Electromyography

Presenter
Dr Sowmya

Contents

Introduction
History
Background of emg/electromyography
Emg defintion
Purpose of emg
Uses of emg
Experimental objectives of emg
Emg types
Emg technique

Continued ..
Emg electrodes

Precautions
Preparations
After care
Risks
Normal results
Abnormal results
Emg in orthodontics and its applications

Introduction
Electromyography is the earliest useful technique
in clinical neurophysiology
Emg is a valuable diagnostic aid in recording the
muscular activity under diverse functional
conditions
Emg changes help in documenting the topography
of diseases process by recording electrical activity
evoked in a muscle by electrical stimulation of its
nerve

History of emg
The most important development in history of study of
muscle action potential fallowed the development of
sensitive recording equipment
In 1987 cathode ray tube was invented by braun
Einthoven designed string galvanometer in1903
Cathode ray oscilloscope was invented by gasser and
erlanger in 1922-most significant advances as it
eliminated limitations of galvanometer
Another major advance in clinical emg came lord
adrian and delton blockwho concentric needle
electrode in 1929
Adrian also introduced use of loud speakers in emg

 Hoefer and guttaman in 1944 recorded

spontaneous in patients with spinal cord injuries
and found it useful in localizing lesions
Denmark reported differences in neurogenic and
myogenic emg changes in 1941
The invest of war injury patients by herburt in
canada resulted in in development of monopolar
needle electrodes
Interaction of jasper,gold seth and fizell paved the
way for development of emg which was
introduced in 1948 by goldseth
In1944 harvey and kuffer applied nerve
conduction studies in patients in peripheral
neuropathy

 The first report of nerve conduction potential in

response to median and ulnar nerve stimulation
was published in 1937
Sensory nerve conduction velocity became an
integral part of electro diagnostic study by 1960

Emg definition
Also called as myogram
Recording and study of intrinsic electrical
properties of skeletal muscle by means of
surface/needle electrode in resting and
contracting states which aids in diagnosis
of neuromuscular diseases
Electromyograph is the instrument used in emg
Eletromyogram is record obtained by emg

Back ground of emg

Skeletal muscle performs mechanical work
Stimulated to contract when brain or spinal cord
activates motor units
An action potential motor neuron causes activation
of muscle fiber
Activation of motor units by action potential
generates stochastic voltage signals in muscle

Purpose of emg
determine -A particular muscle is responding to
stimulation & whether a muscle remains inactive
when not stimulated
Help to diagnosis different diseases causing
weakness a test of motor system ,may help
identify abnormalities of nerves/spinal nerve roots
that may be associated with pain /numbness

Continued..
Distinguish b/n primary muscle diseases and
dennervation myopathies from neuropathies
Identify muscle dysfunction and be treated
Asses health of muscles and nerves that control
muscles
Differentiates primary muscle conditions from
muscles weakness caused by neurological diseases
Emg is a extension of clinical neurological
examination

Obtaining an emg
At ,rest when there is no spontaneous
muscle activity
During slight muscle contraction - to asses
the size, duration of activity of motor units

Emg helps in diagnosis of

Muscular dystrophy
Congenital myopathies
Metabolic myopathies
Myotonias
Radiculopathies
Peripheral neuropathies
Nerve lesions
Spinal muscular atrophy
myasthenia's

Experimental objectives of emg

To observe,record and correlate motor units
recruitment with increase power of skeletal
muscle contraction
To record emg when inducing fatigue

Emg types
Kinesiological emg

Diagnostic emg

 Kinesiological emg
Used for

functional anatomy

force development

reflex contraction of muscle

Diagnostic emg

Test the nerve and muscle integrity

Nerve conduction velocity for nerve damage
\compression
Firing characteristics of motor units, including
analysis of motor units action potential fibrillations, fasciculation and sharp positive
waves

Motor unit action potential

Represent sum of the muscle action potentials supplied by
anterior horn cell
Muscle fibers discharge in a synchrony adjacent to needle
electrodes

MUP-has higher amplitude and longer duration

than action potential produced by single muscle fiber

Nerve conduction test

Slightly different test is often performed
at same time with emg
specially helpful - pain / sensory complains

Sharp positive waves

Triphasic pattern apositive-crossing,bnegative-leaving,crecording in a normal
muscle
In abnormal muscle-a
large positive sharp wave
fallowed by low and
prolonged negativity

Emg electrodes types-surface and needle

Needle electrode
Superior to as quality
of image better
Lesser technical
artifact
More risks of infection
May be painful

Surface electrodes
Preferred noninvasiveness
Chances of loosening
of electrodes during
nerve stimulation
Errors
Less of infection

Types of needle electrodes

Concentric
Monopolar
Single fiber
Macro electrode

 Precautions

no special precautions
patient with the history of bleeding
disorder

a muscle biopsy is - of the diagnostic

work , emg should not be performed at the
same site

 Preparations

no special preparations
using creams /lotions on the day of the

test
Doctor should give information about symptoms,
medical conditions, suspected diagnosis and other
test results

Emg recording
It was einthoven
muscle contraction gives off
an idiomusclular current - action potential
Structural basis of emg is motor unit.
The current generated is so small -amplified
many thousands times to be recorded

Emg accessories
Electrode hand set
Hand dynamometer
Disposable electrodes

Emg recording technique

A needle electrode is inserted through skin
into muscle.
Recordings -while muscle is at rest
contraction
. displayed as electrical waves on the
cathode ray oscilloscope
At same time activity is reproduced as
sound over a speaker
the pressure ,size,shape of wave formaction potential-produced

 EMG-raw signal-voltage difference in

electrical potential measured b/n record
electrodes

Origin-electrical activity tissues

Important guideline
Confirm needle position
Emg alone cannot confirm-antagonistic
muscle-synergistically

Skin

Tendon

Electrode
Nerve

Muscle

Electrode
Tendon

Raw EMG Signal

 After care
Minor pain &bleeding
Muscle-tender

Risks

no significant risks-needle insertion

Normal results

some brief action

increased in nerve diseases

reduced in long standing muscle disorders

Abnormal results

electrical activity at rest

nerve lesions
myotonia/inflammatory myopathies

EMG in orthodontics
History

1 st effort apply emg by robert e moyers

observed normal relations of teeth to each other in same
jaw and with those of opposite jaw influenced by
muscular balance
Muscles relevant mandibular elevators

masseter, temporalis, medial pterygoid

mandibular depressor

lateral pterygoid
Genioglossus role in facial morphology
Mentalis orbicularis -important

Allen Brodie-if we could learn to

control the musculature through
critical period of growth, we might be
able to expect that in at least a
proportion of patients,there would be
spontaneous unfolding of
development ,that we thought
previously must be managed with
orthodontic force

EMG its application-orthodontics

Diagnosis-habits-tongue thrusting

lip &cheek activity,sucking habits

swallowing
palsy

Malocclusions-class1

class2
class3

Treatment aspects- myofunctional appliances

activator
twin block

orthognathic surgery
Retention and relapse
Cleft and palate

EMG activity in class 2

malocclusion patients
Graber in contrast to cl 1, cl 2 patients-abnormal
muscle activity,especially,cl 2div 1
In cl 2div 2-compensatory muscle activityposterior fiber temporalis&masseter
He also added-in cl 3 and cl 2div1maloclussionproblem is dominant bone dysplasia with
adaptive muscle function and tooth irregularity
reflecting a severe basal dysplasia

Pancherz analyzed-emg activity in

masticatory muscles cl 2div1 and
normal occlusion-maximal biting in
centric occlusion and chewing
Maximal biting in
centric occlusion
Cl 2-less emg in
masseter and temporal
than control
Reduction more in
masseter

During chewing
Cl 2 less emg in
masseter than controls
Temporalis no
difference

High positive-b/n emg activity maximal biting

and chewing for both muscles of 2 groups
Impaired muscle activity in cl2 a diverging
dentofacial morphology and unstable occlusal
contact conditions
Moyers emg in children with cl2 div1dysfunction of temporal in habitual occlusion and
rest may be etiological factor-post normal
occlusion

Emg on cl 3
It is believed-correction of anterior cross bite-cl3increased emg of masseter and
temporalis/bilateral improvement of both
Study-deguchi and iwahara-chin cup

reduced masseter activity with no

improvement of bilateral co-ordination of both
Reported-integrated emg activity-in cl3 reduced
than in normal occlusion

Emg on functional appliance

therapy

Neuromuscular reaction
seen in patients wearing
appliance on full time-as
pterygoid response;by
james.mc namara.jrbegins after few months
During 1 few hrs no
change
Distinct change in
muscle activity-few
days/weeks-

 Decrease post temporalis

increase-masseter
significant increase-functionlateral pterygoid
As expt-progressed pterygoid
response decreased gradually-pr
-appliance level
Results treatment with oral
shields caused a decrease in
oro-facial activity during oral
function

Lacouture,et,al-action of 3 types functional

appliance on activity of masticatory muscles
Used-herbst,twin
block,frankel appliance
Study done to lateral
pterygoid hypothesisfunctional and postural
activity of sup and inf heads
of lateral pterygoidincreases-appliance
placement
Emg activity-decreasedplacement of appliance
more lateral pterygoid
Study-did not support
hypothesis

 Sessle bj,wood side

dg.-univer
toronto,canada
Studied functional
appliance-change in
postural emg activity of
muscle
Showed decrease in
postural activity of sup
inf heads of
pterygoid,sup masseter
and ant digastric-morelateral pterygoid

Emg activity-swallowing
Showed characteristic differences-normal and
abnormal swallowing
In mature swallow During teeth apart swallow-

Winders-study force exerted on dentition by perioral

and lingual musculature-swallowing
Concluded during swallowing buccal and labial
musculature do not contract
In tongue thrust swallowing-tongue muscle
hypertrophies-,emg activity increases
Emg activity-returns to normal after correction

Emg in cerebral palsy

Useful in children with cerebral palsy
patients
Paralysis/hyper kinetic activity of muscle
associated with stomatognathic system

Effect of pain orthodontic treatment

Effect from archwire jaw muscle is unclear
Goldrich et al evaluated effect-on masseter emg
activity

emg activity during function reducedsignificantly after treatment started

Shows that orthodontic pain on teeth tend to
reduce muscle activity during function

 Negan

assessed muscle pain and emg activity

before and after treatment with orthopedic
retraction head gear
800 gm force and 75% of force transmitted to tmj
via mandible
No significant increase in muscle activity/muscle
pain associated with orthopedic treatment

Emg activity in cleft lip and

palate patients
Li et al evaluatedmuscle activity in
operated unilateral
cleft lip and palate
Activity masseter
higher activation in
rest position
Lower potential
function

Activity temporalis
Higher activation
Lower potential of
action

 In harmonious activity masticatory

muscles during mandibular border
movement
Higher asymmetry index of masseter and
temporalis

Emg on buccinator activity

In cl 2 div 1 buccinator contracts
excessively and hyper active mentalis
muscle
Post fibers of temporalis exerts a greater
influence in cl2 div 1 than normal
Emg identifies this abnormality

Influence of activator on emg

activity of mandibular elevator
Mirallis r burger faculty of medicine-univ of
chile
Emg activity record-15 children-cl 2 div1
Records-anterior temporal and masseter with or
without activator in postural rest position during
saliva swallowing and maximal clenching
Saliva swallowing-both muscle increased with
activator
Negative correlations-age of children-change of
masseter

Muscle response-twin block

Aggarwal p aims .delhi
Significant increase in activity of masseter
and temporalis
Enhanced stretch reflex of activator muscle
Main force-twin block appears through
increased active tension in stretched muscle
and from initiation of myotactic reflex
activity
Importance of full time wear of appliance

Emg study on mand movement

unilateral cleft lip and palate
patients Saksmoto t ohtsuakak dept of ortho tokoyo
japan
Investigate masticatory muscle function
Improvement in masticatory muscle and jaw
reflexes after ortho treatment
Influence plastic surgery- causes maxillary
retrusion- results skeletal malocclusion
Ortho treatment-designed to compensate
malocclusion

Emg Herbst appliance

Dept of ortho tokoyo medical and dental
univ japan
Examine functional muscular adaptation to
changes in saggital jaw relation by emg
Activity of lateral pterygoid-increased after
wearing appliance remarkably reduced after
4to 6 hrs
These findings indicate multifactorial
effect of adaptation of muscle function
Concluded that functional adaptation were
not dependent only on only on intensity and
functional stimulation

Emg on post orthodontic stability

J adwt ortodontic orthognathic surgery
2002.17[4]307-13
To prevent relapse after ortho treat-retention
is often considered indispensable
To quantify influence of masticatory muscle
on post treatment relapse study was done
Result-emg assessment help in detection of
patients who might need a post orthodontic
retention

Muscular equilibrium and

orthognathic surgery
Evaluate modifications of muscular activity b/n
pre surgical and during year after surgery
Decrease in lower facial height-appears to indicate
that at rest masseter activity tends to normalize
,temporal increases
Maximal contraction reduced temporal and
masseter activity
Increase in vertical dimension causes a change in
muscular tonus depending on associated
osteotomy

 Existence of significant modification after

surgery often reveals a craniomandibular
dysfunction
Emg activity during treatment enables a
perfect re evaluation of these major
vertical discrepancies

Surface emg on TMJ

More specifically delineate and define hypertronic
musculature in the compromised TMJ patients
Series of test necessary differentiate diagnosis
b/n intra capsular and extra capsular
Surface electrodes
Summary-several studies conducted shows
unequivocal evidence to support use of emg for
diagnosis of tmj disorders-robert jankelson

Emg on lip and cheek activity in

sucking habits
Ahlgeren study on lip and cheek activity in sucking
habits
Profound lip[perioral] activity-thumb and dummy sucking
Cheek;buccinator] less evident
Lip and cheek activity more during dummy sucking than
thumb sucking
Activity at rest in perioral muscle-pronounced among
thumb sucking
Lip and cheek activity was Less among control groupboth at rest and during sucking

conclusion
Role of musculature in malocclusion is very important
Facial muscles have various functions that are equally
important
An emg studies have shown ,even at postural rest
position muscles are apparently at function,maintaining
a status quo soft tissue and bony elements
Premature occlusal contacts and compensatory muscle
activity during active function produces a departure
from normal such activities can change bony
morphology accentuating the malocclusion

 Emg helps to identify impaired muscle activity in

malocclusion patients compared to normal and
also muscle activity during various treatment
periods and helps to overcome these abnormalities

References
A text book of clinical neuro physilogy by U K
mishra
Electromyography and its applications in
orthodontics by meenaskhi iyer and ashima
valiathan
Am J orthod Dentofacial Orthop 1988 Aug 94 [2]
97-103
Kokubyo gakki zassgi 1996 mar 63 [1] 18-30
Dr.joseph f .smith medical library
Am J Orthod dentofacialOrthopedic 1990 sep 98
[3] 222-30

 Int j adult orthodon orthognathic surg 2002

17[4] 307-13
Orth fr 2000 jan 71 [1] 37-48
Am j ortho dentofacial orth 1988 aug 94[2]
97-103am j orthod dentofacial orthp 200 apr
117[4]25a
Medical encyclopedia

Thank
you