Clinic Services

Nerve Conduction Studies (NCS) and Needle Electromyography (EMG) are procedures performed to assess and diagnose the structural and functional integrity of the peripheral nervous system, including the peripheral nerves and muscles. These procedures are needed to assess a variety of neurological disorders including nerve compressions, radiculopathies, diabetic neuropathies, myopathies, ALS, and muscular dystrophies.

PATIENT INSTRUCTIONS FOR THE PROCEDURE

1.) No fasting or sedation is required prior to the procedure.

2.) Dress in loose fitting clothes that permit access to the area to be tested or that are easily removed. Wear comfortable shoes that are easily removable.

3.) Please do not apply any moisturizers or lotion on your body on the days leading up to the test.

4.) Based on your medical condition, your physician may request other specific preparations.

5.) Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

MEDICATIONS TO AVOID PRIOR TO PROCEDURE

It is recommended to stop taking blood thinners prior to the EMG. Please always consult with your physician before stopping any medications* and notify our office if your physician advises you not to stop taking any blood thinning medications. Please refer to the list below to see when you should stop taking them prior to your electrodiagnostic test.

LIST OF BLOOD THINNERS (ANTICOAGULANTS)

1 Day (24 Hours) Prior:

1. Fragmin (Dalteparin)

2. Heparin

3. Lovenox (Enoxaparin)

3-4 Days Prior:

1. Eliquis (Apixaban)

2. Aspirin (81 mg “Baby Aspirin”)

3. Aleve/Advil

5 Days Prior:

1. Aspirin & Aspirin containing products

2. Coumadin (Warfarin)

3. Arixtra (Fondaparinux)

4. Plavix (Clopidogrel)

5. Ticlid (Ticlopidine HCl)

6. Effient (Prasugrel)

7. Xalreto (Rivaroxaban)

14 Days Prior:

1. Aggrenox (Aspirin/Dipyridmaole)

2. Refludan (Lepirudin)

3. Angiomax (Bivalirudin)

*For IV Medications, consult with referring doctor.

DESCRIPTION OF THE PROCEDURE

1.) You will be given a gown to wear and asked to remove any clothing, jewelry, hairpins, eyeglasses, hearing aids, or other metal objects that may interfere with the procedure.

2.) You will be asked to sit down or lie down for the test.

NERVE CONDUCTION STUDY (NCS)

1.) A recording electrode will be attached to the skin over the nerve with a special paste and a stimulating electrode will be placed at a known distance away from the stimulating electrode.

2.) The nerve will be stimulated by a mild and brief electrical shock given through the stimulating electrode.

3.) You may experience minor discomfort for a few seconds.

4.) The response of the nerve will be displayed and recorded on a monitor.A recording electrode will be attached to the skin over the nerve with a special paste and a stimulating electrode will be placed at a known distance away from the recording electrode.

ELECTROMYOGRAM (EMG)

1.) A needle electrode that is attached by wires to a recording machine is inserted into a muscle.

2.) When the electrodes are in place, the electrical activity in that muscle is recorded while the muscle is at rest.

3.) Then the physician will ask you tighten (contract) the muscle slowly and steadily. The electrical activity is recorded.

4.) The electrode can be moved a number of timers to record the activity in different areas of the muscle or in different muscles.

AFTER THE PROCEDURE

The skin electrodes will be removed from your skin. The areas of the skin where a needle was inserted will be cleaned. After the test, you may return to your previous activities, unless your physician advises you differently. Your physician may give you additional or alternate instructions after the procedure, depending on your particular medical situation.

RISKS OF THE PROCEDURE

The voltage of the electrical pulses used during NCS is considered very low. There may be risks depending on your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure. Tell your physician if you have a cardiac defibrillator or pacemaker, as precautions may need to be taken.

Information coming soon.

A skin punch biopsy procedure is performed to evaluate diseases such as small fiber neuropathy. This is a simple procedure in which a small circular piece of skin (about 2-3 mm in diameter) is taken from the surface of the skin. The punch biopsies are usually taken from three sites, typically in the lower limb. Your physician will determine the three sites. The entire procedure is performed in the office and takes only a few minutes. 

PROCEDURE

The biopsy areas are first cleaned, usually with alcohol and betadine, and then a local anesthetic such as lidocaine is injected with a very fine needle to numb the area. The patient will feel a slight pinch of the needle and then a brief burning sensation as the anesthetic is injected. Once the skin is anesthetized, with the help of a circular punch needle, a small punch biopsy is made into the skin, about 2-3mm in diameter and about 3mm deep. Three of these biopsies are obtained and sent to specialized dermatopathology labs for processing. No sutures are needed. The biopsy sites heal by scabbing over.

POST-OPERATIVE CARE

After your skin biopsy, keep the biopsy site covered with a Band-Aid. You can apply an over the counter antibiotic ointment, such as Neosporin. This will help healing and minimize scarring. A small rim of redness will likely occur at the edge of the biopsy but if you see excessive redness, fever, chills, pus, or significant pain, it may signify infection, in which case, please contact your physician. Most biopsy sites heal within 1-2 weeks.