The EMG examination, also known as the electrodiagnostic or EDX examination, plays an essential role in the diagnosis of many neuromuscular disorders. Cleveland Clinic's EDX laboratory is one of the largest in the state of Ohio and provides state-of-the-art electrophysiologic analysis, including single-fiber EMG (SFEMG), macro EMG, and motor unit estimation. Over 6,000 EMG examinations are performed each year under the guidance of the Neuromuscular staff, Neuromuscular Fellows, and highly trained technicians. As a result, Cleveland Clinic's EDX laboratory has established a world-renown reputation for its excellence and reliability.
The Electromyography (EMG) Laboratory at Cleveland Clinic has been accredited by the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM).The AANEM established laboratory accreditation criteria for electrodiagnostic (EDX) laboratories to ensure patients receive quality medical care in a safe environment. Laboratory accreditation provides patients, referral sources, and payers with a credible measure to differentiate the laboratory’s quality of care.
The accreditation standards evaluate the diagnostic services and clinical operations essential to providing quality patient care, which include:
- Clinical staff qualifications and continuing education
- Physical facilities
- EDX equipment
- Protocols for performing EDX studies
- Patient reports
- Policies for ensuring the health and safety of every patient
Exemplary Status is the highest level of accreditation an EDX laboratory can achieve under the AANEM Accreditation Program. To be awarded Accreditation with Exemplary Status, physicians performing studies in the laboratory must:
- Have completed a neurology or physical medicine and rehabilitation residency program.
- Have completed a minimum of three months of training in EDX medicine as part of a residency or fellowship program.
- Be certified by the American Board of Electrodiagnostic Medicine (ABEM), or by the American Board of Psychiatry and Neurology (ABPN) in clinical neurophysiology, or by the ABPN/American Board of Physical Medicine and Rehabilitation in neuromuscular disease.
AANEM is a nonprofit membership association dedicated to the advancement of neuromuscular, musculoskeletal, and electrodiagnostic medicine.
For our patients’ convenience, EMG evaluations are performed at multiple locations throughout the region:
The EDX examination is a test that measures the electrical activity in your nerves and muscles. It consists of two parts:
- Nerve conduction studies that measure the ability of specific nerves to transmit electrical impulses, or messages, to muscles.
- Needle electrode examinations that measure the electrical activity in muscles along nerves..
Measuring the electrical activity in nerves and muscles helps detect the presence, location and extent of nerve and muscle disorders. Muscle weakness, nerve pains, and numbness may be due to a problem in the brain, spinal cord, the nerve supplying the muscle, the junction between the nerve and muscle (called the neuromuscular junction) and muscle. The EDX examination can help physicians distinguish where the problem lies.
You will be asked to lie on an examination table. The technician will tape several small, flat metal discs, called electrodes, on your skin. Repeated brief electrical stimuli are administered to the nerve. Electrical waveforms are recorded from muscles or from nerves and measured. You will feel a tingling sensation and twitching in your muscle each time the electrical stimulus is applied. Once the testing has been completed, the skin electrodes are removed.
The nerve conduction studies are then followed by the needle examination by the physician. A small thin needle (about the size of a straight pin) attached by wires to a recording machine will be inserted in the specific muscles being examined. No electrical stimuli or injections are passed through this needle; they simply record your muscle activity. You will be asked to relax and contract the muscles that are being examined. The electrical activity of the muscle will be displayed as electrical waves on a screen that the physician will view. The more relaxed you are, the easier the tests will be. The physician and technician will try to make you as comfortable as possible.
Before the EDX Examination
This test should not be performed until at least three weeks (21 days) have passed since the onset of your symptoms. If it has been less than that, please notify the EMG lab at 216.444.5544, or toll free 1.800.CCF.CARE ext.45544. You may be asked to reschedule at a later date.
- Take medications as prescribed, including any for pain.
- If you are taking anticoagulant medications (coumadin, heparin, lovenox, or crystalline warfarin) or medication for myasthenia gravis (mestinon or pyridostigmine bromide) and have not received instructions from your physician to discontinue your medications for the EDX examination, please call 216.444.5544 or toll free 1.800.223.2273 ext.45544. You may be asked to discontinue these medications for several days before the test. However, DO NOT discontinue medications without first consulting your physician.
- The EDX examination cannot be performed on patients with a bleeding disorder or lymphedema.
- Nerve conduction studies cannot be performed on patients with internal defibrillators. If you have an internal defibrillator and have been scheduled for this test, please call 216.444.5544 or toll free 1.800.223.2273 ext.45544. It will be necessary to assess whether the device can be turned off prior to undergoing this test.
- Patients with internal nerve stimulators must be able to turn them off before nerve conduction studies can be performed If you have an internal nerve stimulator and have been scheduled for this test, please call 216.444.5544.
On the Day of the Test
Eat a normal breakfast and/or lunch. Do not apply any lotions or oils to the skin; it could hinder the electrode connection to the skin.
After the Test
The Neuromuscular Staff evaluates the data collected and the final report is sent to the doctor who referred you for the test (usually between 1-2 working days). Your doctor will provide you with the results.
Neurology appointment office 216.636.5860, or toll free 1.800.CCF.CARE ext.65860.
Desk S90, Ninth floor of the “S” building.
Please call the EDX Laboratory if you have any concerns or questions or wish to speak to a technician: 216.444.5544, or toll free 1.800.CCF.CARE ext.45544.
Learn how to order an EMG Examination for your patient by downloading our guide for providers below.
EMG Laboratory, A Guide for Providers