EMG Q re UE SNAPS

[Taus]

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For those who do EMG's.... do you do proximal stim (ie above/below elbow) on median and/or ulnar SNAPs? I haven't searched the literature... but more people I talk to are saying to just do the distal conductions to eval for peripheral neuropathy and/or distal entrapments and skip proximal SNAP's as they are not reliable. Thoughts?

 

[Sig123]

Proximal SNAPs can be done but temporal dispersion and phase cancellation effectively makes them insignificant. In most cases, all you need is a distal SNAP.

 

[RUOkie]

I agree with Sig123. There is too much variability in the degree of temporal dispersion with SNAPs once the distance gets longer. So you can't rely on them for demyelinating injuries (like an ulnar neuropathy at the elbow). I just do distal stim on SNAPs.

 

[SSdoc33]

plus it adds time and discomfort. cant remember the last time is did as proximal SNAP

 

[Taus]

Thank you. I've had to do what my attendings do in training - trying to decide exactly how I want to do things on my own in a few months.

 

[jonnylingo]

distal only. Like you, did proximal all through residency, but I can't ever think of a case where this added any value to the exam, never changed plan. Waste of time and shocks.