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2. palm: stimulate in the palm 7 cm distal to the wrist site on a line drawn from the median wrist to the web space between the index and middle finger

Distal Distance: 7 cm from wrist

Normal Values:

Significant palm/wrist amplitude ratio: >1.2

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Median Sensory Study (Antidromic)

Recording Site: digit 2 or 3

G1: ring electrode over MCP jt.

G2: 3-4 cm distal over DIP

Stimulation Site:

1. wrist: middle of wrist between tendons of FCR& PL

Distal Distance: 13 cm

Normal Values:

amplitude: >/= 20uV

distal peak latency: </= 3.5 msec

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Median Sensory Palmar Study

Recording Site: Index finger

G1: ring electrode over MCP jt

G2: DIP jt

Stimulation Site:

1. wrist: middle of wrist between tendons of FCR &PL at distance of 13 cm

2. palm: stim at palm, 6.5 cm distal to the wrist site on a line drawn from the median wrist to the index finger

Distal Distance: 6.5 cm

Proximal distance: 13 cm

Normal Values:

Significant palm/wrist amplitude ratio: >1.6

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Ulnar Motor Study

Recording Site: ADM

G1: muscle belly

G2: 5th MCP jt.

Stimulation Site:

1. wrist: medial wrist adjacent to FCU tendon

2. below elbow: 3-4 cm distal to medial epicondyle

3. above elbow: over the medial humerus between the biceps and triceps at a dist 10-12 cm from below elbow site

4. axilla: in the prox axilla, medial to the biceps over the axillary pulse

Distal Distance: 7 cm

Normal Values:

amplitude: >/=6 mV

conduction velocity: >/=49 m/sec

distal latency: </=4.4 msec

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Ulnar Sensory Study

Recording Site: digit 5

G1: ring electrode over MCP jt.

G2: 3-4 cm distal over DIP jt

Stimulation Site:

1. wrist: medial wrist, adjacent to FCU tendon

Distal Distance: 11 cm

Normal Values:

amplitude: >/=17 uV

distal peak latency: </= 3.1 msec

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Dorsal Ulnar Cutaneous Sensory Study

Recording Site: Dorsal hand

G1: web space between digit 5 & 4

G2: 3-4 cm distally over digit 5

Stimulation Site: slightly prox and inferior to ulnar styloid with hand pronated

Distal Distance: 8-10 cm

Normal Values:

amplitude: >/=8 uV

distal peak latency: </=2.5 msec

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Median versus Ulnar- Digit 4 Sensory Study

Recording Site: Ring finger

G1: ring electrode over MCP jt.

G2: 3-4 cm distally over DIP jt

Stimulation Site:

1. median nerve at wrist: middle of wrist between tendon of FCR &PL

2. ulnar nerve at wrist: medial wrist adjacent to FCU tendon

Distal Distance: 12 cm

Normal Values:

Significant latency difference: >/=0.5 msec

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Median versus Ulnar- Palmar Mixed Studies

Median Nerve

Recording Site: median nerve at wrist

G1: bar placed at middle of wrist between tendons of FCR & PL

G2: 3-4 cm proximally

Stimulation Site: median nerve in palm: in the palm 8 cm from active electrode on a line drawn from median wrist to web space between index and middle finger

Distal Distance: 8 cm

Ulnar Nerve

Recording Site: ulnar nerve at wrist

G1: bar at medial wrist, adjacent to FCU tendon

G2: 3-4 cm proximally

Stimulation Site: ulnar nerve in the palm: 8 cm from the active electrode on a line drawn from ulnar wrist to web space between ring & middle finger

Distal Distance: 8 cm

Normal Values:

Significant latency difference: >/=0.4 msec

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Radial Motor Study

Recording Site: EIP

G1: with hand pronated, G1 placed 2 fingerbreadths prox to ulnar styloid

G2: ulnar styloid

Stimulation Site:

1. forearm: over the ulna, 4-6 cm prox to G1

2. elbow: in groove between biceps & BR muscles

3. below spiral groove: lat midarm, between biceps & triceps muscles

4. above spiral groove: posterior prox arm over humerus

Distal Distance: 5-7 cm

Normal Values:

amplitude: >/= 2.0 mV

conduction velocity: >/= 49 m/sec

distal latency: </=2.9 msec

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Radial Sensory Study

Recording Site: Superficial radial nerve

G1: over superficial radial nerve as it runs over Extensor tendons to thumb

G2: 3-4 cm distally over thumb

Stimulation Site: over distal-mid radius

Distal Distance: 10 cm

Normal Values:

amplitude: >/= 15 uV

distal peak latency: </= 2.9 msec

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Medial Antebranchial Cutaneous Study

Recording Site: Medial forearm

G1: 12 cm distal to stimulator site, on line drawn between stim site and ulnar wrist

G2: 3-4 cm distally

Stimulation Site: medial elbow: at midpoint between biceps tendon and medial epicondyle

Distal Distance: 12 cm

Normal Values:

amplitude: >/= 5 uV

distal peak latency: </= 3.2

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Lateral Antebranchial Cutaneous Sensory Study

Recording Site:

G1: 12 cm distal to stimulator site, on a line drawn between the stim site & radial pulse

G2: 3-4 cm distally

Stimulation Site: antecubital fossa: slightly lateral to the biceps tendon

Distal Distance: 12 cm

Normal Values:

amplitude: >/= 10 uV

distal peak latency: </= 3.0 msec

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ROUTINE LOWER EXTREMITY NERVE CONDUCTION TECHNIQUES

Tibial Motor Study

Recording Site: AHB

G1: 1 cm prox & 1 cm inferior to navicular process

G2: MTP jt of great toe

Stimulation Site:

1. medial ankle: above & post to medial malleolus

2. popliteal fossa: midposterior knee over popliteal pulse

Distal Distance: 9 cm

Normal Values:

amplitude: >/= 4.0 mV

conduction velocity: >/= 41 m/sec

distal latency: </= 5.8 msec

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Peroneal Motor Study (EDB)

Recording Site: EDB

G1: dorsal lateral foot with G1 placed over muscle belly

G2: place distally over MTP jt of little toe

Stimulation Site:

1. ankle: anterior ankle, slightly lat to TA tendon

2. below fibular head: lat calf, 1-2 fingerbreadths inferior to fibular head

3. popliteal fossa: lateral popliteal fossa, adjacent to ext hamstrings tendons, at a dist 10-12 cm from below fibular head site

Distal Distance: 9 cm

Normal Values:

amplitude: >/= 2.0 mV

conduction velocity: >/= 44 m/sec

distal latency: </= 6.5 msec

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Peroneal Motor Study (TA)

Recording Site: Tib anterior muscle: prox to mid-anterior calf

G1: muscle belly

G2: place distally over anterior ankle

Stimulation Site:

1. below fibular head: lat calf, 1-2 fingerbreadths inferior to fibular head

2. popliteal fossa: lateral popliteal fossa adjacent to ext hamstrings tendons, at a dist 10-12 cm from below fibular head site

Distal Distance: 5-10 cm

Normal Values:

amplitude: >/= 5.0 mV

conduction velocity: >/= 44 m/sec

distal latency: </= 6.7 msec

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Superficial Peroneal Sensory Study

Recording Site: Lateral ankle

G1: between TA tendon and lateral malleolus

G2: 3-4 cm distally

Stimulation Site:

1. lateral calf

Distal Distance: 14 cm

Normal Values:

amplitude: >/= 6 uV

distal peak latency: </= 4.4 msec

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Sural Sensory Study

Recording Site: Posterior ankle

G1: posterior to lat malleolus

G2: 3-4 cm distally

Stimulation Site: posterior lateral calf.

Distal Distance: 14 cm

Normal Values:

amplitude: >/= 6.0 mV

distal peak latency: </= 4.4 msec

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Saphenous Sensory Study

Recording Site: Medial ankle

G1: between medial malleolus and TA tendon

G2: 3-4 cm distally

Stimulation Site: medial calf: stimulator placed in the groove between tibia and medial gastroc muscles1.

Distal Distance: 14 cm

Normal Values:

amplitude: >/= 4

distal peak latency: </= 4.4 msec

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Medial & Lateral Plantar Motor Studies

Medial Plantar Recording Site:

Abd hallucis brevis muscle

G1: 1 cm prox and 1 cm inferior to navicular prominence

G2: place over MTP jt of great toe

Lateral Plantar Recording Site:

Abd digiti quinti pedis muscle

G1: lateral foot, placed halfway between lat sole of foot and & lat malleolus

G2: MTP jt of little toe

Stimulation Site: medial ankle: above and posterior to medial malleolus.

Distal Distance: 9 cm for AHB; variable for ADQP (10 cm)

Normal Values:

AHB

amplitude: >/= 4.0 mV

conduction velocity: >/= 41 m/sec

distal latency: </= 5.8 msec

ADQP

amplitude: >/= 3.0 mV

conduction velocity: >/= 41 m/sec

distal latency: </= 6.3 msec

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Medial & Lateral Plantar Mixed Nerve Studies

Recording Site: Medial Ankle

G1: above and posterior to medial malleolus

G2: 3-4 cm proximally

Stimulation Site:

1. medial sole (medial plantar nerve): at a distance 14 cm from recording electrodes (measure 7 cm from recording site into the sole of the foot, then an additional 7 cm on a line drawn parallel to the web space between the first and second toes)

2. lateral sole (lateral plantar nerve): at a distance 14 cm from the recording electrodes (measure 7 cm from the recording site into the sole of the foot, then an additional 7 cm on a line drawn parallel to the web space between the fourth and fifth toes)

Distal Distance: 14 cm

Normal Values:

Med plantar

amplitude: >/= 3 uV

distal latency: </= 3.7 msec

Lat plantar

amplitude: 3 uV

distal latency: 3.7 msec

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Soleus H-Reflex

Recording Site: Soleus Muscle

G1: Posterior calf, 2-3 fingerbreadths distal to where the soleus meets the 2 bellies of the gastroc muscles

G2: Achilles tendon

Stimulation Site: popliteal fossa: midposterior knee over the popliteal pulse.

Distal Distance: variable, 20-25 cm

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Reference: Preston D, Shapiro B ed. Electromyography and Neuromuscular Disorders