SAMPLE EMG/NCV REPORT - NORMAL STUDY

John Smith, M.D.

Diplomate, American Board of Physical Medicine and Rehabilitation
Diplomate, American Board of Electrodiagnostic Medicine
Precision Medical Group
1805 E. Dyer Road #110
Santa Ana, CA 92705
Phone: (949) 955-0022 Fax: (949) 955-0220
2/9/2010 12:50:20 PM
Patient: XXXX, Regina DOB: 4/17/1966 Physician: Smith
ID#: XXXX_REGINA_10020 SEX: Female Ref. Phys: Jones
________________________________________________________________________________

Patient Complaints:

Right hand numbness

Patient History:

The patient is referred by Dr. Jones for an electrodiagnostic evaluation of the right upper extremity.
The patient suffered a work related injury while working at an office. The patient reports pain and
numbness in the right hand.

Physical Exam:

GEN: No acute distress, well nourished, well developed

HEENT: Normal cephalic, PERRLA, EOMI
EXT: No clubbing cyanosis or edema
MUSCULOSKELETAL: No asymmetry, mass or tenderness to palpation. Strength is 5/5 in bilateral
upper and lower extremities
SPINE: There is no tenderness to palpation to the cervical or lumbar paraspinal muscles
NEURO: Patient is alert, awake and oriented x 3, muscle tone is normal without clonus.
DTR's are symmetrical and normal in bilateral upper and lower extremities. Sensation to light touch is
normal
Phalen's is negative
Tinel's is negative

ELECTRODIAGNOSTIC STUDY:
Nerve conduction study of the right upper extremity was done today with the surface skin measure at
32 degrees Celcius and above near the site of the recording electrodes.

Informed consent was obtained. Needle electromyography was performed with a monopolar
disposable needle electrode on selected muscles as shown below. Nerve conductions were
performed using standard surface conduction techniques. The patient tolerated the procedure
without complications.
Patient: XXXX, Regina Test Date: 2/9/2010 p. 2

Impression:

There is no electrodiagnostic evidence of a neuropathic or a myopathic process in right upper

extremity at this time. Also, no electrodiagnostic evidence of a neuropathy or a plexopathy in
the right upper extremity based on the nerve conduction studies. Conventional nerve
conduction studies and EMG cannot test the small sensory pain fibers which, when irritated
secondary to compression or tendon inflammation etc., could be a source of pain and
paresthesias from within the sensory nerves, nerve roots, subcutaneous structures, and/or
bony structures, etc.

In compliance with labor code section 4628 and the rules of practice and procedure, specifically 10978 and
10606, the following is supplied.

I declare under penalty of perjury, that all opinions in this report are mine. I performed the evaluation and
cognitive services at Precision Occupational Medical Group 1805 E. Dyer Road #110, Santa Ana, CA 92705
and that, except as otherwise stated herein, the evaluation was performed and the time spent performing the
evaluation was in compliance with the guidelines, if any, established by the Industrial Medical Council or the
Administrative director pursuant to paragraph (5) of subdivision (j) of the section 139.2 or section 5307.6 of the
California Labor Code.

I have complied with the Labor Code section 139.3 and I have offered or received any commissions or
inducements for this consultation. The name and contents of the report and billings are true and correct to the
best of my knowledge, executed on this date.

______________________________________________________________
John Smith, M.D.
Diplomate, American Board of Physical Medicine and Rehabilitation
Diplomate, American Board of Electrodiagnostic Medicine
Patient: XXXX, Regina Test Date: 2/9/2010 p. 3
ELECTRODIAGNOSTIC RESULTS:

EMG
Side Muscle Nerve Root Ins Fibs Psw Amp Dur Poly Recrt Int Comment
Act Pat
Right Abd Poll Brev Median C8-T1 Nml Nml Nml Nml Nml 0 Nml Nml
Right 1stDorInt Ulnar C8-T1 Nml Nml Nml Nml Nml 0 Nml Nml
Right ExtIndicis Radial (Post C7-8 Nml Nml Nml Nml Nml 0 Nml Nml
Int)
Right ExtCarUln Radial (Post C7-8 Nml Nml Nml Nml Nml 0 Nml Nml
Int)
Right ExtCarRad Radial C6-7 Nml Nml Nml Nml Nml 0 Nml Nml
Right BrachioRad Radial C5-6 Nml Nml Nml Nml Nml 0 Nml Nml
Right Biceps Musculocut C5-6 Nml Nml Nml Nml Nml 0 Nml Nml
Right Triceps Radial C6-7-8 Nml Nml Nml Nml Nml 0 Nml Nml
Right Deltoid Axillary C5-6 Nml Nml Nml Nml Nml 0 Nml Nml
Right Upper Cervical Rami Nml Nml
Right Mid Cervical Rami Nml Nml
Right Lower Cervical Rami Nml Nml

Motor Nerves
Site NR Onset Norm O-P Norm Neg Segment Name Delta- Dist Vel Norm
(ms) Onset Amp Amp Dur O (cm) (m/s) Vel
(ms) (mV) (mV) (ms) (ms) (m/s)

Right Median (Abd Poll Brev)

Wrist 2.97 <4.0 13.85 >5.0 5.39 Elbow-Wrist 3.75 23 61.33 >50.0

Elbow 6.72 13.51 5.63

Right Ulnar (Abd Dig Min)

Wrist 2.81 <4.0 12.30 >5.0 5.94 B Elbow-Wrist 3.59 21 58.50 >50

B Elbow 6.41 11.43 6.56 A Elbow-B Elbow 2.50 14 56.00 >50

A Elbow 8.91 10.78 6.72

Right Radial (Ext Ind Prop)

Ext Ind Ext Ind Prop1-Ext

Prop1 1.95 >1.0 4.09 7.34 Ind Prop1 0.00
Patient: XXXX, Regina Test Date: 2/9/2010 p. 4

Sensory Nerves
Site NR Peak Norm P-T Norm Segment Name Delta- Dist Vel Norm
(ms) Peak Amp Amp P (cm) (m/s) Vel
(ms) (µV) (µV) (ms) (m/s)

Right Median Anti (2nd Digit)

Wrist 3.13 <3.7 92.39 >15.0 Wrist-2nd Digit 3.13 >50

Right Ulnar Anti (5th Digit)

Wrist 3.19 <3.8 73.65 >15.0 Wrist-5th Digit 3.19 >50.0

Right Median and Ulnar Ortho (Wrist)

Median
Palm 1.84 <2.3 124.03 >14 Median Palm-Wrist 1.84
Ulnar
Palm 1.78 <2.3 43.04 >6 Ulnar Palm-Wrist 1.78

Right Radial Anti (Base 1st Dig)

Base 1st Base 1st Digit-Base 1st
Digit 2.00 <2.7 53.17 >13 Dig 2.00

FWave/HReflex
NR Lat1 Lat2 Delta Amp
(ms) (ms) (ms) (µV)

Right Median-F (APB)

23.97 0.00 23.97

Right Ulnar-F (ADM)

26.69 0.00 26.69

Right Radial-F (Ext Ind Prop)

23.24 0.00 23.24

Patient: XXXX, Regina Test Date: 2/9/2010 p. 5

Right Median Anti Sensory Right Ulnar Anti Sensory Right Median and Ulnar Ortho Sensory

Median Palm
P
P

O
R
Wrist R
O
Wrist T
R
O P
T
T Ulnar Palm

R
T
O

20 (µV) 2 (ms) 20 (µV) 2 (ms) 20 (µV) 2 (ms)

Right Radial Anti Sensory Right Median Motor Right Median-F

Wrist
O R
P
T
Base 1st Digit
P
O R
T
Elbow
O R

20 (µV) 2 (ms) 5000 (µV) 5 (ms) 5000 (µV) / 200 (µV) 5 (ms)
Right Ulnar Motor Right Ulnar-F Right Radial Motor

Wrist
O P
R

T
P
O B Elbow Ext Ind Prop1
P R O R
T
T
A Elbow
O R
T

5000 (µV) 5 (ms) 5000 (µV) / 200 (µV) 5 (ms) 5000 (µV) 5 (ms)
Right Radial-F

5000 (µV) / 200 (µV) 5 (ms)