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Энмг правой верхней конечности

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17 августа 2019

8 минут Автор: Любовь Добрецова 1653

Многочисленные патологии периферических нервов, отвечающих за иннервацию верхних конечностей, доставляют пациентам нестерпимые мучения, и нередко становятся причинами, приводящими к серьезным осложнениям. При этом достаточно бывает несложного исследования, которое поможет врачу установить правильный диагноз и назначить соответствующую терапию.

Для этого проводится ЭНМГ верхних конечностей, или электромионейрография рук, процедура, позволяющая оценить состояние и работоспособность нервных и мышечных волокон. Благодаря методике, выполняющейся с помощью электрических импульсов, удается узнать, какой конкретно участок поврежден, а также определить степень его поражения.

Суть диагностики

В диагностической нейрофизиологии существует две методики исследования – электромиография (ЭМГ) и электронейрография (ЭНГ), и состояние верхних конечностей можно изучить как первой, так и второй. В чем заключается их различие? ЭМГ представляет собой диагностику электрической активности мышечных волокон в покое и при их сокращении. ЭНГ дает возможность оценить скорость проведения импульса (СПИ) или электрического сигнала по нейронным путям.

Такой способ считается наиболее информативным для выявления полиневропатии, мононевритов, полиневритов и других патологий нервной системы (НС), сопровождающихся поражением нервов рук и ног. При сочетанном выполнении обеих методик, которое применяется в большинстве случаев и называется электронейромиография, удается определять экстрапирамидные и супрасегментарные пирамидные поражения. Благодаря исследованию врачам несложно производить контроль проводимой терапии и при необходимости корректировать ее.

В основе ЭНМГ лежит использование электростимуляции нервных окончаний с последующей интерпретацией показателей вызванных потенциалов (ВП), которые фиксируются с иннервируемой мышцы либо нервного ствола. Стимуляция проводится путем воздействия на две точки, расположенные друг от друга на определенном расстоянии. Это позволяет определить время, за которое возбуждение проходит между точками, то есть СПИ по нервным волокнам.

Электронейромиография верхних конечностей, а именно срединного, локтевого и лучевого нервов, предоставляет возможность не только обнаружить нарушения, но и оценить их степень. Если провести стимуляцию в двух точках сложно, к примеру, при исследовании плечевого сплетения или мышечно-костного нерва, то косвенное представление об их состоянии получают при единичном воздействии на одну. Для этого измеряется латентный период мышечного (М) ответа.

Что показывает

По спаду амплитуды мышечного ответа при повторном раздражении электрическим сигналом нервного пучка делают выводы о присутствии нервно-мышечной утомляемости. Диагностически значимым критерием миастенического синдрома считается прогрессирующий спад амплитуды М-ответа, отмечаемый при частоте воздействия 30-50 импульсов в минуту.

Дополнительно для изучения нервно-мышечной утомляемости применяются фармакологические тесты. На СПИ могут влиять несколько параметров, таких как диаметр нервных волокон и степень их миелинизации, действие медикаментозных средств, возраст человека, проходящего процедуру, времени суток.

Электронейромиография конечностей состоит из нескольких обязательно определяемых составляющих, которые позволяют врачу получить полную картину функциональной способности изучаемого нерва. Сюда входит:

  • регистрация и интерпретация показателей ВП нерва и мышцы (длительность, латентный период, амплитуда и форма);
  • вычисление мотосенсорного и краниокаудального коэффициентов и их изменений;
  • оценка СПИ по чувствительным и двигательным нейронам периферических нервов;
  • определение численности работоспособных двигательных единиц.

Кроме этого, дополнительно уточняется степень снижения СПИ и амплитуды потенциала нервных волокон, что позволяет врачу сделать вывод о целесообразности того или иного терапевтического подхода.

Виды методик ЭНМГ

Независимо от выбранной методики процедуру можно проводить в положении пациента сидя или лежа, что выбирается, руководствуясь самочувствием обследуемого либо поиском наиболее удобного доступа к нужному нерву. Дальнейшие различия обусловлены особенностями предпочтенной методики выполнения диагностики.

Поверхностная

Поверхностная электронейромиография проводится при использовании накожных электродов. Их накладывают на участки кожи, наиболее близко расположенные к необходимому для изучения нерву, и регистрируют прохождения импульсов, вызванных произвольным сокращением мышечных волокон.

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Эта методика является наиболее простой, но она дает меньше информации, потому как не получается оценить работоспособность нервных и мышечных тканей при нагрузках определенного вида. Кроме этого, нет конкретного понимания, какой именно участок поражен, что также снижает качество диагностической ценности.

Игольчатая

Для осуществления игольчатой электронейромиографии в мышцу вводятся концентрические электроды, которые в свою очередь регистрируют произвольные биопотенциалы. Процедура является инвазивной и при вводе электродов сопровождается незначительными неприятными ощущениями, похожими на комариный укус. Зато благодаря ей удается сделать более конкретную запись о функциональном ответе исследуемых нервов и мышц.

Стимуляционная

Данная разновидность электронейромиографии предполагает изучение биопотенциалов при проведении стимуляции периферических нервов. Она может осуществляться как при использовании накожных, так и игольчатых электродов, в зависимости от показаний и противопоказаний к процедуре конкретно для каждого пациента.

Такая методика является наиболее информативной и нередко выполняется после того, как первые две не обеспечили врача достаточным для постановки диагноза материалом. Хотя в отдельных случаях специалисту сразу ясно, что для оптимального эффекта следует проводить именно этот диагностический способ.

Показания к исследованию

Заболевания, при которых необходима электронейромиография рук, достаточно многочисленны. А описываемая методика позволяет более конкретно оценить состояние небольших патологических участков нервов. В этот перечень входят:

  • полинейропатия всех разновидностей;
  • повреждение либо сдавление корешков нерва;
  • туннельный синдром, остеохондроз, невриты;
  • протрузия межпозвоночного диска.
  • периферическая нейропатия.

В таких ситуациях методика дает возможность с высокой точностью диагностировать воспалительные процессы, повреждения и участки сдавливания нервных окончаний верхних конечностей. Дополнительно в ходе исследования можно выяснить, идет ли восстановление нерва, либо необходимо назначение определенных препаратов.

Противопоказания

Перед тем как назначить ЭНМГ, врач должен обязательно удостовериться в том, что пациент не принимает препараты, способные влиять на НС (миорелаксанты, антихолинергики), а также антикоагулянты.

Скорее всего, за несколько дней до проведения исследования их придется отменить. Нельзя также проводить ЭНМГ при установленном кардиостимуляторе, так как электрические воздействия могут нарушить его работу и привести к остановке сердца.

Не осуществляется ЭНМГ и при наличии эндопротезов. Выполнению диагностики может препятствовать повреждение кожных покровов в тех местах, где планируется устанавливать электроды.

Противопоказаниями для исследования являются сердечно-сосудистые болезни, и в частности артериальная гипертензия. ЭНМГ не проводят пациентам с шизофренией, эпилепсией и другими подобными заболеваниями, так как обследование может вызвать обострение.

Относительными противопоказаниями являются беременность и период грудного вскармливания, нарушения свертываемости крови, ОРВИ и лихорадка. То же самое можно отнести и к лишнему весу – у людей с большой жировой прослойкой выполнить процедуру технически не представляется возможным, так как воздействия электрическими сигналами они попросту не почувствуют.

Подготовка

Электронейромиография не предполагает каких-либо сложных подготовительных действий. Пациенту всего лишь рекомендуется за 2-3 дня по процедуры отказаться от приема продуктов, содержащих кофеин, таких как шоколад, кофе, чай, кола и т.д. За 3 часа до непосредственного выполнения диагностики следует воздержаться от курения, так как это может привести к искажению результатов и потребуется повторное прохождение процедуры.

Проведение диагностики

Перед осуществлением процедуры пациента предупреждают о возможных ощущениях, чтобы ему было проще подготовиться морально. Затем ему предлагается снять одежду с верхней части туловища либо просто обнажить руки и удобно расположиться на кушетке. Лежачее положение наиболее предпочтительный вариант, так как так пациенту удается максимально расслабиться.

Накожные (или игольчатые) электроды закрепляются в месте, соответствующем двигательной точке исследуемой мышцы. Индифферентный накладывается над сухожилием, а основной – над брюшком мышцы. Для их закрепления применяется специальный абразивный гель, способствующий крепкому удержанию электродов на необходимое для диагностики время.

Между этими двумя электродами (стимулирующим и регулирующим) фиксируется еще один, выполняющий функцию заземления. Предварительно фетровые фитильки смачиваются в хлориде натрия или другом изотоническом растворе. При этом анод (положительный электрод) крепится дистально, а катод (отрицательный) – над двигательной точкой.

К первому электроду подаются электрические разряды, которые проходят по нервным волокнам и вызывают сокращение мышцы. Время, за которое осуществляется передача сигнала в покое и сокращении, регистрируется на специальном приборе – электронейромиографе. Как правило, накожная методика без применения стимуляции выполняется за 15-60 минут.

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При стимуляционной ЭНМГ рук изучается М-ответ на электрическое раздражение нерва на разных участках, начиная от его выхода из позвоночника и далее по ходу верхней конечности. Таким способом диагносту несложно определить патологии, такие как состояние после неудачной операции или травмы, сопровождающееся повреждением либо рубцеванием нервного волокна.

При выполнении электронейромиографии можно обнаружить увеличение сопротивления по ходу нервного импульса, которое развивается в следующих случаях:

  • вследствие перенесенной нейроинфекции;
  • отравления алкоголем и другими токсичными веществами;
  • нарушения метаболизма при сахарном диабете и т.д.

Данная методика является весьма информативной для диагностирования туннельного синдрома, при котором дополнительно выполняется и игольчатая ЭНМГ, что позволяет оценить возможность нерва к восстановлению. Благодаря ей принимается решение о целесообразности проведения операции.

ЭНМГ – быстрый путь к излечению

Сколько проблем наваливается сразу на человека, если вдруг любая из его конечностей перестает нормально функционировать. Ведь при заболеваниях нервов рук сложно, больно, а иногда и вообще невозможно осуществлять даже такие простые действия, как держать столовые приборы или, к примеру, чистить зубы.

Предотвратить серьезные осложнения заболеваний периферических нервов можно быстро и недорого. Для этого необходимо пройти практически безболезненное исследование – ЭНМГ, благодаря которому определяются мельчайшие нарушения на ранних стадиях. Это позволяет быстро и эффективно излечиться от болезни и восстановить все утраченные функции.

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Современные медицинские процедуры, предлагаемые большинством клиник, больниц и частных кабинетов, выделяются не только высокой точностью, за счет чего последующее лечение и профилактика заболеваний становятся более эффективными и успешными. Хотя для пациента, названия некоторых медицинских процедур могут звучать необычно и даже пугающе, чаще всего за такими специфическими терминами стоит квалифицированная помощь, направленная на улучшение состояния здоровья больного.

Одним из практичных видов диагностики, зарекомендовавшим себя успешным и точным, является электронейромиография (ЭНМГ), предлагаемая в медицинском центре «Аист» в хабаровске, по разумной обоснованной стоимости, полностью соответствующей высокому качеству услуги.
Что такое миография? Какие виды электронейромиографии предлагаются в медицинском центре «Аист»? Какие существуют показания для проведения процедуры? Какой врач на нее направляет? Что включает в себя подготовка и как проходит ЭМГ?

Что такое электронейромиография

ЭНМГ – это специальный вид исследования, применяемый для диагностики самых разных заболеваний и патологий, связанных со спинным мозгом, периферической нервной системой, а также скелетными мышцами.

Эта современная диагностика дает возможность безошибочно определить разновидность и степень заболевания, связанного с поражением мышечных или нервных тканей, после чего специалисту гораздо легче определить точный диагноз и определиться с соответствующим лечением.

Суть ЭНМГ заключается в понимании того, как взаимодействуют и функционируют между собой нервы и мышцы в человеческом организме.

В обычных условиях, когда человек совершает какие-то движения, в его клетках происходят нервные импульсы, которые затем передаются на нейроны спинного мозга, а затем на соответствующие конечности или мышцы. Когда такой импульс достигает мышц, он производит в них изменения, приводящие к ее сокращению и последующему выполнению необходимого движения.

В тех ситуациях, когда нервная система была поражена в результате травмы позвоночника или других факторов, процесс прохождения импульсов по спинному мозгу и нервным окончаниям нарушается, вследствие чего становится невозможным выполнение некоторых движений.

Процедура ЭНМГ помогает выявить какой конкретно участок нервно-мышечной системы поражен травмой, патологией или заболеванием, что определяет последующее лечение или другие действия медиков.

Разновидности ЭНМГ

Показания к процедуре и кто направляет на ЭМГ

Подготовка перед процедурой

Как проводится миография?

Миографию обычно проводят в специально оборудованных кабинетах в больницах, частных клиниках, а используемая техника будет напрямую зависеть от типа самой процедуры и разновидности нервов, подвергающихся обследованию. Во время ЭНМГ, электрические импульсы подаются на конкретные нервы, при помощи специальных медицинских электродов, который врач прикладывает к конкретному участку, в месте прохождения нерва.

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При стимуляции нерва, пациент будет испытывать дискомфорт, связанный с раздражением нервов и сокращениями мышц, но никакой физической боли обычно не наблюдается. Если проводится игольчатая ЭНМГ, то в некоторые мышцы пациента специалист вводит тонкие электроды, за счет чего человек может чувствовать минимальные болевые ощущения, связанные с легким раздражением окончаний.

Преимущества проведения электронейромиографии в «СМ-Клиника»

  • Для проведения процедуры мы используем современное высокоточное оборудование. Это позволяет нам получить максимально достоверные результаты и при необходимости назначить оптимальный курс лечения.
  • Врачи-неврологи, выполняющие исследование, прошли специальное обучение, а их высокий профессионализм гарантирует корректность проведения процедуры и верную интерпретацию результатов.
  • Мы предлагаем доступные цены на электронейромиографию, чтобы обследование мог пройти каждый пациент.

Зачем нужно проходить электронейромиографию

Электронейромиография – один из наиболее информативных методов исследования позволяющий на ранней стадии выявить различные неврологические заболевания, затрагивающие нервы и мышцы.

Первичная электромиография проводится для получения информации необходимой для постановки и подтверждения диагноза. Проведение ЭНМГ дает возможность выяснить, на каком уровне рефлекторной цепи имеется патология и насколько она серьезна.

Во время проведения лечения выявленного заболевания ЭМГ может проводится несколько раз с определенным интервалом для оценки эффективности терапии.

Показания к проведению электронейромиографии

Решение о проведении ЭНМГ принимает врач-невролог, основываясь на существующем диагнозе, осмотре пациента, имеющихся жалобах. Сделать электронейромиографию необходимо в следующих случаях:

  • при наличии жалоб на мышечные боли, спазмы, судороги или же слабость в ногах или руках, при тунельном синдроме (когда нерв зажат в костном канале сухожилиями мышц);
  • при грыжах межпозвонковых дисков и корешковом синдроме;
  • при поражениях мышц и нарушениях мышечного тонуса: мышечной дистрофии, миотонии, миопатии, миастении;
  • при поражениях нервов: нейропатии лицевого нерва, полинейропатии, полимиозите, рассеянном склерозе, полиомиелите, болезни Паркинсона и других заболеваниях;
  • после переломов верхних и нижних конечностей.

ЭНМГ не проводят пациентам, страдающим эпилепсией, психическими расстройствами, имеющим кардиостимулятор, а также в период обострения инфекционных или сердечно-сосудистых заболеваний.

Как подготовиться к проведению электронейромиографии

Как проводится электронейромиография

Перед началом процедуры наш врач обязательно расскажет вам обо всех этапах обследования и о ваших ощущениях. Электромиография проводится амбулаторно в положении лежа или полулежа, при этом важно максимально расслабиться. В зависимости от обследуемой зоны врач определяет места наложения электродов, обрабатывает их антисептическим раствором и смазывает гелем.

Электроды, подсоединенные к электромиографу, специалист фиксирует на коже в области обследуемой мышцы. Сигнал, поступающий к электроду, переходит на нерв и вызывает сокращение мышцы. В ходе процедуры врач может попросить напрячь ту или иную мышцу, сделать это несколько раз или с разным временным интервалом. Все показания и колебания потенциалов фиксируются аппаратом и записываются на бумагу или магнитный носитель. Графически результат электронейромиографии напоминает результаты ЭКГ – там присутствуют такие же скачущие зубцы и волны.

Во время процедуры вы можете ощущать легкое покалывание, которое пройдет после ее завершения.

В зависимости от объема исследования электронейромиография длится от 30 минут до 1 час.

Результаты обследования

Как записаться на электронейромиографию в «СМ-Клиника»

Цены на электронейромиография (ЭНМГ) в «СМ-Клиника»

Наименование услуги Цена (руб.)*
Электронейромиография лица: вызванный кожно-симпатический потенциал 3 400
Электронейромиография лица: круговой мышцы глаза, круговой мышцы рта (лицевой нерв) 3 400
Электронейромиография лица: блинк-рефлекс (тройничный нерв) 3 950
Электронейромиография игольчатая (1 мышца) 3 400
Электронейромиография: Н-рефлекс 3 400
Электронейромиография: тетанизация 4 500
Стимуляционная электронейромиография одной верхней конечности (1 чувствительный нерв) 1 700
Стимуляционная электронейромиография одной верхней конечности (1 нерв) 3 400
Стимуляционная электронейромиография одной верхней конечности (2 нерва) 4 500
Стимуляционная электронейромиография одной верхней конечности (все нервы) 6 750
Стимуляционная электронейромиография одной нижней конечности (1 двигательный нерв) 2 850
Стимуляционная электронейромиография одной нижней конечности (все нервы) 6 750
Дополнителое исследование к стимуляционной электронейромиографии одной верхней конечности при туннельном синдроме (самостоятельно не проводится) 2 850

* Администрация клиники принимает все меры по своевременному обновлению размещенного на сайте прайс-листа, однако во избежание возможных недоразумений, советуем уточнять стоимость услуг в регистратуре или в контакт-центре по телефону +7 (495)

Размещенный прайс не является офертой. Медицинские услуги оказываются на основании договора.

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