What physical assessment should be performed prior to the performance of electrodiagnostic medicine?

Updated: Aug 06, 2019
  • Author: Brian M Kelly, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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As with any meaningful medical consultation, the electrodiagnostic medicine consultation must begin with obtaining a pertinent history and performing a physical examination. The history is not discussed in this article, but it obviously forms the basis of the ensuing examination by providing an understanding of the referring question, the patient's symptoms, and relevant past medical, surgical, and social history.

The physical examination can be quite variable, depending on the clinical history. The examination might range from a very focal neurologic assessment, as might be the case in a focal neurologic injury (eg, knife wound to digital nerve), to a multisystem, generalized examination, as might be needed in a systemic disease presentation (eg, paraneoplastic syndrome). The physical examination should be detailed enough to provide clear differential diagnoses, as well as to help direct any later electrodiagnostic evaluation. [1, 2, 3, 4, 5, 6]

Without an appropriate history and physical examination to guide the sequence and choice of specific electrodiagnostic tests, electromyography (EMG) and nerve conduction studies (NCSs) become an exercise in miscellaneous data collection, which can be misleading, useless, or even potentially dangerous. [8, 9] This article starts with a brief description of general and musculoskeletal examination components but focuses primarily on the neurologic examination.

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