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of single MUPs; (4) a decrease in the number of MUPs and changes in their ring pattern; (5) variation in amplitude and number of phases of MUPs during voluntary contraction of muscle; and (6) the demonstration of special phenomena, such as electrical silence during obvious shortening of the muscle (physiologic contracture) Insertional Activity At the moment the needle is inserted into muscle, there is a brief burst of action potentials that ceases once the needle is stable, provided that it is not in a position to irritate a nerve terminal Increased insertional activity is seen in most instances of denervation as well as in many forms of primary muscle disease and in disorders that dispose to muscle cramps In cases of advanced denervation or myopathy, in which muscle bers have been largely replaced by connective tissue and fat, insertional activity may be decreased and there is a palpable increase in mechanical resistance to the insertion of the needle Abnormal Spontaneous Activity With the muscle at rest, spontaneous activity of single muscle bers and of motor units, known respectively as brillation potentials and fasciculation potentials, is abnormal The two phenomena are often confused Fibrillation is the spontaneous contraction of a single muscle ber It occurs when the muscle ber has lost its nerve supply and is ordinarily not visible through the skin (but may be visible in the tongue) Fasciculation represents the spontaneous ring of an entire motor unit, causing contraction of a group of muscle bers, and may be visible through the skin The irregular ring of a number of motor units, seen as a rippling of the skin, is called myokymia Fibrillation Potentials When a motor neuron is destroyed by disease or its axon is interrupted, the distal part of the axon degenerates, a process that takes several days or more The muscle bers formerly innervated by the branches of the dead axon that is, the motor unit are disconnected from the nervous system For reasons that are still obscure, the chemosensitive region of the sarcolemma at the motor end plate spreads after denervation to involve the entire surface of the muscle ber Then, 10 to 25 days after death of the axon, the denervated bers develop spontaneous activity; each ber contracts at its own rate and without relation to the activity of neighboring bers This spontaneous activity is associated with a totally random conglomeration of brief di- or triphasic brillation potentials (Fig 45-7A) having a duration of 1 to.

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Figure 45-7 A Fibrillations and positive sharp waves This spontaneous activity was recorded from a totally denervated muscle no motor unit potentials were produced by attempts at voluntary contraction The brillations (above arrow) are 1 to 2 ms in duration, 100 to 300 mV in amplitude, and largely negative (upward) in polarity following an initial positive de ection A typical positive sharp wave is seen above the star B Fasciculation This spontaneous motor unit potential was recorded from a patient with amyotrophic lateral sclerosis It has a serrated con guration and it red once every second or two Calibrations: 5 ms (horizontal) and 200 mV in A; 1 mV in B (vertical)

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