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Optimal reference electrode placement for accessory and axillary nerve conduction studies.

Timothy J Day¹

¹Department of Clinical Neurophysiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.

|February 29, 2020

Summary

This summary is machine-generated.

Optimizing reference electrode placement in nerve conduction studies (NCSs) is crucial. A sternal reference electrode offers favorable characteristics for accessory and axillary NCSs, ensuring more accurate compound muscle action potential (CMAP) measurements.

Keywords:

accessory nerve axillary nerve compound muscle action potential motor nerve recording nerve conduction studies proximal nerve conduction reference electrode

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Area of Science:

Neuroscience
Clinical Electrophysiology
Neuromuscular Diagnostics

Background:

Nerve conduction studies (NCSs) are vital for diagnosing peripheral nerve disorders.
Accurate electrophysiological measurements depend on optimal electrode placement.
Proximal motor NCSs, particularly for accessory and axillary nerves, require careful technique.

Purpose of the Study:

To evaluate alternative reference electrode (E2) locations for proximal motor nerve conduction studies.
To determine the impact of different E2 sites on the accuracy and reliability of accessory and axillary NCS.
To identify optimal reference electrode placements for improved compound muscle action potential (CMAP) assessment.

Main Methods:

Multi-channel recordings were performed using various belly:E2 montages for accessory and axillary nerve conduction studies.
Recordings were made from trapezius or deltoid muscles, referred to different sites and then to a remote electrode.
Statistical comparison, including grouped statistics and correlation analysis, was used to analyze response variability and distortion.

Main Results:

Accessory NCSs showed comparable responses across different belly:E2 montages.
Axillary NCSs exhibited greater variability with certain reference electrode placements.
Low amplitude contamination and signal distortion were observed with specific E2 sites, while the sternal reference demonstrated favorable characteristics.

Conclusions:

Reference electrode (E2) site selection significantly influences the measured compound muscle action potential (CMAP) in NCSs.
A sternal reference electrode is recommended for accessory and axillary NCSs due to its favorable characteristics.
Ipsilateral acromion or deltoid insertion sites may yield less representative CMAP values, potentially impacting diagnostic accuracy.