1. Guideline: Needle EMG examination of at least 1 muscle innervated by the C5, C6, C7, C8, and T1 spinal roots in a symptomatic limb, performed and interpreted by a specially trained physician. Cervical paraspinal muscles at 1 or more levels, as appropriate to the clinical presentation, should be examined (except in patients with prior cervical laminectomy using a posterior approach). If a specific root is suspected clinically, or if an abnormality is seen on the initial needle EMG examination, additional studies as follows:
Examination of 1 or 2 additional muscles innervated by the suspected root and a different
Demonstration of normal muscles above and
below the involved root.
2. Guideline: At least 1motor and 1sensory NCS should be performed in the clinically involved limb to determine if concomitant polyneuropathy or nerve entrapment exists. Motor and sensory NCSs of the median and ulnar nerves should be performed if symptoms and signs suggest CTS or ulnar neuropathy. If 1 or more NCSs are abnormal, or if clinical features suggesting polyneuropathy are present, further evaluation may include NCSs of other nerves in the ipsilateral and contralateral limbs to define the cause of the abnormalities.
3. Option: If needle EMG examination is abnormal, needle EMG of 1or more contralateral muscles may be necessary to exclude bilateral radiculopathy, or to differentiate between radiculopathy and polyneuropathy, motor neuron disease, spinal cord lesions, or other neuromuscular disorders.
4. Option: Perform median and/or ulnar F-wave studies in suspected C8 or T1 radiculopathy. Compare with the contralateral side if necessary.
5. Option: Perform cervical nerve root stimulation to help in identifying radiculopathy.
6. Option: Perform H-reflex study of the flexor carpi radialis to assist in identifying pathology of the C6 and C7 nerve roots.