Summit Orthopedics electrodiagnostic medicine specialist David Rippe, M.D., tells you what to expect when you have an appointment for an EMG.
If you’re experiencing troublesome symptoms like numbness, tingling, weakness, or pain in your hands, arms, shoulder, neck, back, legs, or feet, the simplest task can feel overwhelming. The key to effective treatment is knowing the exact cause and location of the damaged nerve or muscle that is responsible for the symptoms. To get to the bottom of your symptoms, your doctor may refer you for an EMG. Here’s what you can expect at your EMG appointment.
EMG stands for electromyography. It is a muscle and nerve test that evaluates the body’s nerves and muscles from the neck all the way down the arm to the fingers and from the low back all the way down the leg to the bottom of the feet. The test takes place in the clinic, using a standard patient examination room and the EMG equipment.
“The EMG machine looks like a bulky computer,” said electrodiagnostic medicine physician David Rippe, M.D., Summit’s EMG expert.
During the first part of the appointment, Dr. Rippe talks with patients about their symptoms, learns about their medical history, and conducts a physical exam to test strength, sensation, and reflexes.
“The EMG test can be customized based on the problems or symptoms, so this information helps me to design the test,” Dr. Rippe said.
Part 1 of the EMG appointment: Nerve conduction studies
The first part of the test consists of nerve conduction studies.
“Using a handheld stimulator, I place it over the skin where the nerve is and deliver a small stimulus,” Dr. Rippe said. He compares the sensation to a mild static electricity shock. “I always demonstrate on my own wrist and hand first, so the patient can see what the test looks like,” he said.
Each nerve conduction study evaluates a specific nerve pathway. Multiple nerves are tested in each limb. The level of discomfort is generally mild. “Most patients that were nervous about the test state that they got too worried over a small thing,” Dr. Rippe said.
Part 2 of the EMG appointment: the EMG
The test’s second part is the EMG itself, using the computer to “listen to the muscles.” It uses a thin needle about the size of an acupuncture needle to test the muscles. “There is no electrical stimulation — we’re just listening to the muscle’s energy as the EMG device turns that energy into sound,” Dr. Rippe said. A typical test covers six to eight muscles or more on an arm or leg.
What do muscles sound like? To the untrained ear, it sounds like static. “Some people describe it as sounding like rain on a tin roof,” Dr. Rippe said.
The EMG is done in two steps, first when the muscle is loose and relaxed, and again while Dr. Rippe is gently pushing or pulling on the muscle to activate it. Each one provides key information that helps Dr. Rippe with the diagnosis. After the test, Dr. Rippe analyzes the data, compiles a report, and sends it to the patient’s referring physician within a day or two.
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