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Electrodiagnostic medicine
Electrodiagnostic medicine (EDX) is a medical subspecialty of neurology, clinical neurophysiology, and physical medicine and rehabilitation. Electrodiagnostic physicians apply neurophysiologic techniques, including needle electromyography and nerve conduction studies to diagnose, evaluate, and treat patients with impairments of the neurologic, neuromuscular, and/or muscular systems. The provision of a quality electrodiagnostic medical evaluation requires extensive scientific knowledge that includes anatomy and physiology of the peripheral nerves and muscles, the physics and biology of the electrical signals generated by muscle and nerve, the instrumentation used to process these signals, and techniques for clinical evaluation of diseases of the peripheral nerves and sensory pathways〔Electrodiagnostic Medicine, 2nd edition, Daniel Dumitru, Anthony A. Amato, and Machiel Zwarts; Hanley & Belfus; 2002.〕
==Training==
In the United States, neurologists receive training in performing needle electromyography and nerve conduction studies during a fellowship in clinical neurophysiology or neuromuscular medicine.〔http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/187_clinical_neurophysiology_07012014_1-YR.pdf.〕〔http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/183-343_neuromuscular_med_07012014_1-YR.pdf〕 Physical medicine and rehabilitation physicians receive this training during their residency.〔http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/340_physical_medicine_rehabilitation_07012014.pdf〕 and can get further training in a neuromuscular fellowship. The American Board of Electrodiagnostic Medicine certifies US physicians in electrodiagnostic medicine.〔http://www.abemexam.org〕 In Europe, nerve conduction studies and electromyography training may be part of neurology, physical medicine and rehabilitation, or clinical neurophysiology training. In the United States, there is also a certification in neuromuscular medicine. This certification is open only to neurologists and physical medicine and rehabilitation specialists that have completed a fellowship in neuromuscular medicine. The neuromuscular medicine examination includes electrodiagnostic testing as part of the certification examination but also includes broader topics such as genetics, biopsy, and rehabilitation.〔http://www.abms.org/member-boards/contact-an-abms-member-board/american-board-of-physical-medicine-and-rehabilitation/〕〔http://www.abms.org/member-boards/contact-an-abms-member-board/american-board-of-neurology/〕 Technologists sometimes assist in the performance of the NCSs but do not the interpretation. In the United States, the Current Procedural Terminology code of the American Medical Association, states "“Waveforms must be reviewed on site in real time…” In addition, it states that the “Reports must be prepared on site by the examiner, and consists of the work product of the interpretation of numerous test results…along with summarization of clinical and electrodiagnostic data, and physician or other qualified health care professional interpretation.〔American Medical Association’s (AMA) 2014 Current Procedural Terminology Professional Codebook〕
Patients will typically be referred to a specialist in electrodiagnostic medicine if they have numbness, tingling, pain, weakness or spasms. Common muscle and nerve disorders seen by these type of specialists include pinched nerves in the neck or back (radiculopathy), carpal tunnel syndrome, and neuropathies. More uncommon diseases include ALS, myasthenia gravis, and chronic inflammatory demyelinating polyneuropathy. Using their broader training, physicians in electrodiagnostic medicine, often perform more detailed evaluations which may include laboratory tests, CT or MRI scans, genetic evaluation, biopsy of nerve, skin, or muscle, or perform neuromuscular ultrasound. A more complete listing of disorders and testing can be found under neuromuscular medicine.
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