A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. These tests may be performed by medical specialists such as clinical neurophysiologists, physical therapists, physiatrists (physical medicine and rehabilitation physicians), and neurologists who subspecialize in electrodiagnostic medicine. In the United States, neurologists and physiatrists receive training in electrodiagnostic medicine (performing needle electromyography (EMG) and NCSs) as part of residency training and, in some cases, acquire additional expertise during a fellowship in clinical neurophysiology, electrodiagnostic medicine, or neuromuscular medicine. Outside the US, clinical neurophysiologists learn needle EMG and NCS testing.
Purpose and indications
Nerve conduction studies along with needle electromyography measure nerve and muscle function, and may be indicated when there is pain and/or weakness in any extremity which could indicate spinal nerve compression or some other neurologic injury or disorder. Spinal nerve injury does not cause neck, mid back pain or low back pain, and for this reason, evidence has not shown EMG or NCS to be helpful in diagnosing causes of axial lumbar pain, thoracic pain, or cervical spine pain.
The nerve conduction study consists of the following components:
Equipment
Below is a general list of equipment used during an NCS, but it may not include everything an NCA practitioner may use.
- "Electrodiagnostic machine with stimulator" These electrodes record the nerve's electrical response and are referred to as surface recording electrodes. This value is usually 0.1 msec or less. NCS results provide information on whether a nerve conducts electrical signals at a normal speed and strength. Abnormalities in latency, amplitude, conduction velocity or temporal dispersion can indicate:
- Demyelination Injury: A condition where the protective myelin sheath of the nerve is damaged, but the axon of the nerve is not. Some of the common disorders that nerve conduction studies can diagnose are:
- Carpal tunnel syndrome
- Cubital Tunnel Syndrome
- Guillain–Barré syndrome
- Guyon's canal syndrome
- Peripheral neuropathy
- Peroneal neuropathy
- Spinal disc herniation
- Tarsal Tunnel Syndrome
- Ulnar neuropathy
Types of studies
Motor NCS
Motor NCS are obtained by stimulating a nerve containing motor fibers and recording at the belly of a muscle innervated by that nerve. The compound muscle action potential (CMAP) is the resulting response and depends on the motor axons transmitting the action potential, the status of the neuromuscular junction, and muscle fibers. The CMAP amplitudes, motor onset latencies, and conduction velocities are routinely assessed and analyzed. As with sensory NCS, conduction velocity is calculated by dividing distance by time. In this case, however, the distance between two stimulation sites is divided by the difference in onset latencies of those two sites, providing the conduction velocity in the segment of the nerve between the two stimulation sites. This method of calculating conduction velocity avoids being confounded by time spent traversing the neuromuscular junction and triggering a muscle action potential (since these are subtracted out).
Sensory NCS
Sensory NCS is performed by electrical stimulation of a peripheral nerve while recording the transmitted potential at a different site along the same nerve. Three main measures can be obtained: sensory nerve action potential (SNAP) amplitude, sensory latency, and conduction velocity. The SNAP amplitude (in microvolts) represents a measure of the number of axons conducting between the stimulation site and the recording site. Sensory latency (in milliseconds) is the time that it takes for the action potential to travel between the stimulation site and the recording site of the nerve. The conduction velocity is measured in meters per second. It is obtained by dividing the distance between the stimulation site and the recording site by the latency: Conduction velocity = Distance/Latency.
thumb|360px|alt=An example screenshot showing the results of a sensory nerve conduction velocity study|Sensory NCS: An example screenshot showing the results of a sensory nerve conduction velocity study of the right median nerve.
F-wave study
F-wave study uses supramaximal stimulation of a motor nerve and recording of action potentials from a muscle supplied by the nerve. This is not a reflex, per se, in that the action potential travels from the site of the stimulating electrode in the limb to the spinal cord's ventral horn and back to the limb in the same nerve that was stimulated. The F-wave latency can be used to derive the conduction velocity of the nerve between the limb and spine. In contrast, the motor and sensory nerve conduction studies evaluate conduction in the segment of the limb. F waves vary in latency and an abnormal variance is called "chrono dispersion". Conduction velocity is derived by measuring the limb length, D, in millimeters from the stimulation site to the corresponding spinal segment (C7 spinous process to wrist crease for median nerve). This is multiplied by two as it goes to the cord and returns to the muscle (2D). 2D is divided by the latency difference between mean F and M and 1 millisecond subtracted (F-M-1). The formula is <math>\frac{2 D}{F-M-1}</math>.
H-reflex study
An h-reflex study uses stimulation of a nerve and recording the electrical reflex discharge from a muscle in the limb. This also evaluates conduction between the limb and the spinal cord. Still, in this case, the afferent impulses (those going toward the spinal cord) are in sensory nerves, while the efferent impulses (those coming from the spinal cord) are in motor nerves. This process cannot be changed.
Repetitive nerve stimulation
Patient risk and complications
Nerve conduction studies are beneficial to diagnose certain diseases of the nerves of the body. The test is not invasive, but can be painful due to the electrical shocks administered during the test. The shocks are associated with a low amount of electric current, so they pose minimal risk to the patients. Still, there is technically the risk of "bodily injury from electrical shock". However, relative risks should be considered based on patient history and physical.