Board of Medicine

A Policy Statement on Needle EMG

Approved by the Iowa Board on February 10, 2005

This policy statement is not a legally binding opinion of the board, but is only intended to provide guidance to the public. The board may make formal policy only through administrative rules, declaratory orders or contested case decisions.

Electrodiagnostic studies are done in individuals with a sensory or motor disturbance to assist in the diagnosis of neuromuscular diseases or conditions. The studies are designed based on the individual patient’s history, physical and differential diagnosis and are adjusted during the course of the study as new information is received. Needle electromyography (EMG) is one of several tests that comprise electrodiagnostic studies and it is usually performed in conjunction with nerve conduction velocity tests. This policy statement addresses needle EMG and who can perform it safely and where it should be performed.

Needle EMG is an invasive diagnostic procedure used to evaluate the physiology of the peripheral nervous system and muscles—to rule out, diagnose, describe, and follow diseases. It requires the insertion of a needle electrode through the skin and into the muscle.1 The muscle’s electrical characteristics at rest and in action are shown through wave-forms on an oscilloscope and through characteristic sounds.

The skill of the examiner is paramount in conducting and interpreting needle EMG testing. Needle EMG is an invasive procedure; needle electrodes are inserted into muscles at varying depths as muscle fibers are fired. The patient’s problem dictates which muscles are studied. They may include common muscles of the arms and legs but may also include muscles in the throat, near the eyes, the tongue and the pelvic region. Accurate placement of the needles is required to avoid significant veins or arteries, lung puncture or nerve damage. Testing is painful and expensive and should be limited to the minimum muscles necessary.

Interpretation must occur during the performance of the needle EMG for several reasons. The muscles studied will vary based on new information gained during the course of the testing. In addition, most EMG machines cannot permanently copy the sounds emitted during testing and the oscilloscope tracings are too difficult and expensive to copy. 2 For this reason, test results must be analyzed in the course of the test; results cannot be documented and retrieved at a later date, as is the case with routine laboratory tests.

M.D.s and D.O.s trained in the complexities of the nerve and muscle physiology as well as medical instrumentation would all agree that it is nearly impossible to learn the proper medical indications for this diagnostic procedure as well as to become proficient in the technical requirements necessary to perform these tests without completing an allopathic or osteopathic medical school and a specialized residency or fellowship program in neurology or physical medicine and rehabilitation. Continuing medical education courses do not provide sufficient in-depth preparation to an M.D. or D.O. to become proficient in needle EMG. Non-M.Ds/D.Os cannot perform these same tests with comparable quality or with the same diagnostic acumen as medically trained physicians. These procedures require a foundation of medical knowledge in order to interpret these electrophysiology recordings and correlate them to a medical diagnosis upon which additional medical or surgical interventions may be recommended.

Needle EMG leads to definitive diagnoses that can determine the need for and type of neurosurgery. It can confirm the diagnosis of chronic, debilitating neurological diseases where the patient should have the full panoply of medical, pharmaceutical and surgical options. Needle EMG constitutes the practice of medicine and must be performed by an Iowa-licensed M.D. or D.O. with residency training inneuro-electrophysiology. This physician should be on-site and available to interact with the patient and technician as the test is administered to interpret the findings.

This policy statement is not a legally binding opinion of the board, but is only intended to provide guidance to the public. The board may make formal policy only through administrative rules, declaratory orders or contested case decisions.

1. Can needle EMG’s be safely performed and interpreted by other health professionals?

No. Needle EMG can be painful and expensive and should be limited to those muscles that need to be tested to diagnose a condition. Only an M.D. or D.O. with residency training in neuro-electrodiagnostic medicine should perform and interpret needle EMG because of the sophistication of testing and array of treatment options that should be available to the patient. These tests require full knowledge of human anatomy, physiology, pathophysiology, and a wide range of medical and surgical treatment modalities. An M.D. or D.O., who has not completed residency training in neuro-electrodiagnostic medicine is not qualified to conduct or interpret needle EMG. Nor are there other health professionals who are qualified because they lack in-depth underlying preparation combined with recognized residency training in neuro-electrodiagnostic medicine. Professional school and continuing educational programs are not adequate training to obtain the knowledge basis needed to perform and interpret needle EMGs.

2. May an M.D. or D.O., specifically trained in neuro-electrodiagnostic medicine, interpret needle EMG’s from off-site?

No. The examiner must be present to conduct a history and physical to determine whether an EMG is appropriate and which muscles to test, to identify whether the electrodes are properly placed, to interpret the findings and adjust the testing as it goes along, and to assure proper documentation of the procedure, normal and abnormal findings and make a final diagnosis. An off-site physician lacks the immediate interactive data necessary for complete interpretation of needle EMG.

1Needle placement is deep in the muscle and is not superficial as is venipuncture for taking blood samples or the placement of
acupuncture needles.
2 Recommended Policy for Electrodiagnostic Medicine, American Association of Electrodiagnostic Medicine, 2004: 6-7.

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