Practical tips for trainees: Nerve conduction studies, near nerve technique
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The document provides practical tips for trainees on nerve conduction studies (NCS) and near nerve measurements, emphasizing general aspects, equipment, and contraindications. It covers methods for both motor and sensory NCS, detailing the necessary preparation and the significance of various electrode types. Additionally, it discusses specific conditions such as carpal tunnel syndrome and complications that may arise during procedures.
Practical tips for trainees: Nerve conduction studies, near nerve technique
- 1. Practical tips for trainees II. NCS and near nerve Edina Timea Varga MD, PhD Department of Neurology, University of Szeged 30 August 2017 www.varganeuro.com
- 3. I. Nerve conduction study (NCS) – general aspects II. Motor nerve conduction studies I. inchig II. (F-waves, H-reflex) III. Sensory nerve conduction studies IV. Near nerve measurements
- 4. motor NCS sensory NCS http://bcs.whfreeman.com/thelifewire9e Purves et al. Life The Science of Biology IVth Edition 1995. http://chadwaterbury.com http://emedicine.medscape.com/article/1846028-overview http://jdr.sagepub.com http://www.erikstalberg.com/www.varganeuro.com
- 10. Accessories 1. Skin prep pads / disinfectant 2. Ground electrode 3. Stimulator 4. Registering electrodes (superficial / needle) 5. Electrode cables 6. Ring electrodes 7. (Electrode gel) 8. Thermometer (built in / external) 9. Distilled water (prevents fur formation) 10. Marker 11. Gloves 12. Tape-measure 13. Medical tape /cotton wool 14. Heating lamp / warm water bath / heating pads www.varganeuro.com
- 12. II-III. Motor and sensory NCS
- 13. Nerve conduction study (NCS) =electroneurography (ENG) www.varganeuro.com orthodromic - antidromic
- 14. Nerve conduction study (NCS) =electroneurography (ENG) www.varganeuro.com orthodromic - antidromic
- 15. Nerve conduction study (NCS) =electroneurography (ENG) www.varganeuro.com orthodromic - antidromic temperature position of ground electrode supramaximal stimulation repeatable curves averaging (sensory NCS)
- 16. Nerve conduction study (NCS) www.varganeuro.com
- 17. Nerve conduction study (NCS) www.varganeuro.com
- 18. Nerve conduction study (NCS) www.varganeuro.com
- 19. Nerve conduction studies (NCS) motor NCS sensory NCS http://bcs.whfreeman.com/thelifewire9e Purves et al. Life The Science of Biology IVth Edition 1995. http://chadwaterbury.com http://emedicine.medscape.com/article/1846028-overview http://jdr.sagepub.com http://www.erikstalberg.com/www.varganeuro.com
- 20. Nerve conduction studies (NCS) motor NCS sensory NCS www.varganeuro.com
- 21. onset/distalis latency (DL) Nerve conduction studies (NCS) www.varganeuro.com
- 22. onset/distalis latency (DL) Nerve conduction studies (NCS) ∆T www.varganeuro.com
- 23. amplitude amplitude Nerve conduction studies (NCS) www.varganeuro.com
- 24. ∆T conduction velocity=distance / ΔT Nerve conduction studies (NCS) www.varganeuro.com
- 25. Nerve conduction studies (NCS) duration area under the curve morphology temporal dispersion www.varganeuro.com conduction block https://mmcneuro.files.wordpress.com/2012/12/mmn-cb.jpg?w=271&h=322
- 26. needle electrode superficial registration www.varganeuro.com Nerve conduction studies (NCS)
- 27. stimulation with superficial electrode registration with needle www.varganeuro.com Nerve conduction studies (NCS) Radial nerve motor NCS
- 28. ∆T www.varganeuro.com Motor NCS of median nerve 1. 2.
- 29. www.varganeuro.com Motor NCS of ulnar nerve
- 30. Motor NCS of ulnar nerve Registration simultaneously from two muscles (AMD – FDI)
- 31. www.varganeuro.com Motor NCS of ulnar nerve INCHING 1 inch= 2.54 cm
- 32. Inching possible about any nerve segments localisation 1 inch= 2.54 cm
- 33. Sensory NCSs of median nerve www.varganeuro.com
- 34. www.varganeuro.com Sensory NCSs of median nerve Orthodromic stimulation over 2 different segments
- 35. www.varganeuro.com Sensory NCS of radial nerve antidromic stimulation
- 36. superficial electrodes sensory nerve conduction Sensory NCS of medial and lateral plantar nerve www.varganeuro.com
- 37. Carpal tunnel syndrome (CTS) www.varganeuro.com
- 38. Carpal tunnel syndrome (CTS) www.varganeuro.com MODERATE
- 39. Carpal tunnel syndrome www.varganeuro.com MILD MODERATE SEVERE Muscle Nerve. 2011 Oct;44(4):597-607
- 40. Compression neuropathies Affected nerve Site of compression suprascapular nerve lig. transversum scapulae superius brachial plexus / medial fasciculus TOS – thoracic outlet syndrome median nerve wrist elbow CTS pronator teres sy interosseus anterior sy ulnar nerve wrist elbow UTS cubitalis tunnel sy/Guyon’s tunnel dorsal interosseal nerve radialis tunnel sy (where the nerve enters supinator muscle) lateral femoral cutaneous nerve (meralgia paraesthetica) ligamentum inguinale obturator nerve obturator channel piriformis nerve hiatus piriformis posterior tibial nerve tarsal tunnel syndrome (malleolus medialis-flexor retinaculum) peroneal nerve / plantar branches Morton’s metatarsalgia www.varganeuro.com
- 44. Near nerve technique closer to the nerve higher detectable answer more precise information www.varganeuro.com
- 45. Indication If the nerve could not be investigated by non/invasive technique (superficial NCS, US, MRI…) If the nerve is diameter<7 um (n. calcaneus med.) running deeply (ulnar, alveolaris inf. nerve) hard to differentiate the distal branches(plantar/palmar interdigital branches): tarsal tunnel/Morton’s metatarsalgia n. cut. fem. lat. Became more and more limited due to high resolution ultrasound… www.varganeuro.com
- 46. Contraindications local infection, decubitus anticoagulant treatment (?) – rel. external pacemaker – abs. implanted PM, ICD, (VNS, DBS) – rel. Al-Sheekle, Preston, Shapiro Muscle&Nerve 2003; 27:517-26. www.varganeuro.com
- 47. Possible complications bleeding infection (SINGLE USE!!! Needles are acceptable HIV, CJD, hepatitis – HBV!), needle top! nerve lesion pain electric damage Al-Sheekle, Preston, Shapiro Muscle&Nerve 2003; 27:517-26. www.varganeuro.com
- 49. n. cutaneus femoris lateralis n. tibialis / rami plantares mediales et laterales n. ulnaris www.varganeuro.com
- 50. N. cutaneus femoris lateralis http://www.neurofys.uu.se/v2/docs/metod/index_eng.php Preston&Shapiro 2. Edition www.varganeuro.com
- 51. superficial electrodes sensory nerve conduction Sensory NCS of medial and lateral plantar nerve www.varganeuro.com
- 52. Near nerve technique tarsal tunnel syndrome Morton’s metatarsalgia www.varganeuro.com
- 56. Cubital tunnel syndrome – near nerve www.varganeuro.com
- 59. Special thanks to Professor S. Beniczky Professor A. Antal Professor E. Stålberg Rudsel Schoobaar, Cadwell Industries, Inc. www.varganeuro.com
- 60. Thank you for your attention www.varganeuro.com