2025 Workshop Handout Bundle-W90RFA Pearls and Pitfalls in NCS

W90RFA Pearls and Pitfalls in NCS - Spiegelberg Rosenworth

Pdf Summary

This document provides a concise yet detailed guide for performing nerve conduction studies (NCS), highlighting key techniques, common pitfalls, and important considerations. It focuses on both sensory and motor nerve testing procedures, emphasizing electrode placement accuracy and the physiological factors affecting results.<br /><br />Key technical points include maintaining a 3-4 cm distance between recording and reference electrodes for sensory nerves to optimize amplitude, and placing the motor nerve reference electrode on electrically silent structures like bone or tendon. Temperature control is critical as cold limbs can falsely increase amplitude, prolong latency, and affect conduction velocity, especially in sensory nerves. Ensuring patient warmth and minimizing movement during repetitive stimulation is important to avoid artifacts mistaken for true neuromuscular abnormalities.<br /><br />The guide details standard electrode placements and stimulation sites for various nerves:<br />- Median, ulnar, and superficial radial sensory nerves, including antidromic and orthodromic techniques.<br />- Motor studies for median (Abductor pollicis brevis), ulnar (Abductor digiti minimi), radial (Extensor digitorum communis or Extensor indicis), musculocutaneous (biceps), spinal accessory (upper trapezius), and facial nerves.<br />- Lower limb nerves including sural and superficial peroneal sensory nerves, as well as peroneal, tibial, and anterior tibialis motor nerves.<br /><br />Typical amplitude and latency values are provided for reference in these standard tests. The importance of side-to-side comparisons for clinical interpretation is highlighted.<br /><br />References include foundational AANEM publications and authoritative texts on neurophysiology and electrodiagnosis, ensuring the recommendations are evidence-based and widely accepted. Overall, the document serves as a practical workshop manual for clinicians performing NCS, aiming to improve accuracy and diagnostic reliability through proper technique and awareness of common errors.

Keywords

nerve conduction studies

ncs

NCS techniques

sensory nerve testing

motor nerve testing

electrode placement

temperature control in NCS

median nerve conduction

ulnar nerve studies

amplitude and latency values

clinical interpretation of NCS