Ultrasound guidance increases diagnostic yield of needle EMG in plegic muscle |
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| Institution: | 1. Department of Clinical and Experimental Medicine, Policlinico “G.Martino”, University of Messina, Via Consolare Valeria n1, 98124 Messina, Italy;2. Unit of High Intensity Neurorehabilitation, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy;3. Department of Neuromotor Rehabilitation, IRCCS “San Raffaele Pisana”, Via della Pisana 235, Rome 00163, Italy;4. Department of Geriatrics, Neurosciences & Orthopaedics, Università Cattolica, Largo Agostino Gemelli n8, 00168 Rome, Italy;1. Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan;2. Emeritus of Gifu University, Japan;3. Hermitage of Magnetoencephalography, Japan;1. Department of Neurorehabilitation, Neurological Area, IRCCS San Raffaele Hospital, Milan, Italy;2. Experimental Neurophysiology Unit, Division of Neuroscience, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy;3. University Vita-Salute San Raffaele, Milan, Italy;1. Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, IS, Italy;2. Laboratory of Synaptic Immunopathology, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy;3. Service of Medical Statistics & Information Technology, Fondazione Fatebenefratelli per la Ricerca e la Formazione Sanitaria e Sociale, Lungotevere de'' Cenci 5, 00186 Rome, Italy;1. Division of Developmental Medicine, Boston Children’s Hospital, 02215, United States;2. Harvard Medical School, 02215, United States;3. The Banyan, 600037, India;4. College of Medicine, University of Illinois at Chicago, 60612, United States;5. College of Medicine, University of Florida, 32610, United States;6. Department of Psychology, Temple University, 19122, United States;1. Yale School of Medicine, Department of Neurology, 15 York Street, LCI 9, P.O. Box 208108, New Haven, CT 06519, USA;2. Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Ave, Boston, MA 02215, USA |
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| Abstract: | ObjectivesTo increase the specificity of motor unit potential (MUPs) detection by using ultrasound guided electromyography (USG-EMG) in patients with muscle plegia due to traumatic nerve lesions.MethodsForty-six patients with recent nerve trauma underwent baseline standard EMG (ST-EMG) evaluation with evidence of absent MUPs. In 41 of them, ST-EMG was repeated after 2–3 months (T1) and the patients were accordingly divided in two groups: ST-EMG+ (if MUPs were detected) or ST-EMG- (MUPs not detected). Then, ST-EMG- patients underwent muscle ultrasound evaluation (M-US) and, if isles of muscular contractility were found, they also had USG-EMG. The same protocol was repeated 4–6 months after baseline (T2).ResultsAt T1, 22/41 patients were ST-EMG+. While 19/41 were ST-EMG-; 9 of these patients had M-US consistent with residual muscular activity, for that reasons underwent USG-EMG with 7 of 9 demonstrating MUPs (at T2 all of these 7 patients resulted ST-EMG). In the other 2 patients, we found no MUPs at T1 but they became ST-EMG+ or USG-EMG positive at T2. The remaining 10 ST-EMG- patients had no EMG or US evidence of muscle contraction at T1, but at T2 2 of 10 became ST-EMG+ and 2 had USG-EMG showing MUPs. In the remaining 6 patients still M-US negative at T2, complete denervation was diagnosed. Concerning the 22 patients who were ST-EMG+ at T1, all but one showed increase of MUPs at T2.ConclusionsIn this study, we demonstrated the utility of US guidance when performing EMG evaluation in locating isles of muscular contractility in patients who have no detectable MUPs on EMG after nerve trauma.SignificanceUSG-EMG significantly increases the specificity of needle EMG allowing earlier detection of MUPs. |
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| Keywords: | Traumatic nerve lesion Plegia Nerve ultrasound evaluation Needle electromyography Early diagnosis |
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