomboid Major
Median to Thumb Infraspinatus Serratus Anterior
Radial to Dorsum & Deltoid Triceps
Thumb Teres Minor First Dorsal
Lateral Antebrachial Biceps Interosseous
Cutaneous Brachioradialis Upper Cervical
Brachialis Paraspinals
Abnormal Motor Normal Motor Supinator
Pronator Teres
Axillary (Deltoid) Median (APB)
Extensor Carpi
Musculocutaneous Ulnar (ADM)
Radialis
(Biceps)
Flexor Carpi Radialis
Suprascapular
(Infraspinatus)
Clinical Presentation:
Weakness in nearly all C5-6 innervated muscles; most affected are Supraspinatus,
Infraspinatus, Deltoid, and Brachioradialis.
Sensory loss in lateral arm, lateral forearm, lateral hand and thumb.
Reflexes: Biceps and Brachioradialis are depressed or absent. Triceps reflex is normal.
1432
Reference Guides
Middle Trunk Assessment

(C7)

Median to 2nd Digit Median to Thumb Pronator Teres Deltoid
Median to 3rd Digit Ulnar to 5th Digit Flexor Carpi Radialis Biceps
Radial to Thumb Triceps Brachioradialis
Anconeus First Doral
Extensor Digitorum Interosseous
Abnormal Motor Normal Motor Com Mid Cervical
Radial (EIP or EDC) Median (APB) Paraspinals
Ulnar (ADM)
Middle Trunk injuries are very rare, they mimic C7 radiculopathy.
Weakness is seen primarily in the Pronator Teres, Flexor Carpi Radialis, and Triceps.
Sensory loss in middle finger and posterior forearm.
Reflexes: Only Triceps is abnormal.
1433
Lower Trunk Assessment

(C8, T1)

Ulnar to 5th Digit Median to 2nd Digit Abductor Digiti Deltoid
Medial Antebrachial Radial to Thumb Minimi Biceps
Cutaneous First Dorsal Brachioradialis
Dorsal Ulnar Interrosseous First Doral
Cutaneous APB Interosseous
Flexor Pollicis Mid Cervical
Abnormal Motor Normal Motor Longus Paraspinals
Extensor Indicis
Median (APB) Proprius
Ulnar (ADM) Flexor Carpi Ulnaris
Flexor Digitorum
Profundus
*Basically all Ulnar

innervated muscles,
and C8-T1 Median
innervated muscles
(APB, FPL, PQ), and
C8 Radial innervated
muscles (EIP, EPB)
Middle Trunk injuries are very rare, they mimic C7 radiculopathy.
Weakness is seen primarily in the Pronator Teres, Flexor Carpi Radialis, and Triceps.
Sensory loss in middle finger and posterior forearm.
Reflexes: Only Triceps is abnormal.
1434
Reference Guides
Posterior Cord Assessment

(Radial, Axillary, Thoracodorsal)

Radial to Thumb Median to 2nd Digit Deltoid Biceps
Ulnar to 5th Digit Teres Minor Pronator Teres
Brachioradialis First Dorsal
Abnormal Motor Normal Motor Supinator Interosseous
Triceps Mid Cervical
Radial (EIP and Median (APB) Extensor Carpi Paraspinals
EDC) Ulnar (ADM) Radialis
Axillary (Deltoid) Extensor Digitorum
Com
Extensor Indicis
Proprius
Radial palsies (wrist drop and finger drop), weakness of arm extension, weakness of shoulder
abduction, and adduction.
Sensory loss involves lateral arm, posterior arm and forearm, and radial innervated dorsal
portion of hand.
Reflexes: Triceps and Brachioradialis reflexes are abnormal. Biceps is normal.
1435
Lateral Cord Assessment

(Musculocutaneous, C6-7 portion of Median)

Median to Thumb Radial to Dorsum Biceps Infraspinatus
Median to 2nd Digit Ulnar to 5th Digit Brachialis Supraspinatus
Median to 3rd Digit Pronator Teres Brachioradialis
Lateral Antebrachial Flexor Carpi Radialis Supinator
Cutaneous Deltoid
Teres Minor
Abnormal Motor Normal Motor Rhomboid Major
Triceps
Musculocutaneous Median (APB) First Dorsal
(Biceps) Ulnar (ADM) Interosseous
Upper Cervical
Paraspinals
Weakness of arm pronation and wrist flexion (median nerve - PT, FCR). Weakness of elbow
flexion (radial nerve - biceps).
Sensory loss to the lateral forearm, lateral hand, and first 3 fingers.
Reflexes: Biceps reflex is abnormal.
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Reference Guides
Medial Cord Assessment

(C8-T1 Median, Ulnar)
- Nearly identical to Lower Trunk plexopathy, except for intact C8 Radial fibers
Ulnar to 5th Digit Radial to Dorsum First Dorsal Deltoid
Medial Antebrachial Median to 2nd Digit Interosseous Biceps
Cutaneous Abductor Pollicis Pronator Teres
Brevis Triceps
Abnormal Motor Normal Motor Flexor Pollicis Extensor Carpi
Longus Ulnaris
Median (APB) Flexor Carpi Ulnaris Extensor Indicis
Ulnar (ADM) Flexor Digitorum Proprius
Profundus Mid Cervical
Paraspinals
Weakness of all ulnar innervated muscles and C8-T1 median innervated muscles (APB, FPL,
FDP). The finger extensors (radial) are spared.
Sensory loss in medial arm, medial forearm, medial hand, and 4th and 5th fingers.
Reflexes: All normal.
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Median Nerve Diagram
1438
Reference Guides
Ulnar Nerve Diagram
1439
Radial Nerve Diagram
1440
Reference Guides
Musculocutaneous Nerve Diagram
1441
Suprascapular Nerve Diagram
1442
Reference Guides
Axillary Nerve Diagram
1443
Lumbar Plexus
1444
Reference Guides
Sacral Plexus
1445
Femoral and Fibular Nerve Diagram
1446
Reference Guides
Sciatic and Tibial Nerve Diagram
1447
NCV Setups
NCV Index
Upper Limb Motor Nerves

Median
Ulnar
Ulnar Inching Across Elbow
Radial
Musculocutaneous
Axillary
Suprascapular
Lower Limb Motor Nerves

Femoral
Fibular (to Extensor Digitorum Brevis)
Fibular (to Tibialis Anterior)
Tibial
Medial Plantar
Lateral Plantar
Upper Limb Sensory Nerves

Median Antidromic
Median Orthodromic
Median Across Palm
Median/Ulnar Comparison to 4th Digit
Median/Radial Comparison to 1st Digit
Median/Ulnar Palm Comparison to Wrist
Ulnar Orthodromic
Median Inching (across the wrist)
Dorsal Cutaneous
Medial Antebrachial Cutaneous
Lateral Antebrachial Cutaneous
Ulnar Antidromic
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Reference Guides
Radial Antidromic
Lower Limb Sensory Nerves

Sural Antidromic
Superficial Fibular Antidromic
Saphenous Antidromic
Medial Plantar
Lateral Plantar
Medial Plantar Mixed
Lateral Plantar Mixed
1449
Upper Limb Motor Nerves
Median Motor
1450
Reference Guides
1451
MEDIAN MOTOR - Example Traces
1452
Reference Guides
Ulnar Motor
1453
1454
Reference Guides
ULNAR MOTOR - Example Traces
1455
Ulnar Motor Inching Across Elbow
1456
Reference Guides
Radial Motor
1457
1458
Reference Guides
Example Trace (First Stimulation Site):
1459
Musculocutaneous Motor
1460
Reference Guides
Axillary Motor
1461
Suprascapular Motor
1462
Reference Guides
Lower Limb Motor Nerves
Femoral Motor
1463
Fibular Motor (EDB)
1464
Reference Guides
1465
Example Traces:
1466
Reference Guides
Fibular Motor (Tibialis Anterior)
1467
Tibial Motor
1468
Reference Guides
1469
Example Traces:
1470
Reference Guides
Medial Plantar Motor
1471
Lateral Plantar Motor
1472
Reference Guides
Upper Limb Sensory Nerves
Median Antidromic Sensory
1473
MEDIAN ANTI SENSORY - Example Trace
1474
Reference Guides
Median Orthodromic Sensory
1475
Example Traces:
1476
Reference Guides
Median Across Palm Sensory
1477
Example Traces:
1478
Reference Guides
Median/Ulnar Sensory Comparison to 4th Digit
1479
Example Traces:
1480
Reference Guides
Median/Radial Sensory Comparison to 1st Digit
1481
1482
Reference Guides
Example Traces:
1483
Median/Ulnar Palm Sensory Comparison to Wrist
1484
Reference Guides
Example Traces:
1485
Ulnar Antidromic Sensory
1486
Reference Guides
ULNAR ANTI SENSORY - Example Trace
1487
Ulnar Orthodromic Sensory
1488
Reference Guides
Example Trace:
1489
Radial Antidromic Sensory
1490
Reference Guides
Example Trace:
1491
Median Inching (across the wrist)
1492
Reference Guides
Example Traces:
1493
Dorsal Cutaneous
1494
Reference Guides
Example Trace:
1495
Medial Antebrachial Cutaneous
1496
Reference Guides
Example Trace:
1497
Lateral Antebrachial Cutaneous
1498
Reference Guides
Example Trace:
1499
Lower Limb Sensory Nerves
Sural Antidromic Sensory
1500
Reference Guides
Example Trace:
1501
Superficial Fibular Antidromic Sensory
1502
Reference Guides
1503
Example Trace:
1504
Reference Guides
Saphenous Antidromic Sensory
1505
Medial Plantar Sensory
1506
Reference Guides
Lateral Plantar Sensory
1507
Medial Plantar Mixed
1508
Reference Guides
Lateral Plantar Mixed
1509
F Wave / H Reflex Setups

F Wave / H Reflex Index
Median F Wave
Ulnar F Wave
Fibular F Wave
Tibial F Wave
H Reflex (Tibial)
1510
Reference Guides
Median F Wave
1511
Median F Wave Example Traces:
1512
Reference Guides
Ulnar F Wave
1513
Ulnar F Wave Example Traces:
1514
Reference Guides
Fibular F Wave
1515
Fibular F Wave Example Traces:
1516
Reference Guides
Tibial F Wave
1517
Tibial F Wave Example Traces:
1518
Reference Guides
H Reflex
1519
Tibial H-Reflex Example Traces:
1520
Reference Guides
EMG Muscles
Muscle Index
Hand Muscles
Abductor Pollicis Brevis
Adbductor Digiti Minimi
First Dorsal Interosseous
Forearm Muscles
Flexor Digitorum Superficialis
Extensor Indicis
Extensor Carpi Radialis
Extensor Digitorum Communis
Extensor Pollicis Longus
Abductor Pollicis Longus
Pronator Teres
Brachioradialis
Anconeus
Supinator
Pronator Quadratus
Arm Muscles
Biceps Brachii
Triceps
Brachialis
Shoulder Muscles
Pectoralis Major
Supraspinatus
Infraspinatus
Latissimus Dorsi
1521
Teres Major
Deltoid
Serratus Anterior
Rhomboid Major
Levator Scapula
Trapezius
Foot Muscles
Extensor Digitorum Brevis
Abductor Digiti Quinti
Abductor Hallucis
Leg Muscles
Posterior Tibialis
Fibularis Longus
Gastrocnemius - Lateral
Gastrocnemius - Medial
Anterior Tibialis
Soleus
Extensor Hallucis Longus
Extensor Digitorum Longus
Thigh Muscles
Biceps Femoris - Long Head
Biceps Femoris - Short Head
Adductor Longus
Vastus Medialis
Vastus Lateralis
Rectus Femoris
Adductor Magnus
Gracilis
Hip Muscles
Gluteus Maximus
Gluteus Medius
1522
Reference Guides
Iliopsoas
Non-Limb Muscles
Orbicularis Oris
Orbicularis Oculi
Sternocleidomastoid
Cervical Paraspinals
Lumbosacral Paraspinals
Innervation and Action
Common Arm Muscles
1523
Common Leg Muscles
1524
Reference Guides
Hand
Abductor Pollicis Brevis
1525
Abductor Digiti Minimi
1526
Reference Guides
First Dorsal Interosseous
1527
Forearm
1528
Reference Guides
Flexor Digitorum Superficialis
1529
1530
Reference Guides
Extensor Indicis
1531
1532
Reference Guides
Extensor Carpi Radialis
1533
Extensor Digitorum Communis
1534
Reference Guides
Extensor Pollicis Longus
1535
Abductor Pollicis Longus
1536
Reference Guides
Pronator Teres
1537
Brachioradialis
1538
Reference Guides
Anconeus
1539
Supinator
1540
Reference Guides
Pronator Quadratus
1541
Arm
Biceps Brachii
1542
Reference Guides
Triceps
1543
Brachialis
1544
Reference Guides
Shoulder
Pectoralis Major
1545
Supraspinatus
1546
Reference Guides
Infraspinatus
1547
Latissimus Dorsi
1548
Reference Guides
Teres Major
1549
Deltoid
1550
Reference Guides
Serratus Anterior
1551
Rhomboid Major
1552
Reference Guides
Levator Scapula
1553
Trapezius
1554
Reference Guides
Foot
Extensor Digitorum Brevis
1555
Abductor Digiti Quinti
1556
Reference Guides
Abductor Hallucis
1557
Leg
Posterior Tibialis
1558
Reference Guides
Fibularis Longus
1559
Gastrocnemius - Lateral Head
1560
Reference Guides
Gastrocnemius - Medial Head
1561
Anterior Tibialis
1562
Reference Guides
Soleus
1563
Extensor Hallucis Longus
1564
Reference Guides
Extensor Digitorum Longus
1565
Thigh
Biceps Femoris - Long Head
1566
Reference Guides
Biceps Femoris - Short Head
1567
Adductor Longus
1568
Reference Guides
Vastus Medialis
1569
Vastus Lateralis
1570
Reference Guides
Rectus Femoris
1571
Adductor Magnus
1572
Reference Guides
Gracilis
1573
Hip
Gluteus Maximus
1574
Reference Guides
Gluteus Medius
1575
IIiopsoas
1576
Reference Guides
Non-Limb
Orbicularis Oris
1577
Orbicularis Oculi
1578
Reference Guides
Sternocleidomastoid
1579
Cervical Paraspinals
1580
Reference Guides
Lumbosacral Paraspinals
1581
EP Setups
EP Index
Median SEP (2 Channel)

Tibial SEP (2 Channel)
Upper SEP Dermatomes
Lower SEP Dermatomes
Auditory EP
Visual EP
Cognitive EP (P300)
1582
Reference Guides
1583
2 Ch. Median SEP Example Traces:
1584
Reference Guides
1585
1586
Reference Guides
1587
1588
Reference Guides
1589
2 Ch. Tibial SEP Example Traces:
1590
Reference Guides
1591
3 Ch. Tibial SEP Example Traces:
1592
Reference Guides
1593
Upper SEP Dermatomes
1594
Reference Guides
Lower SEP Dermatomes
1595
AEP Setup
1596
Reference Guides
AEP Example Traces:
1597
VEP Setup
1598
Reference Guides
1 Ch. VEP Example Traces:
1 channel VEP
1599
P300 Setup
1600
Reference Guides
3 Ch. P300 Example Traces:
1601
Blink Setup
Blink Reflex Setup
1602
Reference Guides
Blink Reflex Example Traces:
1603
Brainstem Lesions and Blink Reflex Responses
1604
Reference Guides
1605
SSR
SSR Hand
1606
Reference Guides
SSR Hand Example Traces:
1607
SSR Foot
1608
Reference Guides
SSR Foot Example Traces:
1609

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Reference Guides

Brachial Plexus Root Distribution

Brachial Plexus Studies

Motor Nerve Median (APB) Perform conduction studies in all nerves

If there is weakness in Lower Trunk, test

Segments of the Brachial Plexus tested by specific nerve conduction studies

Lateral Lateral Antebrachial Median sensory to 2nd

Posterior Radial sensory Radial sensory

Medial Ulnar sensory to 5th

Brachial Plexus Muscle Innervation

Upper Trunk Assessment

Nerve Conduction Studies Needle EMG

Abnormal Sensory Normal Sensory Abnormal Normal

Middle Trunk Assessment

Nerve Conduction Studies Needle EMG

Abnormal Sensory Normal Sensory Abnormal Normal

Sensory loss in middle finger and posterior forearm.

Reflexes: Only Triceps is abnormal.

Lower Trunk Assessment

Nerve Conduction Studies Needle EMG

*Basically all Ulnar

Sensory loss in middle finger and posterior forearm.

Reflexes: Only Triceps is abnormal.

Posterior Cord Assessment

Nerve Conduction Studies Needle EMG

Reflexes: Triceps and Brachioradialis reflexes are abnormal. Biceps is normal.

Lateral Cord Assessment

Nerve Conduction Studies Needle EMG

Reflexes: Biceps reflex is abnormal.

Medial Cord Assessment

Reflexes: All normal.

Median Nerve Diagram

Ulnar Nerve Diagram

Radial Nerve Diagram

Musculocutaneous Nerve Diagram

Suprascapular Nerve Diagram

Axillary Nerve Diagram

Femoral and Fibular Nerve Diagram

Sciatic and Tibial Nerve Diagram

Upper Limb Motor Nerves

Ulnar Inching Across Elbow

Lower Limb Motor Nerves

Fibular (to Extensor Digitorum Brevis)

Fibular (to Tibialis Anterior)

Upper Limb Sensory Nerves

Median Across Palm

Median/Ulnar Comparison to 4th Digit

Median/Radial Comparison to 1st Digit

Median/Ulnar Palm Comparison to Wrist

Median Inching (across the wrist)

Medial Antebrachial Cutaneous

Lateral Antebrachial Cutaneous

Lower Limb Sensory Nerves

Superficial Fibular Antidromic

Medial Plantar Mixed

Lateral Plantar Mixed

Upper Limb Motor Nerves

MEDIAN MOTOR - Example Traces

ULNAR MOTOR - Example Traces

Ulnar Motor Inching Across Elbow

Example Trace (First Stimulation Site):

Lower Limb Motor Nerves

Fibular Motor (EDB)