PROSPECTIVE BLINDED COMPARISON OF SURFACE VS WIRE ELECTROMYOGRAPHIC ANALYSIS OF MUSCLE RECRUITMENT IN SHOULDER INSTABILITY.

Abstract

This pilot study assesses level of agreement between surface and fine wire electromyography (EMG), in order to establish if surface is as reliable as fine wire in the diagnosis and treatment of abnormal muscle patterning in the shoulder. 18 subjects (11 female, mean 36 years) with unstable shoulders were recruited after written consent and ethical approval. Anthropometric information and mean skinfold size for triceps, subscapular, biceps and suprailiac sites were obtained. Triple stud self adhesive surface electrodes (“Triode” – Thermo Scientific) were placed over Pectoralis Major (PM), Latissimus Dorsi (LD), Anterior Deltoid (AD) and Infraspinatus (IS) at standardised locations. A ‘Medi-Link’ dual channel surface EMG (Electro Medical Supplies) displayed a rectified smoothed signal. Patients performed five identical uniplanar standard movements (flexion, abduction, external rotation, extension and cross body adduction). After a rest period, a dual needle technique for fine wire insertion was used displaying a raw EMG signal on a ‘Sapphire II’ four channel EMG unit. An experienced examiner in each technique reported if muscle activation patterns differed from agreed normal during any movement and were blinded to the other test results. Sensitivity, specificity and kappa values for level of agreement between methods were calculated for each muscle according to the method of Altman. 15 patients were successfully tested. Sensitivity, specificity and kappa values between techniques for each muscles were PM (57%, 50%, 0.07), LD (38%, 85%, 0.22), AD (0%, 76%, −0.19) and IS (85%, 75%, 0.6). Only IS demonstrated high sensitivity and specificity and a moderate level of agreement between the two techniques. There was no correlation between skinfold size and agreement levels. Surface did not agree with wire analysis for PM, LD and AD, although IS did show moderate agreement. Subcutaneous fat did not appear to affect correlation.