A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of

electrical conduction Electrical resistivity (also called specific electrical resistance or volume resistivity) is a fundamental property of a material that measures how strongly it resists electric current. A low resistivity indicates a material that readily allows ...

, of the motor and

sensory nerve A sensory nerve, or afferent nerve, is a general anatomic term for a nerve which contains predominantly somatic afferent nerve fibers. Afferent nerve fibers in a sensory nerve carry sensory information toward the central nervous system (CNS) fro ...

s of the

human body The human body is the structure of a human being. It is composed of many different types of cells that together create tissues and subsequently organ systems. They ensure homeostasis and the viability of the human body. It comprises a hea ...

. These tests may be performed by medical specialists such as clinical neurophysiologists, physical therapists, chiropractors, physiatrists (physical medicine and rehabilitation physicians), and

neurologists Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...

who subspecialize in

electrodiagnostic medicine Electrodiagnosis (EDX) is a method of medical diagnosis that obtains information about diseases by passively recording the electrical activity of body parts (that is, their natural electrophysiology) or by measuring their response to external elec ...

. In the United States, neurologists and physiatrists receive training in

(performing needle

electromyography Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph to produce a record called an electromyogram. An electromyo ...

(EMG) and NCSs) as part of residency training and in some cases acquire additional expertise during a fellowship in clinical

neurophysiology Neurophysiology is a branch of physiology and neuroscience that studies nervous system function rather than nervous system architecture. This area aids in the diagnosis and monitoring of neurological diseases. Historically, it has been dominated ...

, electrodiagnostic medicine, or neuromuscular medicine. Outside the US, clinical neurophysiologists learn needle EMG and NCS testing. Nerve conduction velocity (NCV) is a common measurement made during this test. The term NCV often is used to mean the actual test, but this may be misleading, since velocity is only one measurement in the test suite.

Medical uses

Nerve conduction studies along with needle

measure nerve and muscle function, and may be indicated when there is pain in the limbs, weakness from spinal nerve compression, or concern about some other neurologic injury or disorder., which cites * * Spinal nerve injury does not cause neck, mid back pain or low back pain, and for this reason, evidence has not shown EMG or NCS to be helpful in diagnosing causes of axial lumbar pain, thoracic pain, or cervical spine pain. Nerve conduction studies are used mainly for evaluation of paresthesias ( numbness, tingling, burning) and/or weakness of the arms and legs. The type of study required is dependent in part by the symptoms presented. A physical exam and thorough history also help to direct the investigation. Some of the common disorders that can be diagnosed by nerve conduction studies are: *

Carpal tunnel syndrome Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with median neuropathy at the carpal tunnel. Most CTS is related to idiopathic compression of the median nerve as it travels through the wrist at the carpal tunn ...

Cubital Tunnel Syndrome Ulnar nerve entrapment is a condition where the ulnar nerve becomes physically trapped or pinched, resulting in pain, numbness, or weakness, primarily affecting the little finger and ring finger of the hand. Entrapment may occur at any point from ...

Guillain–Barré syndrome Guillain–Barré syndrome (GBS) is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. Typically, both sides of the body are involved, and the initial symptoms are changes in sensation or pain oft ...

* Guyon's canal syndrome *

Peripheral neuropathy Peripheral neuropathy, often shortened to neuropathy, is a general term describing disease affecting the peripheral nerves, meaning nerves beyond the brain and spinal cord. Damage to peripheral nerves may impair sensation, movement, gland, or or ...

* Peroneal neuropathy *

Spinal disc herniation Spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical ...

* Tarsal Tunnel Syndrome *

Ulnar neuropathy Ulnar neuropathy is a disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve with resultant numbness and tingling. It may also cause weakness or and paralysis of the muscles supplied by the nerve. Sig ...

Technique

The nerve conduction study consists of the following components * Motor NCS * Sensory NCS *

F wave In neuroscience, an F wave is one of several motor responses which may follow the direct motor response (M) evoked by electrical stimulation of peripheral motor or mixed (sensory and motor) nerves. F-waves are the second of two late voltage change ...

study * H-reflex study The nerve conduction study is often combined with needle ''

''.

Other

The Department of Health and Human Services Inspector General recently identified the use of NCSs without a needle electromyography at the same time a sign of questionable billing.

Motor NCS

''Motor NCS'' are obtained by stimulating a motor nerve and recording at the belly of a muscle innervated by that nerve. The compound muscle action potential (CMAP) is the resulting response, and depends on the motor axons transmitting the action potential, status of the neuromuscular junction, and muscle fibers. The CMAP amplitudes, motor onset latencies, and conduction velocities are routinely assessed and analyzed. As with sensory NCS, conduction velocity is calculated by dividing distance by time. In this case, however, the distance between two stimulation sites is divided by the difference in onset latencies of those two sites, providing the conduction velocity in the segment of nerve between the two stimulation sites. This method of calculating conduction velocity thereby avoids being confounded by time spent traversing the neuromuscular junction and triggering a muscle action potential (since these are subtracted out).

Sensory NCS

''Sensory NCS'' are performed by electrical stimulation of a peripheral nerve while recording the transmitted potential at a different site along the same nerve. Three main measures can be obtained: sensory nerve action potential (SNAP) amplitude, sensory latency, and conduction velocity. The SNAP amplitude (in microvolts) represents a measure of the number of axons conducting between the stimulation site and the recording site. Sensory latency (in milliseconds) is the time that it takes for the action potential to travel between the stimulation site and the recording site of the nerve. The conduction velocity is measured in meters per second and is obtained dividing the distance between stimulation site and the recording site by the latency: Conduction velocity = Distance/Latency

F-wave study

''F-wave study'' uses supramaximal stimulation of a motor nerve and recording of

action potential An action potential occurs when the membrane potential of a specific cell location rapidly rises and falls. This depolarization then causes adjacent locations to similarly depolarize. Action potentials occur in several types of animal cells ...

s from a muscle supplied by the nerve. This is not a

reflex In biology, a reflex, or reflex action, is an involuntary, unplanned sequence or action and nearly instantaneous response to a stimulus. Reflexes are found with varying levels of complexity in organisms with a nervous system. A reflex occurs ...

, per se, in that the action potential travels from the site of the stimulating electrode in the limb to the spinal cord's ventral horn and back to the limb in the same nerve that was stimulated. The F-wave latency can be used to derive the conduction velocity of nerve between the limb and spine, whereas the motor and sensory nerve conduction studies evaluate conduction in the segment of the limb. F waves vary in latency and an abnormal variance is called "chrono dispersion". Conduction velocity is derived by measuring the limb length, D, in millimeters from the stimulation site to the corresponding spinal segment (C7 spinous process to wrist crease for median nerve). This is multiplied by 2 as it goes to the cord and returns to the muscle (2D). 2D is divided by the latency difference between mean F and M and 1 millisecond subtracted (F-M-1). The formula is

\frac

H-reflex study

H-reflex study uses stimulation of a nerve and recording the reflex electrical discharge from a muscle in the limb. This also evaluates conduction between the limb and the spinal cord, but in this case, the afferent impulses (those going toward the spinal cord) are in sensory nerves while the efferent impulses (those coming from the spinal cord) are in motor nerves. This process cannot be changed.

Specialized testing

Repetitive nerve stimulation

Interpretation of nerve conductions

The interpretation of nerve conduction studies is complex and requires the expertise of health care practitioners such as clinical neurophysiologists, medical neurologists, physical therapists, chiropractic neurologists or physiatrists. In general, different pathological processes result in changes in latencies, motor, and/or sensory amplitudes, or slowing of the conduction velocities to differing degrees. For example, slowing of the NCV usually indicates there is damage to the

myelin Myelin is a lipid-rich material that surrounds nerve cell axons (the nervous system's "wires") to insulate them and increase the rate at which electrical impulses (called action potentials) are passed along the axon. The myelinated axon can ...

. Another example, slowing across the wrist for the motor and sensory latencies of the

median nerve The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus. The median nerve originates from the lateral and medial cords of the brachial plexus, and has cont ...

indicates focal compression of the median nerve at the wrist, called

carpal tunnel syndrome Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with median neuropathy at the carpal tunnel. Most CTS is related to idiopathic compression of the median nerve as it travels through the wrist at the carpal tunn ...

. On the other hand, slowing of all nerve conductions in more than one limb indicates generalized diseased nerves, or generalized

peripheral neuropathy Peripheral neuropathy, often shortened to neuropathy, is a general term describing disease affecting the peripheral nerves, meaning nerves beyond the brain and spinal cord. Damage to peripheral nerves may impair sensation, movement, gland, or or ...

. People with

diabetes mellitus Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

often develop generalized peripheral neuropathy.

Patient risk

Nerve conduction studies are very helpful to

diagnose Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems enginee ...

certain

disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

s of the nerves of the body. The test is not invasive, but can be

pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

ful due to the

electrical shocks Electrical injury is a physiological reaction caused by electric current passing through the body. The injury depends on the density of the current, tissue resistance and duration of contact. Very small currents may be imperceptible or produce ...

and electrical burns. The shocks are associated with a low amount of

electric current An electric current is a stream of charged particles, such as electrons or ions, moving through an electrical conductor or space. It is measured as the net rate of flow of electric charge through a surface or into a control volume. The movi ...

so they are not dangerous to anyone. Patients with a permanent

pacemaker An artificial cardiac pacemaker (or artificial pacemaker, so as not to be confused with the natural cardiac pacemaker) or pacemaker is a medical device that generates electrical impulses delivered by electrodes to the chambers of the heart ei ...

or other such implanted stimulators such as deep brain stimulators or spinal cord stimulators must tell the examiner prior to the study. This does not prevent the study, but special precautions are taken. Cardiac pacemakers and implanted cardiac defibrillators (ICDs) are used increasingly in clinical practice, and no evidence exists indicating that performing routine electrodiagnostic studies on patients with these devices pose a safety hazard. However, there are theoretical concerns that electrical impulses of nerve conduction studies (NCS) could be erroneously sensed by devices and result in unintended inhibition or triggering of output or reprogramming of the device. In general, the closer the stimulation site is to the pacemaker and pacing leads, the greater the chance for inducing a voltage of sufficient amplitude to inhibit the pacemaker. Despite such concerns, no immediate or delayed adverse effects have been reported with routine NCS.. No known contraindications exist from performing needle EMG or NCS on pregnant patients. In addition, no complications from these procedures have been reported in the literature. Evoked potential testing, likewise, has not been reported to cause any problems when it is performed during pregnancy.

References

External links

EMG & Nerve Conduction Education & Resources

Association of EMG technologists of Canada

American Association of Neuromuscular & Electrodiagnostic Medicine

American Board of Electrodiagnostic Medicine

WebMD summary of EMG and NCS

American Association of Sensory Electrodiagnostic Medicine
{{Electrodiagnosis Electrodiagnosis Neurophysiology Neurology procedures de:Nervenleitgeschwindigkeit#Messung