The seed for this book was planted by a second-year resident in Neurology, Vicente (ÑÐÐ¬EnzoÑÐÐ) Trapani, who desired a handbook in electromyography (EMG) that emphasized both muscle localization and clinical pearls. A gifted artist, Trapani envisioned a text that would provide high-quality illustrations of skeletal muscles that included nerve, plexus, and root supply; photographs of each muscle in a healthy subject to identify optimum site of EMG needle insertion; clinical features of the major conditions affecting peripheral nerves; and electrodiagnostic strategies for confirming suspected lesions of the peripheral nervous system.
The book was also nurtured by my personal experience as a program director in Clinical Neurophysiology. Many residents and fellows offered encouragement and constructive criticism. This added further incentive to improve the content and style to make it more useful for trainees in neurology and physical medicine rehabilitation programs. This book should be of value to these trainees and to practicing electromyographers regardless of their clinical disciplines. The book also provides numerous aids to the examination of the peripheral nervous system, which should prove useful to members of other specialties, including critical care medicine, neurological surgery, and family practice. The general practitioner may also choose to use this book as an anatomical guide.
Many of the anatomical and clinical descriptions contained in this book are derived from reviews of several editions Gray's Anatomy as well as Sunderland's writings on peripheral nerves and nerve injuries. Additionally, publications by the American Association of Electrodiagnostic Medicine proved invaluable. Therefore, this book should ideally be used in conjunction with these other sources.
The book is divided into sections based on the major peripheral nerves. Each nerve is illustrated, and its anatomy reviewed in the text. This followed by a detailed outline of the clinical conditions and entrapment syndromes that affect the nerve, including a list of the etiologies, clinical features, and electrodiagnostic strategies used for each syndrome. General comments about the syndrome are also provided. Finally, each muscle supplied by the peripheral nerve is shown in an anatomical illustration and in a corresponding human photograph. The illustration shows the root, plexus, and peripheral nerve supply to the muscle. Written text provides information about the muscle origin, tendon insertion, voluntary activation maneuver, and site of optimum needle insertion. The latter is identified by a black dot (or sometimes a needle electrode) in both the anatomical illustration and the corresponding human photograph. This ensures that pertinent bony, muscular, and soft tissue landmarks can be used to guide the electromyographer to a specific point on the skin for needle insertion. Potential pitfalls associated with the needle insertion are pointed outÑÐÐ¤usually adjacent muscles or structures that may be entered by mistake. Clinical correlates pertinent to the muscle being examined are also added.
I hope that use of this book will promote interest and research in peripheral neuroanatomy and electrodiagnostic medicine.
About the Author
A. Arturo Leis and Vincente C. Trapani are both at University of Mississippi Medical Center, Jackson.