Electrodiagnosis

Electrical stimulators to diagnose, to evaluate certain conditions

 study of electrical activity of motor units when stimulated by electrical pulses

 considers the normal and abnormal behavior of the response of motor unit when stimulated
 interpretation of its results can be used for diagnosis and prognosis in disorders of
neuromuscular complex

MOTOR UNIT

 the functional unit of centrally controlled muscle function and consists the anterior horn cell,
motor neuron and muscle fibers innervated by the nerve.

STRUCTURES TO BE STIMULATED:

NERVE FIBERS

 can respond to both long and short pulse duration

 less intensity can be applied for long pulse duration; higher intensity for short pulse duration
(intensity and pulse duration are inversely proportional)
 has property of accommodation which can be overcomed by increasing the intensity and using
abrupt change of intensity (rectangular)

MUSCLE FIBERS

 has little or no accommodation property; respond more to long pulse duration

Reaction of Degeneration

 reaction wherein muscles are deprived of their nerve supply or denervation; won’t respond to
short pulse duration [because the muscle is needed to respond to the pulse]; degeneration of
the nerve.

2 types:

 partial reaction of degeneration – decrease response to short pulse duration.

 complete reaction of degeneration – no more response to short pulse duration.

Reaction of structures to electrical stimulus can be affected with the following:

 Skin and subcutaneous tissue resistance to the current – greater resistance would need higher
intensity
 Edema – since the structures are deeply located due to edema so higher intensity is needed to
reach the structures
 Inflammation and pain – since patient already have sense of discomfort, giving electrical
stimulus can further add more discomfort
 Temperature – heat increases the sensitivity of the structures to electrical stimulus so it can
decrease the intensity but with cold, it decreases the sensitivity of the structures so needs
higher intensity.
  Amount of subcutaneous tissue – thicker is the subcutaneous tissue can cause the structures to
become more deeply situated and needs higher intensity to stimulate the structures
 Humidity (temperature of the environment) – easily allow the current to flow; hot humidity
decreases the value of intensity. Less intensity is needed.
 Electrode at the structure – if cathode is placed on the structure, then less intensity is needed to
stimulate the structures
 Location of muscles – more superficial muscles are stimulated, as compared to deep muscles.
 Size of muscle – larger muscles need higher intensity to be stimulated as compared to small
muscles.
 Pressure application from the electrode/s – greater pressure is placed by the electrode/s can
increase the current density and distance of the electrode/s from the structure is near so less
intensity is needed.
 [Distance of electrode from structure]
 Tension of the muscle – the greater the tension, the less tendency to contract so greater
intensity is used.

Electrodiagnostic Methods

Rheobase

 least intensity of the current required to produce minimal perceptible/palpable or visible

contraction using a pulse of infinite duration

parameter settings:

a. pulse waveform: rectangular

b. pulse duration: long (100 – 300 ms.)

 normal value: 2 – 18 mA; 5 -35 V

Chronaxie

 duration in milliseconds necessary to produce minimal perceptible/palpable or visible

contraction with a stimulus that is twice the rheobase.
 normal value: less than 1 ms. (0.05 – 0.5 ms.)

Accommodation ratio / accommodation quotient

 ratio between impulse threshold of exponential progressive current to the impulse threshold of
rectangular pulse using the same pulse duration

exponential progressive current impulse threshold

rectangular current impulse threshold

 normal ratio: 3 to 6
 denervated: below 3
  no accommodation: 1 and below

[if 1; meaning equal ang duha; indicates no structures accommodated -> there is absence of the nerve]

Strength duration curve

 a curve obtained in a graph by joining points that represent the threshold values along the
ordinate (y-axis) for various durations of stimulus at the abscissa (x-axis)
 minimal palpable/perceptible or visible contraction should be elicited
 choice of at least 6 pulses to a maximum of 10 pulses
 pulse duration can range from 0.02 to 1,000 ms.
 long pulse duration should be at least 100 ms.
 is done 10 – 14 days after the onset of lesion
 utilization time (point at which the curve begins to flatten horizontally) can be determined,
which signify the probable pulse duration which will be suitable for stimulation if the structure is
to be treated

 innervated: the graph is more at lower level and the curve shifts to the left
 denervated: the graph is steeper and curve shifts to the right
 partially innervated/partially denervated: there is presence of kink (discontinuity of curve); right
portion are denervated component and at left of curve are innervated component.

Pulse ratio

 the ratio of intensity of the current needed to produce muscle contraction with 1 ms. to that
required to produce muscle contraction with 100 ms.

 innervated: less than 2.2: 1 (10 mA : 5 mA)

 partially denervated or partially innervated: greater than 2.5: 1 (15mA: 5mA)
 completely denervated: no respond to 1 ms.

Nerve excitability test

 uses a short pulse duration (0.1 ms. or 1ms.) utilizing rectangular pulse to determine the
state of excitability of the nerve trunk which causes several muscles to contract
 minimal perceptible/palpable or visible contraction
 value is compared to the opposite side and a difference of 3 mA or 8 volts or more will
indicate denervation

Ex: Left side = 10 mA; Right side = 6 mA; Difference of 4 mA Therefore, there is denervation

Different sites of nerve trunk:

Place one electrode exactly on the nerve trunk; the other is slightly away from the nerve trunk

 Facial nerve – anterior to the mastoid process (contraction of facial muscles)

 Erb’s point – lower inner angle of the supraclavicular fossa (contraction of deltoids, biceps
brahii, brachialis, brachioradialis
 Ulnar nerve
o above the medial epicondyle of the elbow (contraction of wrist flexors and ulnar
deviators, finger flexors)
o above the wrist near the ulnar borer (thumb adductors, MCP flexors)
 Radial nerve – halfway of the arm posteriorly (wrist extensors and finger Extensors)
 Tibial nerve – above the center of popliteal fossa ( plantarflexor of ankle and toes)
 Deep peroneal nerve – behind the head of fibula (ankle dorsiflexors)
 Superficial peroneal nerve – one centimeter below the deep peroneal nerve (ankle evertors)