Fibular motor nerve conduction studies: Investigating the mechanism for compound muscle action potential amplitude drop with proximal stimulation

Kamel, Jordan; Knight-Sadler, ROry; Roberts, Leslie

doi:10.1002/mus.24671

Cited by 5 publications

(4 citation statements)

References 3 publications

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“…Several papers have drawn attention to the importance of E2 placement to achieve reliable CMAPs in motor NCS 3‐7 . Some E2 sites may be contaminated by near field or far field potentials (FFP) arising from adjacent muscles, or even the target muscle that detracts from the utility of those studies 5,8‐11 …”

Section: Introductionmentioning

confidence: 99%

Proximal fibular nerve conduction studies to tibialis anterior: Optimal E2 (reference electrode) placement

Day

2020

Muscle and Nerve

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Background Several E2 (reference electrode) positions are described for fibular (peroneal) nerve conduction studies to tibialis anterior (TA). Methods This study compared the contribution of different E2 sites to the TA motor response, using remote referential recordings and different bipolar montages. Results The medial knee contributes minimal electrical activity to the bipolar TA recordings, whereas tibial, ankle, and toe references resulted in very similar, moderate amplitude contributions consistent with far field potentials. These observations were very similar in controls and in patients with lower leg symptoms and signs. Conclusions Standard montages using distal leg or foot E2 sites result in lower amplitudes with distortion arising from the E2 electrode, compared with the TA‐Knee montage. Optimal measurement of the TA motor response is achieved using a medial knee reference, without compromising measures of fibular nerve conduction across the knee.

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Section: Introductionmentioning

confidence: 99%

Proximal fibular nerve conduction studies to tibialis anterior: Optimal E2 (reference electrode) placement

Day

2020

Muscle and Nerve

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“…However, when E2 records volume‐conducted or far‐field potentials, it may cancel part of the E1 near‐field potentials . Previous studies have demonstrated the contribution of the E2 signal to the CMAP amplitude in the motor conduction studies to the abductor digiti minimi (ADM), abductor pollicis brevis (APB), abductor hallux (AH), and extensor digitorum brevis (EDB) muscles …”

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confidence: 99%

Optimal E2 (reference) electrode placement in fibular motor nerve conduction studies recording from the tibialis anterior muscle

et al. 2018

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elucidate a definitive time frame in which recovery was obtained. In addition, the scope of analysis was limited because of the small sample and lack of controls. However, the time of recovery was similar to that in a previous EMG outcome study. 3 This report describes EMG findings of recovery after decompression of paralabral cysts at the suprascapular or spinoglenoid notch with arthroscopy or ultrasound-guided aspiration. Our results show that neurophysiological findings of nerve entrapment normalized after decompression. Long-term studies with more patients and follow-ups are required to determine time to recovery.We thank Nicole Hurwitz, BS, and Jennifer Cheng, PhD, for their assistance with the manuscript preparation process.Ethical Publication Statement: We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. 2. Fehrman DA, Orwin JF, Jennings RM. Suprascapular nerve entrapment by ganglion cysts: a report of 6 cases with arthroscopic findings and review of the literature. Arthroscopy 1995;11 (6):727-734. 3. Feinberg JH, Nguyen ET, Boachie-Adjei K, Gribbin C, Lee SK, Daluiski A, et al. The electrodiagnostic natural history of Parsonage-Turner syndrome. Muscle Nerve 2017;56(4):737-743. 4. Ferretti A, De Carli A, Fontana M. Injury of the suprascapular nerve at the spinoglenoid notch. The natural history of infraspinatus atrophy in volleyball players. Am J Sports Med 1998;26(6):759-763. 5. Zehetgruber H, Noske H, Lang T, Wurnig C. Suprascapular nerve entrapment. A meta-analysis. Int Orthop 2002;26(6):339-343. 6. Arriaza R, Ballesteros J, Lopez-Vidriero E. Suprascapular neuropathy as a cause of swimmer's shoulder: results after arthroscopic treatment in 4 patients. Am J Sports Med 2013;41(4):887-893. 7. Shah AA, Butler RB, Sung SY, Wells JH, Higgins LD, Warner JJ. Clinical outcomes of suprascapular nerve decompression. J Shoulder Elbow Surg 2011;20(6):975-982. 8. Krarup C, Boeckstyns M, Ibsen A, Moldovan M, Archibald S. Remodeling of motor units after nerve regeneration studied by quantitative electromyography. Clin Neurophysiol 2016;127(2):1675-1682. 9. Hill LJ, Jelsing EJ, Terry MJ, Strommen JA. Evaluation, treatment, and outcomes of suprascapular neuropathy: a 5-year review. PM R 2014; 6(9):774-780. 10. Westerheide KJ, Dopirak RM, Karzel RP, Snyder SJ. Suprascapular nerve palsy secondary to spinoglenoid cysts: results of arthroscopic treatment. Arthroscopy 2006;22(7):721-727. 11. Lafosse L, Tomasi A, Corbett S, Baier G, Willems K, Gobezie R. Arthroscopic release of suprascapular nerve entrapment at the suprascapular notch: technique and preliminary results. Arthroscopy 2007;23(1):34-42. 12. Fernandes MR, Fernandes RJ. Indirect arthroscopic decompression of spinoglenoid cyst with suprascapular neuropathy: report of two cases and literature review. Rev Bras Ortop 2010;45(3):306-311.Additional supporting information may be found in the online version of this article.

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“…For the common peroneal nerve, an amplitude reduction of approximately 30% and an area reduction of approximately 20% could be seen as normal. Some empirical data for amplitude and area reduction also show similar findings [24][25][26][27][28]. For the common peroneal nerve, an amplitude reduction of 30% and area reduction of 25% were viewed as normal in several studies [25][26][27][28], and for the tibial nerve, an amplitude reduction of up to 40% and an area reduction of up to 25% were observed in the normal population [24,25,27].…”

Section: Proximal Amplitude and Area Reduction Compared To Distal Sti...mentioning

confidence: 62%

Reference Standards for Nerve Conduction Studies of Individual Nerves of Lower Extremity With Expanded Uncertainty in Healthy Korean Adults

Kim

Shim³

et al. 2022

Ann Rehabil Med

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Objective To develop a set of reference standards for tibial motor, common peroneal motor, sural sensory, and superficial peroneal sensory nerve conduction studies (NCSs) with expanded uncertainty in a healthy Korean population.Methods Standardized procedures were conducted for individual lower extremity NCSs of 199 healthy participants in their 20s (n=100) and 50s (n=99). Mean values and expanded uncertainties for parameters were analyzed with thorough consideration of multiple uncertainty factors under the International Guide to the Expression of Uncertainty in Measurement. In addition, side-to-side differences in onset latency, amplitude, and nerve conduction velocity (NCV) were analyzed.Results Mean (reference range) for distal onset latency, baseline to negative peak amplitude, NCV of tibial motor nerve in males in their 20s were 4.3 ms (3.1–5.4 ms), 7.1 mV (3.4–10.9 mV), and 50.7 m/s (42.2–59.3 m/s), respectively; sural sensory nerve baseline to negative peak amplitude in males in their 20s was 21.7 μV (8.3–35.2 μV). Including the aforementioned data, we present a vast dataset of normative mean values and expanded uncertainties for NCSs of the leg in a healthy Korean population. Furthermore, upper limits for normal side-to-side differences for onset latency, amplitude, and NCV of each nerve are suggested.Conclusion To our knowledge, this is the first study to present the reference standards of leg NCSs with consideration for multifactorial uncertainties in an Asian population. We expect these results to help practitioners make reliable and reproducible clinical decisions.

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Fibular motor nerve conduction studies: Investigating the mechanism for compound muscle action potential amplitude drop with proximal stimulation

Abstract: A greater R-CMAP contribution to the fibular CMAP leads to greater phase cancellation and temporal dispersion. The resulting amplitude drop seen in the proximal CMAP can be large enough to be classified incorrectly as "probable conduction block" by several different diagnostic criteria.

Cited by 5 publications

References 3 publications

Proximal fibular nerve conduction studies to tibialis anterior: Optimal E2 (reference electrode) placement

Proximal fibular nerve conduction studies to tibialis anterior: Optimal E2 (reference electrode) placement

Optimal E2 (reference) electrode placement in fibular motor nerve conduction studies recording from the tibialis anterior muscle

Reference Standards for Nerve Conduction Studies of Individual Nerves of Lower Extremity With Expanded Uncertainty in Healthy Korean Adults

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