Do all neuropathy patients need an EMG at least once?

EMG, which consists of nerve conduction studies and needle electromyography, is an essential diagnostic tool in the evaluation of patients with suspected peripheral neuropathy. Many neurologists order an EMG for all patients with suspected peripheral neuropathy. Not surprisingly, evidence now exists that shows EMG is a major driver of health care costs associated with neuropathy diagnoses. As neurologic practice evolves from fee for service to value-based compensation, neurologists will need to justify the diagnostic utility of EMG (outcome) relative to its cost. While carefully performed studies of diagnostic utility in many patient populations are lacking, a robust literature provides guidance regarding the potential role and limitations of EMG in neuropathy diagnosis as well as the pitfalls referring providers and electrodiagnostic consultants must consider. Do all neuropathy patients need an EMG at least once? This article attempts to answer this question using an illustrative case to highlight critical factors every neurologist must consider before ordering an EMG for neuropathy diagnosis.