Technical, Physiological and Anatomic Considerations in Nerve Conduction Studies

  • James B. Caress


Nerve conduction studies and their interpretation are subject to a variety of factors. First, technical factors including submaximal stimulation, environmental electrical noise, inaccurate placement of the recording electrodes, and stimulus artifact can substantially interfere with accurate recording of nerve and muscle responses. Second, physiological factors, such as the effects of body height and age, can cause profound variation in all nerve conduction parameters, and studies require interpretation keeping these individual variations in mind. Another physiological factor is temperature, in which cooling can produce a variety of changes, including slowing of conduction velocity and increase of response amplitude. Anatomic factors are also important, the most common being the Martin-Gruber anastomosis, usually presenting with a reduction in response amplitude with proximal stimulation of the ulnar nerve, and the second most common being the presence of an accessory peroneal nerve. Paying constant attention to all of these details is a critical element to the accurate performance and interpretation of nerve conduction studies.

Key Words

Conduction velocity distal latency Martin-Gruber anastomosis nerve conduction study stimulation temperature 


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  1. 1.
    Kincaid JC, Brasher A, Markand ON. The influence of the reference electrode on CMAP configuration. Muscle Nerve 1993;16: 392–396.PubMedCrossRefGoogle Scholar
  2. 2.
    Hodgkin AL, Katz B. The effect of temperature on the electrical activity of the giant axon of the squid. J Physiol (Lond) 1949; 109: 240–249.Google Scholar
  3. 3.
    Rutkove SB. The effects of temperature in neuromuscular electrophysiology. Muscle Nerve 2001;24: 867–882.PubMedCrossRefGoogle Scholar
  4. 4.
    Rivner MH, Swift TR, Malik K. Influence of age and height on nerve conduction. Muscle Nerve 2001;24: 1134–1141.PubMedCrossRefGoogle Scholar
  5. 5.
    Falco FJE, Hennessey WJ, Braddom RL, Goldberg G. Standardized nerve conduction studies in the upper limb of the healthy elderly. Am J Phys Med Rehabil 1992;71: 263–271.PubMedCrossRefGoogle Scholar
  6. 6.
    Falco FJE, Hennessey WJ, Goldberg G, Braddom RL. Standardized nerve conduction studies in the lower limb of the healthy elderly. Am J Phys Med Rehabil 1994;73: 168–174.PubMedCrossRefGoogle Scholar
  7. 7.
    Preston DC, Shapiro BE. Electromyography and Neuromuscular Disorders. Butterworth-Heinemann, Boston, MA, 1998.Google Scholar

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • James B. Caress
    • 1
  1. 1.Department of NeurologyWake Forest University School of MedicineWinston Salem

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