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Kansas
Oh, I have walked in Kansas
Through many a harvest field,
And piled the sheaves of glory there
And down the wild rows reeled:
Each sheaf a little yellow sun,
A heap of hot-rayed gold;
Each binder like Creation's hand
To mould suns, as of old.
-Vachel Lindsey.
ElectromyographyElectromyography (EMG) is a medical technique for evaluating and recording physiologic properties of muscles at rest and while contracting. EMG is performed using an
instrument called an
electromyograph, to produce a record called an
electromyogram. An electromyograph detects the
electrical potential generated by muscle
cells when these cells contract, and also when the cells are at rest.
Electrical characteristics
The electrical source is the muscle membrane potential of about −70mV. Due to the applied method, the resulting measured potentials range between less than 50 μV and 20 to 30 mV.
Typical repetition rate of muscle unit firing is about 7–20 Hz, depending on the size of the muscle (eye muscles versus seat (gluteal) muscles), previous axonal damage and other factors. Damage to motor units can be expected at ranges between 450 and 780 mV.
Procedure
To perform EMG, a needle electrode is inserted through the skin into the muscle tissue. A trained medical professional (most often a physiatrist, neurologist, or physical therapist) observes the electrical activity while inserting the electrode. The insertional activity provides valuable information about the state of the muscle and its innervating nerve. Normal muscles at rest make certain, normal electrical sounds when the needle is inserted into them. Then the electrical activity when the muscle is at rest is studied. Abnormal spontaneous activity might indicate some nerve and/or muscle damage. Then the patient is asked to contract the muscle smoothly. The shape, size and frequency of the resulting motor unit potentials is judged. Then the electrode is retracted a few millimeters, and again the activity is analyzed until at least 10-20 units have been collected. Each electrode track gives only a very local picture of the activity of the whole muscle. Because skeletal muscles differ in the inner structure, the electrode has to be placed at various locations to obtain an accurate study.
A motor unit is defined as one motor neuron and all of the muscle fibers it innervates. When a motor unit fires, the impulse (called an action potential) is carried down the motor neuron to the muscle. The area where the nerve contacts the muscle is called the neuromuscular junction, or the motor end plate. After the action potential is transmitted across the neuromuscular junction, an action potential is elicited in all of the innervated muscle fibres of that particular motor unit. The sum of all this electrical activity is recorded as a motor unit potential. This electrophysiologic activity is evaluated during an EMG. The composition of the motor unit, the number of muscle fibres per motor unit, the metabolic type of muscle fibres and many other factors affect the shape of the motor unit potentials in the myogram.
Nerve conduction testing is also often done at the same time as an EMG.
Because of the needle electrodes, EMG may be somewhat painful or extremely painful to the patient, and the muscle may feel tender for a few days. There also exists "needleless EMG"—an EMG performed using surface electrodes—though it gives much less accurate results with a higher level of disturbance from the surrounding environment.
Normal results
Muscle tissue at rest is normally electrically inactive. After the electrical activity caused by the irritation of needle insertion subsides, the electromyograph should detect no abnormal spontaneous activity (i.e. a muscle at rest should be electrically silent, with the exception of the area of the neuromuscular junction, which is normally electrically very spontaneously active). When the muscle is voluntarily contracted, action potentials begin to appear. As the strength of the muscle contraction is increased, more and more muscle fibers produce action potentials. When the muscle is fully contracted, there should appear a disorderly group of action potentials of varying rates and amplitudes (a complete recruitment and interference pattern).
Abnormal results
Abnormal results may be caused by the following medical conditions (please note this is nowhere near an exhaustive list of conditions that can result in abnormal EMG studies) :
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