Description of EMG waves

File Muscle Disease Description Key Word

Insertional activity recorded from the biceps brachii (BB) in a healthy Typical pattern of
Normal F01
volunteer with the needle tip quickly moved five times into the muscle. normal insertional
BB Healthy subject
Needle stimulation induces a short-lasting irregular discharge, which activity
REST Insertion-1
abates immediately with cessation of needle movement.

Insertional activity recorded from the biceps brachii (BB) in a patient Myotonic
with myositis. Each needle insertion induces a myotonic discharge, discharge without
F02 which appears as a run of positive sharp waves lasting for at least 1 clinical myotonia
BB Myositis second with decreasing frequency. Myotonic discharges, though
Insertion-2 frequently observed in myositis, do not accompany clinical myotonia,
which depends on a greater number of simultaneously discharging
muscle fibers.
Myogenic
Insertional activity recorded from the triceps brachii (TB) in a patient Myotonic
F03
REST with chronic myositis. In addition to fibrillation potentials, needle discharge
TB Chronic myositis
movement induces myotonic discharges not associated with clinical associated with
Insertion-3
myotonia. fibrillation potential

An unusual type of insertional activity recorded from the biceps brachii Insertional activity
F04
(BB) in a patient with increased muscle membrane excitability probably associated with
BB Hypothyroidism
related to hypothyroidism. Needle movements induce a sound hyperexcitable
Insertion-4
resembling a bullet fired in a video game. muscle membrane

Spontaneous activity recorded from the tibialis anterior (TA) in a EP noise without
healthy volunteer. Endplate (EP) noise appears with the tip of the EP spike
Normal F05 needle near the motor point and disappears after a slight withdrawal of
TA Healthy subject the needle. This represents a group of miniature endplate potentials
REST EP noise recorded extracellularly simulating the sound of a seashell placed
against the ear. This recording contains some high-frequency noise in
the background.
 Spontaneous activity recorded from the tibialis anterior (TA) in a EP noise and EP
healthy volunteer. High-frequency endplate (EP) spikes spike
characteristically discharge very irregularly often associated with a
low-amplitude EP noise in the background. The initially negative
F06
biphasic spikes represent single muscle fiber potentials recorded by
TA Healthy subject needle tip placed near the nerve terminals. The initially positive
EP noise and
triphasic waveform may result if the shaft rather than the tip of the
EP sike-1
needle register the same discharge. In this recording, EP spikes, 2 ms
in duration, exceed the measurement limit of 500 µV, indicating a close
proximity between the tip of the recording electrode and the generator
Normal source.

REST
F07 Spontaneous activity recorded from the tibialis anterior (TA) in a Typical
healthy volunteer. Endplate (EP) noise appears with the insertion of appearance of EP
TA Healthy subject
EP noise and the needle into the muscle through the fascia, followed by a run of noise followed by
EP spike-2 irregularly firing high-frequency EP spikes. EP spike

Spontaneous activity recorded from the biceps brachii (BB) in a Typical EP noise
F08
healthy volunteer. Endplate (EP) spikes appear with EP noise in the and EP spike
BB Healthy subject background. recorded with the
EP noise and
tip of the needle
EP spike-3
close to the source

Spontaneous activity recorded from the extensor digitorum communis EP spike without
F09 (EDC) in a healthy volunteer. High-frequency, irregular endplate (EP) EP noise
EDC Healthy subject spikes recorded in this tracing without the EP noise sound less crispy
EP spike probably because the needle tip lies slightly away from the generator
source.

Insertional activity recorded from the extensor digitorum communis Typical motor cycle
F10
Myogenic (EDC) in a patient with myotonic dystrophy. Myotonic discharge sound of myotonic
EDC Myotonic dystrophy induced by needle movement shows a gradual increment and a discharge
Myotonic
REST decrement in frequency and amplitude. This activity involving different
discharge-1
muscle fibers sequentially sounds like an accelerating and
 decelerating motor cycle.

Insertional activity recorded from the extensor digitorum communis Typical motor cycle
F11
(EDC) in a patient with myotonic dystrophy. In raster mode, negative sound of myotonic
EDC Myotonic dystrophy spikes seen at the beginning, gradually turn into repeated positive discharge
Myotonic
spikes. Myotonic discharge with characteristic fluctuation in frequency
discharge-2
sounds like an accelerating and decelerating motorcycle engine.

Insertional activity recorded from the extensor digitorum communis Myotonic

F12
(EDC) in an asymptomatic patient with paramyotonia congenita. Some discharge
Paramyotonia
EDC single motor unit potentials appear in addition to typical myotonic recorded in
Myotonic congenita
discharges, which represent repetitive firing of single muscle fibers clinically
discharge-3
induced by needle movements. unaffected muscle
Myogenic
Insertional activity recorded from the triceps brachii (TB) in a patient Myotonic
REST F13
with chronic myositis. In addition to fibrillation potentials observed at discharge without
TB Chronic myositis the beginning and at the end, myotonic discharges follow needle clinical myotonia.
Myotonic
movements. This finding, though nonspecific, commonly appear in
discharge-4
myositis showing no clinical evidence of myotonia.

Insertional activity recorded from the tibialis anterior (TA) in a Myotonic

27-year-old woman with childhood acid maltase deficiency. Myotonic discharge without
F14 discharge appears immediately after needle insertion. This tracing, clinical myotonia
recorded outside the EMG lab, contains small, high-tone alternating
TA Acid maltase deficiency
Myotonic current artifacts in the background. The patient, with no clinical
discharge-5 evidence of myotonia, had respiratory muscle paralysis requiring a
mechanical ventilator. She gradually improved by enzyme
replacement therapy with α-glucosidase (Myozyme).

F15 Myotonic discharges triggered by voluntary contraction of the tibialis Polyphasic MUP
anterior (TA) in the same patient as F14. Positive waveforms seen at showing an early
TA Acid maltase deficiency
Myotonic the beginning subsequently transform to negative spikes. Motor unit recruitment
discharge-6 potentials, at the beginning show an increased number of polyphasic
 units and an early recruitment. Although nonspecific, recording
myotonic discharges helps establish an early diagnosis of this disease,
now treatable with enzyme replacement therapy.

Insertional activity recorded from the extensor digitorum communis Myotonic

F16
(EDC) in a patient with polio sequelae. Myotonic discharge appears discharge
EDC Post-polio syndrome despite absence of clinical myotonia. This finding, though not seen as recorded in a
Myotonic
constantly as in myotonic disorders, characterizes same neurogenic denervated muscle
discharge-7
disorders as a feature of denervation.

Spontaneous activity recorded from the extensor digitorum communis Typical single
(EDC) in a patient with amyotrophic lateral sclerosis (ALS). Fibrillation muscle fiber
potentials and positive sharp waves, seen in ALS, indicate the loss of discharge
F17 spinal motoneurons. Both activities usually show a regular firing consisting of
EDC ALS pattern although they may also discharge at a progressively faster or fibrillation
Fib and PW-1 slower frequency. Differences in waveform reflect the spacial potentials and
relationship between the recording surface of the needle tip and the positive sharp
Neurogenic discharging muscle fibers. Occasional runs show irregular firing waves
patterns and a shift from regular to irregular discharges.
REST
Spontaneous activity recorded from the triceps brachii (TA) in a patient Transition of
with amyotrophic lateral sclerosis (ALS). Note two fibrillation potentials positive sharp
F18
and one positive sharp wave discharging regularly. The firing rate of waves to fibrillation
TB ALS
one of the fibrillation potentials gradually accelerates. The positive potentials
Fib and PW-2
sharp waves recorded in this sample have a small spike in the middle,
indicating a partial transition toward a fibrillation potential.

Spontaneous activity recorded from the biceps brachii (BB) in a patient Typical
with brachial plexus compressive injuries sustained during a surgery 3 spontaneous
F19
Compression weeks earlier. The tracings show many fibrillation potentials and single muscle fiber
BB
neuropathy positive sharp waves, all firing regularly. discharges seen in
Fib and PW-3
a denervated
muscle
 Spontaneous activity recorded from the extensor carpi radialis (ECR) 3 Good example of
months after sustaining a 8severe traumatic radial nerve palsy. In myotonic
F20 addition to a large number of fibrillation potentials and positive sharp discharges mixed
ECR Radial nerve palsy waves, myotonic discharges appear in the middle of tracing, readily with spontaneous
Fib and PW-4 identifiable by the characteristic noise heard. single muscle fiber
discharges in a
denervated muscle

Spontaneous activity recorded from the biceps brachii (BB) in a patient Low-amplitude
with dermatomyositis. The recording shows many low-amplitude, long- positive sharp
duration positive sharp waves with regularly recurring high-amplitude waves and
fibrillation potentials in the background. Despite the overall high-amplitude
F21
appearance and sound of irregular firing, detailed analysis reveals that fibrillation
BB Dermatomyositis
individual single muscle fiber potentials discharge regularly as best potentials, each
Fib and PW-5
seen in the raster mode. Fibrillation potentials and positive sharp firing regularly
waves constitute an essential finding in diagnosing active myositis.
Their absence in a clinically weak muscle usually speaks against this
possibility.

Spontaneous activity recorded from the rectus femoris (RF) at rest in a Myotonic and
Myogenic F22
patient with a biopsy proven inclusion body myositis (IBM). The tracing spontaneous
RF IBM
shows typical fibrillation potentials and positive sharp waves, and in single muscle fiber
REST Fib and PW-6
the latter half, a run of myotonic discharge. discharges

Spontaneous activity recorded from the triceps brachii (TB) in a patient Fibrillation
with chronic myositis. Several fibrillation potentials appear, all firing potentials recorded
F23 regularly. With the needle electrode located close to the signal source, with the needle tip
TB Chronic myositis a single muscle fiber discharge can reach the order of millivolt in close to the source
Fib and PW-7 amplitude. In contrast, potentials recorded with the needle tip far from
the signal source show a smaller amplitude and longer duration,
making it difficult to clearly identify individual waveforms.

F24 Fukuyama muscular Spontaneous activity recorded from the biceps brachii (BB) during Fibrillation
BB
dystrophy partial voluntary contraction in a patient with Fukuyama muscular potential and
 Fib and PW-8 dystrophy. Fibrillation potentials and positive sharp waves observed positive sharp
throughout the tracing indicate active degeneration of muscle fibers. waves
Despite an attempt to record at rest, potentials induced by voluntary
contraction appear at two points in the beginning of the recording.

Spontaneous activity recorded from the rectus femoris (RF) at rest in a A high-amplitude
patient with inclusion body myositis (IBM). This tracing shows a spontaneous
F25 high-amplitude, irregularly firing doublet in addition to typical fibrillation discharge probably
RF IBM potentials from two or three muscle fibers. The larger discharge recorded close to a
Fib and PW-9 probably represents an unstable single muscle fiber potential recorded hypertrophic
Myogenic
close to the hypertrophic muscle fiber often reported in IBM. Note a muscle fiber, often
distant MUP seen in the background. seen in IBM
REST

Spontaneous activity recorded from the triceps brachii (TB) in a patient Fibrillation
with chronic myositis. Positive sharp wave and negative spikes appear potential and
F26 independently and consecutively at 19Hz, without waxing and waning positive sharp
TB Chronic myositis seen in myotonic discharge. Varying temporal relationship between waves firing
Fib and PW-10 the two suggests the origin from independent single muscle fibers independently at a
rather than sequential activation observed in complex repetitive similar frequency
discharge (CRD).

Spontaneous activity recorded from the extensor digitorum communis Typical pattern of
(EDC) in a patient with cervical radiculopathy. Complex repetitive CRD showing
discharge (CRD) consists of a series of single muscle fiber discharge sequential
F27
which repeats regularly, producing a sound resembling a machine gun discharges of a
EDC Cervical radiculopathy
(which I know only in movies). Repetitive potentials with such group of single
CRD-1
Neurogenic consistency result from ephaptic transmission among different muscle fibers
hyperexcitable muscle fibers triggered by a spontaneous single
REST muscle fiber discharge, which serves as pacemaker.

Spontaneous activity recorded from the tibialis anterior (TA) in a Typical CRD
F28
patient with familial chronic progressive spinal muscular atrophy. The beginning and
TA Familial chronic SMA
first complex repetitive discharge (CRD) induced by the initial needle ending abruptly
CRD-2
movement gradually turns into a simple waveform discharging at a
 regular interval before abrupt cessation. The second CRD maintains a
consistent waveform for some period and then suddenly abates. Both
have a frequency of about 70 Hz and thus might have originated from
the same source. The CRD represents a number of muscle fibers
forming a circuit, firing sequentially through ephaptic transmission.

Spontaneous activity recorded from the biceps brachii (BB) in a patient Unstable CRD,
with cervical radiculopathy. Although a complex repetitive discharge showing slight
F29
(CRD) typically repeats the same pattern regularly, a close analysis of waveform change
BB Cervical radiculopathy
this tracing shows slight changes in the waveforms from one discharge
CRD-3
to the next, probably indicating either instability of ephaptic
transmission or a slight movement of the needle tip.

Spontaneous activity recorded from the biceps brachii (BB) in a patient Fasciculation
Neurogenic with amyotrophic lateral sclerosis (ALS). Unlike a voluntarily activated potentials firing
F30 motor unit potential (MUP), which fires semi rhythmically, a slowly and
REST BB ALS fasciculation potential shows a low frequency and irregular firing irregularly at
Fasciculation-1 pattern, making the two easily distinguishable. The discharges shown distance
in this tracing has a dull sound as they originate at some distance from
the recording tip of the needle.

Spontaneous activity recorded from the biceps brachii (BB) in a patient Fasciculation
with amyotrophic lateral scoliosis (ALS). This tracing contains three potentials firing in
F31 types of fasciculation potentials each changing the waveform slightly a cluster
BB ALS and randomly with successive discharges: high- and low-frequency
Fasciculation-2 units and those appearing immediately after each large fasciculation.
Although firing occurs irregularly, fasciculation potentials originating
from the same or different motor units tend to form a cluster.

Spontaneous activity recorded from the clinically unaffected biceps Typical

F32 brachii (BB) in a 60-year-old woman with a bulbar ALS. Fasciculation fasciculation
BB Bulbar ALS potentials, considered crucial in the diagnosis of ALS, abound in this potentials
Fasciculation-3 tracing despite the absence of fibrillation potentials or positive sharp observed alone
waves.
 Spontaneous activity recorded from the extensor digitorum communis Fasciculation
(EDC) in a patient with the cramp fasciculation syndrome with normal potentials
F33 muscle strength and a CK level. He had no abnormalities other than a associated with
Cramp fasciculation
EDC 15-year history of recurrent cramps in the calf and generalized muscle muscle cramps but
syndrome
Fasciculation-4 spasms. A number of fasciculation potentials appear irregularly at a no other
relatively high frequency in the first half of the recording and at a lower abnormalities
frequency in the latter half.

Spontaneous activity recorded from the first dorsal interosseous (FDI) Typical myokymic
in a patient with an idiopathic polyneuropathy. Myokymic discharges, discharge seen in
F34
otherwise known as grouped fasciculation potentials, consist of two to a demyelinating
FDI Polyneuropathy
eight consecutive spontaneous single motor unit discharges, occurring neuropathy
Myokymia-1
repetitively. Such findings, commonly observed in post-radiation
plexopathy, may also appear in demyelinating neuropathies.

Neurogenic Spontaneous activity recoded from the same muscle as described in Myokymic
F34. The firing rate within each cluster reaches 200 Hz, resembling discharge with a
F35
REST neuromyotonic discharges. A rapid change in the waveform seen in high firing rate
FDI Polyneuropathy
the middle of tracing suggests a slight movement of the recording reminiscent of
Myokymia-2
needle electrode. neuromyotonic
discharge

Spontaneous activity recorded from the extensor digitorum communis Fasciculation

(EDC) in a patient with an entrapment neuropathy. Different types of potential, paired
spontaneous discharges shown include fasciculation potentials and fasciculation
F36 paired fasciculation potentials. The repetitive complex waveform seen potentia, and
EDC Radial nerve palsy in the middle of this tracing also represents a form of myokymic myokymic
Myokymia-3 discharge. The potential lasting for at least 200 ms probably results discharge
from ephaptic transmission among a number of nerve or muscle fibers
initially triggered by a fasciculation potential which serves as
pacemaker.

F37 Spontaneous activity recorded from the rectus femoris (RF) in a Myokymic
RF Alcoholic neuropathy
patient with alcoholic neuropathy and clinical evidence of myokymia. discharge showing
 Myokymia-4 Each of two myokymic discharges, one high and the other low in progressive
amplitude, consists of three or four consecutive discharges forming a amplitude
unit, which then repeats every few seconds. The discharge frequency reduction
within a unit reaches 300 Hz. Then, the spikes become progressively
smaller as they face the refractory period of the preceding discharge.

Spontaneous activity recorded from the first dorsal interosseus (FDI) in Myokymic
F38 a patient with Kennedy’s disease. The recording shows fasciculation discharge as
potentials, or spontaneous discharge of a motor unit, and myokymic compared to
FDI Kennedy's disease
Myokymia and discharges, or grouped fasciculation potentials. Recording also shows fasciculation
fasciculation-1 several doublets associated with contraction of FDI abducting the potential
index finger.
Neurogenic

REST Spontaneous activity recorded from the gastrocnemius (GC) in a Typical myokymic
37-year-old woman with clinical features of the Isaac’s syndrome discharges, the
F39 characterized by hypertrophy of the lower-limb muscles and extensive term sometimes
myokymia persisting during sleep. The recording shows fasciculation used
GC Isaac's syndrome
Myokymia and potentials and myokymic discharges. Despite the typical clinical synonymously with
fasciculation-2 presentation, laboratory studies failed to document anti K-channel a neuromyotonic
antibodies usually seen in this disorder. discharge not seen
in this tracing

Insertional activity recorded from the biceps brachii (BB) in a patient Neuromyotonic
F40
with cervical radiculopathy. The tracing shows high-frequency discharge seen in
BB Cervical radiculopathy
repetitive discharges from a single motor unit at around 150 Hz without radiculopathy
Neuromyotonia
waxing and waning seen in myotonic discharge.

Motor unit potentials (MUPs) during voluntary contraction of the tibialis The effect of
anterior (TA) in a healthy volunteer. The first MUP recorded produces needle placement,
Normal F41 a dull sound indicating its distant location. The rise time shortens with altering the
TA Healthy subject needle advancement, sharpening the sound and increasing the peak distance to the
VOLUNTARY MUP-1 amplitude. This tracing shows a recording during the weakest muscle discharging motor
contraction to avoid the recruitment of other motor units, which unit, which in turn,
interferes with MUP analysis. dictates the
 amplitude of MUP

Motor unit potentials (MUPs) recorded from the tibialis anterior (TA) High-amplitude
during voluntary contraction in a patient with amyotrophic lateral MUP firing rapidly
sclerosis (ALS). Despite a substantial waveform change after each
Neurogenic F42 needle movement, all potentials recorded in this tracing originate from
TA ALS the same motor unit. Amplitude and waveform vary substantially
VOLUNTARY MUP-2 depending on the location of the recording electrode. Placing the
needle tip close to the signal source improves the analysis. The
surviving motor units may discharge at 40-50 Hz to compensate for the
loss in the number of spinal motoneurons.

Motor unit potentials (MUPs) recorded from the extensor digitorum Normal recruitment
communis (EDC) during voluntary contraction in a healthy volunteer. showing a greater
F43
Applying greater force results in a gradual increase in the number of number of MUP
EDC Healthy subject
motor units recruited with eventual shift to an interference pattern with increasing
MUP-3
induced by maximum contraction. Isometric contraction helps maintain force
Normal the location of the needle tip despite gradually increasing force.

VOLUNTARY Motor unit potentials (MUPs) recorded from the biceps brachii (BB) in a Discharge pattern
healthy volunteer. This tracing recorded during progressively stronger of a normal MUP
F44
contraction shows a couple of motor units firing at a slow rate initially during
BB Healthy subject
during a weak effort and more rapidly later before the recruitment of progressively
MUP-4
other units by greater voluntary force, eventually leading to a full stronger
interference pattern with a maximal effort. contraction

Motor unit potentials (MUPs) recorded from the first dorsal interosseus Attenuation of
(FDI) in a patient with amyotrophic lateral scoliosis (ALS). The MUP MUP with
Neurogenic F45 amplitude gradually decreases as the firing interval becomes irregular repetitive
FDI ALS and returns to the original level after a few seconds of rest. This type of discharge
VOLUNTARY MUP-5 attenuation suggests depletion of acetylcholine (ACh) at the nerve reflecting ACh
terminal sometimes observed with repetitive nerve stimulation. depletion at the
nerve terminal
 Motor unit potentials (MUPs) recorded from the biceps brachii (BB) Doublets showing
during voluntary contraction in a patient with amyotrophic lateral a smaller
scoliosis (ALS). Doublets, as seen in this recording, make a amplitude for the
F46
characteristic sound of double firing. The second of the two discharges second as
BB ALS
has a smaller amplitude as it falls in the relative refractor period of the compared to the
MUP-6
muscle fibers. A prolonged firing interval seen after each doublet first discharge
indicates delayed depolarization of the spinal motoneurons, as often
observed in ALS.

Motor unit potentials (MUPs) recorded from the biceps brachii (BB) Unstable
during voluntary contraction in a patient with amyotrophic lateral polyphasic MUP
F47
scoliosis (ALS). Most polyphasic potentials seen in this tracing show indicating active
BB ALS
varying waveforms after each firing, indicating instability at the nerve degeneration and
MUP-7
terminal and neuromuscular junction observed in an early stage of regeneration of
regeneration. motor fibers
Neurogenic

VOLUNTARY Motor unit potentials (MUPs) recorded from the thoracic paraspinal Relatively stable
muscle (PSM) during voluntary contraction in a patient with MUP indicating an
F48
amyotrophic lateral scoliosis (ALS). The biphasic MUP with a relatively intermediate stage
PSM ALS
stable waveform indicates an intermediate stage of regeneration. In of regeneration
MUP-8
ALS, abnormalities seen in the thoracic PSM helps not only confirm
the diagnosis but also evaluate the respiratory muscle function.

Motor unit potentials (MUPs) recorded from the triceps brachii (TB) A small number of
during voluntary contraction in a patient with amyotrophic lateral high-amplitude
F49 scoliosis (ALS). A maximum voluntary contraction immediately after MUP firing rapidly
TB ALS the start of recording recruits only four high-amplitude potentials to compensate for
MUP-9 without completely filling the baseline. This type of reduced the loss of motor
interference associated with rapid firing of remaining MUP denotes a units
substantial loss of the functional motor units.

F50 Motor unit potentials (MUPs) recorded from the extensor digitorum Late recruitment
EDC ALS communis (EDC) during voluntary contraction in a patient with with single motor
MUP-10 amyotrophic lateral scoliosis (ALS). Only one motor unit discharges unit firing rapidly
 rapidly during the maximum contraction, showing a very reduced forming "picket
interference referred to as "picket fence" pattern. The baseline drift fence" pattern
indicates activation of other motor units at a distance in addition to the during a maximal
surviving motor unit within the recording radius of the electrode. In the contraction
absence of normal recruitment, a compensatory increase in firing rate
of existing motor units may reach 50 Hz.

Motor unit potentials (MUPs) recorded from the paraspinal muscles Typical finding for
(PSM) in a 38-year-old man with a familial ALS caused by FUS gene chronic
abnormality, which also affected one brother. Except for an early denervation
onset, the patient had the same clinical features as a sporadic case showing a large
F51
with the initial weakness affecting the lower limb. Severe trunk muscle amplitude MUP
PSM Familial ALS
weakness prevented unassisted rise from the supine position. A firing rapidly to
Neurogenic MUP-11
maximal contraction induces a single high-amplitude, long-duration compensate for a
MUP, which fires rapidly at 20 Hz to compensate for the lack of late recruitment
VOLUNTARY
recruitment. This pattern, resembling a "picket fence" in appearance, indicating the loss
indicates a severe loss of functional motor axons. of functional units

Motor unit potentials (MUPs) recorded from the abductor pollicis brevis An abnormal MUP,
(APB) 4 months after a brachial plexus injury inflicted by a motor cycle showing waveform
accident. This tracing recorded during a weak muscle contraction variability as a sign
F52 shows a polyphasic MUP changing the waveform from one discharge of instability of the
APB Brachial plexus injury to the next, best seen with the low cut filter elevated to 500 Hz and the regenerating nerve
MUP-12 sweep speed set at 1 ms/division. The finding suggests an early stage terminals
of regeneration characterized by incomplete myelination and unstable
nerve terminals, showing an abnormally increased jitter and
intermittent blocking

Motor unit potentials (MUPs) recorded during voluntary contraction Polyphasic MUP
F53
from the first dorsal interosseus (FDI) in a chronic polio patient. The showing satellite
FDI Post-polio syndrome
tracing shows a stable and polyphasic MUP accompanied by satellite potentials
MUP-13
potentials.

F54 RF Post-polio syndrome Motor unit potentials (MUP) recorded from the rectus femoris (RF) High-amplitude
 during voluntary contraction in a patient with chronic polio myelitis. A MUP
MUP-14 simple-form MUP exceeding 10 mV in amplitude indicates a stable
condition with completed regeneration of nerve fibers.

Motor unit potentials (MUPs) recorded from the first dorsal interosseus Irregular grouped
Neurogenic
(FDI) during voluntary contraction in a patient with psychogenic firing of several
VOLUNTARY
weakness. Apparent effort to contract the muscle gave rise to a motor units,
F55 tremulous movement without generating much force. The recording forming a tremor
FDI Psychogenic weakness shows a grouped discharge, a pattern typically seen in a tremor, which discharge seen in
MUP-15 may superficially mimic a polyphasic MUP. A maximal effort enhances hysterical
the tendency to grouping without inducing a full interference pattern. weakness
This finding often indicates an insufficient central drive considered
typical for hysterical weakness.

Motor unit potentials (MUPs) recorded from the first dorsal interosseus Early recruitment
(FDI) during voluntary effort in a patient with Becker muscular of small,
F56
dystrophy (MD). The recording obtained during a gradually increasing short-duration,
FDI Becker MD
contraction force shows small, short-duration, polyphasic potentials. polyphasic MUP
MUP-16
Note a typical finding of early recruitment making the baseline invisible
even with a slight muscle contraction.

Motor unit potentials (MUPs) recorded from the same muscle as Small polyphasic
described in F56 during voluntary contraction. In myopathy, early MUP showing a
Myogenic F57
recruitment of multiple motor units often precludes assessment of each typical early
FDI Becker MD
individual MUP. The tracing shows both short- and long-duration recruitment with
VOLUNTARY MUP-17
polyphasic potentials and the abundance of a small MUP, probably minimal muscle
derived from a single muscle fiber. contraction

Motor unit potentials (MUPs) recorded from the biceps brachii (BB) Early recruitment
during voluntary contraction in a patient with mitochondrial of small single fiber
F58
Mitochondrial encephalomyopathy. An early recruitment during a slight muscle potential as well as
BB
encephalomyopathy contraction readily leads to MUP overlap. The tracing contains unstable
MUP-18
long-duration polyphasic potentials as well as small potentials derived polyphasic units
from a single muscle fiber. The polyphasic potentials seen during the
 weakest muscle contraction show an unstable waveform.

Motor unit potentials (MUPs) recorded from the triceps brachii (TB) Typical findings in
during voluntary contraction in a patient with chronic myositis. myositis consisting
Spontaneous activities in the form of fibrillation potentials appear at the of spontaneous
beginning of the recording. Subsequently, weak muscle contraction single muscle fiber
gives rise to a small MUP derived from a single muscle fiber, in discharge and
F59
addition to many polyphasic potentials, best observed in the raster early recruitment of
TB Chronic myositis
mode. With the patient at rest, the tracing again shows only fibrillation a small MUP
MUP-19
potentials, which exceed 1 mV in amplitude, indicating the proximity of
the needle to the signal source. Patients with active myositis typically
show a combined EMG abnormality of a polyphasic MUP with early
recruitment and spontaneous single muscle fiber discharge from
Myogenic
muscle degeneration.
VOLUNTARY
Motor unit potentials (MUPs) recorded from the biceps brachii (BB) Fibrillation
during voluntary contraction in a patient with myositis. This tracing potentials firing
recorded during a slight effort, reveals a number of short-duration, low regularly and
F60
-amplitude MUP indistinguishable from fibrillation potentials by single muscle fiber
BB Myositis
waveform. Fibrillation potentials, however, maintain a regular firing MUP increasing
MUP-20
pattern, whereas an MUP shows an increasing firing frequency with a the firing frequency
greater force of muscle contraction. with voluntary
effort

Motor unit potentials (MUPs) recorded from the rectus femoris (RF) A high-amplitude,
during minimal muscle contraction in a patient with inclusion body short-duration,
myositis (IBM). The tracing shows a high-amplitude, short-duration spiky MUP seen in
F61 MUP probably recorded with the needle tip very close to a single IBM, probably
RF IBM hypertrophic muscle fiber. The presence of other surviving muscle originating from a
MUP-21 fibers in the vicinity within the recording radius gives rise to a fork- hypertrophic single
shaped MUP. A high-amplitude, short-duration MUP does not muscle fiber
necessarily indicate a neuropathic process. Note a gain of 1
mV/division used for this recording.
 Motor unit potentials (MUPs) recorded from the severely affected Short-duration
deltoid during voluntary contraction in a patient with generalized MUP showing an
myasthenia gravis (MG). Although MUP waveform rarely changes in early recruitment
mild cases, an early recruitment of a short-duration MUP characterizes and varying
severe weakness, as exemplified in this tracing. This firing indicates a waveform best
F62
functional loss and secondary degeneration of the muscle fibers. In seen with
Deltoid MG
these cases, MUP waveform often varies from one discharge to the low-frequency
MUP-22
next, reflecting instability of neuromuscular transmission. This cutoff filter
abnormality becomes more apparent if displayed with the increased to
low-frequency cutoff filter increased to 500 Hz, which, by removing 500Hz
low-frequency components, enhances fluctuation of high-frequency
spikes.
Myogenic
Motor unit potentials (MUPs) recorded from the severely affected Unstable
VOLUNTARY
deltoid during voluntary contraction in a patient with Lambert-Eaton polyphasic MUP
myasthenic syndrome (LEMS). All potentials originate from the same showing
F63
motor unit, despite the substantially varying waveform. All spike considerable
Deltoid LEMS
components may abate in some cases. These abnormalities become waveform
MUP-23
more apparent in a raster mode display using increased sensitivity and variability best
slow sweep speed. These motor units show frequent blocking and seen in a raster
increased jitters if tested by single-fiber studies. mode

Motor unit potentials (MUPs) recorded from the biceps brachii (BB) Small,
during voluntary contraction in a patient with myositis. The tracing long-duration MUP
F64
shows an early recruitment of many small, long-duration potentials showing typical
BB Myositis
during a slight muscle contraction. An overlap of many potentials early recruitment
MUP-24
makes it difficult to distinguish an individual MUP, which, therefore,
must undergo scrutiny during a very minimal muscle contraction.