How is the physical assessment for electrodiagnostic medicine determined?

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

Answer

The exact nature of the physical examination should be determined by the clinician and is influenced by many factors, including (but not limited to) the patient's history, physical findings, physician and patient time constraints, and patient preference. Not only should the physical examination clearly direct the electrophysiologic examination, it should serve also as a backdrop in interpreting the electrophysiologic findings. For example, examination findings of weakness and atrophy should correlate with electrodiagnostic findings of axonal loss. A finding of median nerve slowing at the wrist alone, without amplitude drop or evidence of denervation with a presumptive diagnosis of CTS, would be inadequate to explain weakness and atrophy. The lack of internal consistency here should alert the careful electromyographer to additional differentials and testing.

A case of shoulder pain in which there is incidental electrodiagnostic evidence for C8 radiculopathy provides another example of interpreting the results of the electrodiagnostic evaluation in the context of the physical examination. If the physical examination findings suggest that most of the symptoms are related to an adhesive capsulitis problem, this finding should be noted clearly in the final conclusions. Such results indicate that the limited range and dysfunction with pain at the shoulder is not due to the C8 radiculopathy.

An accurate and directed physical examination also can expedite the electrodiagnostic evaluation by potentially limiting the number of nerves and muscles that might otherwise be studied, and by helping the practitioner to form diagnostic impressions and therefore to be more specific.


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