Testing Information and Consent

What you should know about the EMG and NCS Examinations

Your doctor has ordered an EMG and NCS test. Here is some information on what to expect.

Preparation:

1. You should not apply any lotions or oils to your skin on the day of your test.

2. Wear loose fitting clothing allowing both your pants legs to be rolled up above your

knees and your sleeves to be rolled up easily to your shoulders.

3. If you have a pacemaker, have had a mastectomy, take blood-thinning medications, or have a bleeding disorder, please notify the doctor before beginning the tests. The tests can still be done, but modifications may be made.

4. You may also take pain medication before the tests and you are encouraged to continue your usual medications as prescribed because they will not affect the test results.

5. Other than a mild tenderness where the needles are placed, there are no significant complications expected.

What:

Electromyography (EMG) and nerve conduction studies (NCS) are used to indicate how well your nerves and muscles are working. Nerve conduction studies measure both the speed and the size of the electrical signals that are being transmitted by your nerves. EMG measures the electrical activity within the muscles that specific nerves supply signals to.

Why:

These tests can determine whether ongoing nerve injury or muscle damage is contributing to your current symptoms. They provide objective documentation for many suspected diagnoses such as carpal tunnel syndrome and also help to rule out certain conditions that can contribute to your complaints.

How:

In a nerve conduction study, small sticker electrodes are placed upon your skin and specific nerves in your arm, leg, back or neck are stimulated using a handheld stimulator. The stimulator sends a small electrical impulse to the specific nerves chosen and these nerves are chosen based on the nature of your complaints. The nerve impulses are then recorded and stored for analysis. EMG uses a thin needle to go into muscles to record the relationship between nerves and muscles.

Who:

All studies are performed or supervised by board certified specialists who have received special training in this area of diagnostic testing.

When:

Your doctor will receive the test results in a formal report, typically within 2 days.

Consent to EMG & NCS Examination

First name

Last name

Date of Birth

Do you have a doctor’s referral for testing?

Yes

I declare that the info I’ve provided is accurate & complete

I acknowledge and understand that as a result of the performance of the procedure(s) identified that there is a material risk that I may suffer infection, allergic reaction and/or skin discoloration. In very rare cases, pneumothorax (collapsed lung) has been reported following EMG. I have been given ample opportunity to ask questions and any questions I have asked have been answered or explained in a manner satisfactory to me. By signing below, I acknowledge that I have read or had it read or explained to me and I understand this form and I voluntarily consent to allow any qualified provider from Direct Performance Physical Therapy (DPPT), and all medical personnel under supervision who are involved in performing such procedures described or otherwise referred to herein, to perform EMG and NCS

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Testing Information and Consent

Consent to EMG & NCS Examination

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