1. Guideline: Needle EMG examination of at least 1
muscle innervated by the C5, C6, C7, C8, and T1
spinal roots in a symptomatic limb, performed and
interpreted by a specially trained physician. Cervical paraspinal muscles at 1 or more levels, as
appropriate to the clinical presentation, should be
examined (except in patients with prior cervical
laminectomy using a posterior approach). If a
specific root is suspected clinically, or if an
abnormality is seen on the initial needle EMG
examination, additional studies as follows:
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Examination of 1 or 2 additional muscles innervated by the suspected root and a different
peripheral nerve.
-
Demonstration of normal muscles above and
below the involved root.
2. Guideline: At least 1motor and 1sensory NCS
should be performed in the clinically involved limb
to determine if concomitant polyneuropathy or
nerve entrapment exists. Motor and sensory NCSs
of the median and ulnar nerves should be performed
if symptoms and signs suggest CTS or ulnar
neuropathy. If 1 or more NCSs are abnormal, or if
clinical features suggesting polyneuropathy are
present, further evaluation may include NCSs of
other nerves in the ipsilateral and contralateral limbs
to define the cause of the abnormalities.
3. Option: If needle EMG examination is abnormal,
needle EMG of 1or more contralateral muscles
may be necessary to exclude bilateral radiculopathy, or to differentiate between radiculopathy
and polyneuropathy, motor neuron disease, spinal
cord lesions, or other neuromuscular disorders.
4. Option: Perform median and/or ulnar F-wave
studies in suspected C8 or T1 radiculopathy.
Compare with the contralateral side if necessary.
5. Option: Perform cervical nerve root stimulation to
help in identifying radiculopathy.
6. Option: Perform H-reflex study of the flexor carpi
radialis to assist in identifying pathology of the C6
and C7 nerve roots.
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