What is the role of musculoskeletal assessment in electrodiagnostic medicine?

Updated: Aug 06, 2019
  • Author: Brian M Kelly, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

Expertise in the musculoskeletal examination is tremendously helpful in electrodiagnostic consultations, especially when pain and dysfunction are presenting problems. Pain obviously has many different generators and is often not associated directly with the nervous system. For example, having the ability to define myofascial pain with referral patterns can help to avoid an extensive search for radiculopathy that does not exist. This skill is important in assessing complaints of weakness as well. Pain can often inhibit function, mimicking neurologic weakness and misleading the electromyographer into looking for axonal or conduction block conditions. Also, tenosynovitis in the wrist and fingers is a common presentation and is often mistaken for carpal tunnel syndrome (CTS).

Another issue that needs to be assessed is any potential barriers to normal neurologic function. For example, the finding of focal muscle atrophy does not imply definitive axonal injury or entrapment. Joint contracture may be present for neurologic or rheumatologic reasons or other means of contracture, such as postburn scarring. This immobility may eventually lead to disuse atrophy.

During the musculoskeletal examination, an attempt should be made to define range of motion (ROM), areas of tenderness, or trigger points. The pain or dysfunctions should be isolated to joint, ligament, tendon, bone, muscle, or skin. The differences in active ROM versus passive ROM and the understanding of kinesiologic function for stabilizing and reciprocal muscles can lead to accurate diagnosis of involved structures that may or may not correlate with neurologic problems. For example, the assessment of scapulohumeral rhythm may suggest weakness in the scapular rotators rather than in the deltoid, or it may point out mechanical problems, such as scapular rib adhesions or adhesive capsulitis and frozen shoulder syndromes.


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