ENMG Flashcards by Luan Henrique Honório Rocha

O que acontece com amplitude com perda axonal

Diminui

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O que é latência?

Do estímulo até o início da onda

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Como está a latência em desmielinizacao

Prolonged

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Tempo de resposta tardia nos MS

20-35 ms

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Tempo de resposta tarde nos MIS

45-60 ms

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O que é onda F

Estímulo supra máximo motor distal que vai até medula, ativa neurônios motores e voltam distalmente

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O que inclui resposta tardia

Onda F e reflexo H

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O que devemos responder ao observamos onda F e reflexo H

Se existem e se tem latências mínimas

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O que é o reflexo H

Estimulação de um nervo sensitivo para produzir uma resposta motora tardia

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Característica perda axonal inicial

Diminuição da amplitude

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Característica perda axonal tardia

Além da diminuição de amplitude, latência pode aumentar um pouco e velocidade diminuir por perda de fibras grossas

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Características desmielinizacao

Diminui velocidade de condução e dispersão temporal (aumento da duração). Pode ter bloqueio de condução.

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O que é bloqueio de condução

Redução de pelo menos 50% de amplitude/area proximal comparada com distal

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O que vemos na desmielinizacao proximal

Prolongamento de onda F e reflexo H

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EMG neurogenica

Unidades motoras grandes e polifásicas e diminuição do recrutamento

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EMG miopatica

Unidades motoras pequenas, polifasicas e com recrutamento motor precoce

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Tipos de sensibilidade avaliadas na ENMG

Tátil, vibratória e propriocepcao

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Para avaliar fibras finas

Quantitative testing and autonomic testing

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Raíz ulnar

C8-T1

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Raíz mediano

C5-T1

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Raíz radial

C5-T1

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Fibular nerve root

L4-S2

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Sural nerve root

S1-S2

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Tibial nerve root

L4-S3

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Peroneal nerv root

L4-S2

What is motor unit recruitment?

Activation of motor units with voluntary muscle contraction

Distal motor amplitude medial nerve

Above 5 mV

Distal motor amplitude ulnar nerve

Above 5,8 mV

Distal motor amplitude tibial nerve

Above 2 mV

Distal motor amplitude peroneal

Above 2,2

Distal motor latency median

Bellow 4,3 ms

Distal motor latency ulnar

Bellow 3,5 ms

Distal motor latency tibial

Bellow 7,3 ms

Distal motor latency peroneal

Bellow 6 ms

Distal motor duration ulnar and tibial

Bellow 8,1 ms

Distal motor duration median

Bellow 7,7

Distal motor duration peroneal

Bellow 8,6

Motor nerves evaluated in NCS

Tibial, peroneal, median, ulnar

Sensory nerves evaluated in NCS

Sural, superficial peroneal, median, ulnar

F-waves evaluated in NCS

Tibial, median, ulnar

H-reflex evaluated in NCS

Tibial

Stimulation site in motor tibial

Ankle and knee

Recording site in motor tibial

FHB (flexor hallucis brevis)

Stimulation site in motor peroneal

Ankle, fibular head, above knee

Recording site in motor peroneal

EDB (Extensor Digitorum Brevis), TA (Transverse abdominis) if peroneal nerve palsy

Stimulation site in sensory sural

Ankle

Recording site in sensory sural

Calf

Stimulation site in sensory superficial peroneal

Leg

Recording site in sensory superficial peroneal

Ankle

Stimulation site in Tibial f-waves

Ankle

Recording site in Tibial f-waves

FHB (flexor hallucis brevis)

Stimulation site in motor median

Wrist median anterior, elbow at the pulse

Recording site in motor median

APB (abductor pollicis brevis)

Stimulation site in motor ulnar

Wrist anterior lateral, bellow elbow, above elbow (usually 10 cm diference)

Recording site in motor ulnar

ADM (abductor digiti minimi), if ulnar neuropathy, add FDI (first dorsal interosseous)

Stimulation site in sensory median

Palm, D2

Recording site in sensory median

Wrist

Stimulation site in sensory ulnar

Palm, D5. Wrist if ulnar neuropathy

Recording site in sensory ulnar

Wrist. Above elbow if ulnar neuropathy

Stimulation site in median f-waves

Wrist anterior medial

Recording site in median f-waves

APB (abductor pollicis brevis)

Stimulation site in ulnar f-waves

Wrist anterior lateral

Recording site in ulnar f-waves

ADM (abductor digiti minimi)

Stimulation site in tibial H-reflex

Knee

Recording site in tibial H-reflex

Soleus

Stimulation site in sensory sural

Ankle

Recording site in sensory sural

Calf

How much can we accept of amplitude decrease when going more proximal?

20%

What to do when you don’t get a wave?

Increase voltage or duration or position of stimulation of active and reference

Duration classic setup in machine

0,2ms

The light in the stimulater means what?

The direction of the stimulus

Difference between motor and sensitive stimulation

Sensitive is continuous, motor no

Amplitude in contraction

200mV

Amplitude in rest

50mV

Colors of cables meaning

Green ground, black active, red reference

ENMG Flashcards

(75 cards)