EDX
Introduction to electrodiagnosis
Definition
• Medical subspeciality to utilize neurophysiologic techniques to
(diagnose – evaluate – treat ) patients with physical impairment
in ( nerve – muscle – neuromuscular junction )
Indications contraindications
• Determine region of abnormality
• Determine distribution of abnormality • Active skin disease or soft tissue
• Determine type of abnormality
• Determine severity of abnormality
infection
• Determine prognosis of abnormality
• Determine date and duration of
abnormality
• Hypertrophic scars ( scare tissue )
• Aid in diagnosis of abnormity and predict
the prognosis • Sever bleeding
• Aid in selecting treatment options
• Localize correct location for injection of
• Cardiac peacemaker
intramuscular agents
Precautions
• Thin patient ( as nerves being superficial )
• Morbid obesity ( subcutaneous tissue be as an insulator )
• Blood disorder ( as hemophilia )
EDX machine
component
• Screen and desktop
• Stimulating electrode
• Recording electrode
(surface electrode –
needle electrode)
• Ground electrode
• Amplifier
Recording electrodes
Surface electrodes Needle electrodes
For NCS – EMG – RNS – Late Response For EMG only
Stimulating Electrode Ground Electrode
Pit Falls
• Poor history taking or poor physical examination
• Non physiological factors as noise ( sounds above 60 Hz )
• Physiological factors as :
Age : in
1. newborn C.V 50% of adult
2. 1:3 years C.V 75% of adult
3. Above 3 years C.V. Same of adult
• Technical errors
• Anatomical errors
• Measurement error
• Anomalous innervation as ( martin gruber anastomosis – riche cannieu anastomosis – accessory
peroneal nerve )
• Temperature
• Stimulation over subcutaneous tissue
Orthodromic Antidromic
• Recording potential in its original • Recording potential in opposite
direction : direction of original direction :
• Motor potential : from A.H.C to • Motor potential : from muscle to
muscle A.H.C
• Sensory potential : from sensory • Sensory potential : from P.H.C to
receptors to P.H.C sensory receptors
Brachial plexus
• Root: 5 roots ( C5 – C6 – C7 – C8 – T1 )
• Trunk: 3 trunk ( superior – middle – inferior )
• Divisions : 2 division ( anterior and posterior ) for every trunk
• Cord: 3 cords ( lateral – medial – posterior )
• Terminal branches : there's a lot of branches as : median nerve – ulnar
– radial – musculocutaneous – axillary