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Videos

Videos

Videos are for demonstration purposes only

Myoguide Animated Clinical Video

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Pathology in Cervical Dystonia can be associated with “trigger points”(see our whitepaper on trigger points for a great resource). The trigger point locations are found by physical examination, and manual palpation. They are found to be nodular in nature, or “tight spots” in the muscle. These areas can be marked, after pre-treatment examination, for easy location, once the needle EMG guided injection procedure is ready.

It is quite difficult to find the optimal injection locations without Myoguide, as there is a subtlety related to the depths where hyperactive muscle fibers reside. Myoguide allows the clinician to see and hear the EMG signal, providing confirmation that the needle is indeed in the best location.

Another important aspect relates to re-injected sites. Sites injected in previous encounters may still exhibit a degree of neuromodulation. It is of benefit to be able to see the EMG signal, as it provides information about activity that EMG audio alone cannot. The injection dose can be titrated to suit the activity. Hence, we now have a way to evaluate where the optimal injection site is and how much medication is appropriate to inject. This helps to prevent injection of higher volumes and can reduce the concomitant diffusion to adjacent sites.

The video demonstrates the value of Myoguide in finding the injection site, as indicated by a significantly increased level of EMG activity. EMG can be monitored by Myoguide’s high fidelity EMG audio, by our large integrated EMG signal display, and by viewing the integrated EMG and EMG RMS indicators on the display screen.

You will also notice the clinician holding Myoguide easily activates the MUTE feature, by pressing the two sideways arrows, as indicated by the pause symbol. This is a very convenient way to shut the audio off while waiting for the next injection. Any button press will switch the EMG audio back to the previously set volume.

Myoguide Animated Quickstart Guide

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This video presents an overview of Myoguide’s features and operation. This is brief review. For more detail please see Myoguide’s Operator’s Manual.

Myoguide Back Muscle Video

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Myofascial pathology is often associated with “trigger points” (see our whitepaper on trigger points for a great resource)The trigger point locations are found by physical examination, and manual palpation. They are found to be nodular in nature, or “tight spots” in the muscle. These areas are marked for easy location, once the needle EMG guided injection procedure is ready. It is quite difficult to find the optimal injection locations without Myoguide, as there is a subtlety related to the depths where hyperactive muscle fibers reside. Myoguide allows the clinician to see and hear the EMG signal, providing confirmation that the needle is indeed in the best location. Another important aspect relates to re-injected sites. Sites injected in previous encounters may still exhibit a degree of neuromodulation. It is of benefit to be able to see the EMG signal, as it provides information about activity that EMG audio alone cannot. The injection dose can be titrated to suit the activity. Hence, we now have a way to evaluate where the optimal injection site is and how much medication is appropriate to inject. This helps to prevent injection of higher volumes and can reduce the concomitant diffusion to adjacent sites. The video demonstrates the value of Myoguide in finding the injection site, as indicated by a significantly increased level of EMG activity. Once more, you will also notice the clinician holding Myoguide easily activates the MUTE feature, by pressing the two sideways arrows, as indicated by the pause symbol. This is a very convenient way to shut the audio off while waiting for the next injection. Any button press will switch the EMG audio back to the previously set volume.

Myoguide & Ultrasound Piriformis Muscle Demo

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The Piriformis exists deep in the lower back/pelvic area, in close proximity to the sacrum, sacroiliac joints and interior hip joints. Nerve supply to the Piriformis muscle is via the L5/S1/S2 spinal nerve roots which are known problem areas affected by many spinal conditions.

There are several symptoms associated with “Piriformis Syndrome” such as pain in the hip, pain in the center of the butt, or pain down the back of the leg: The first symptom suggesting Piriformis syndrome would be pain in and around the outer hip bone. The tightness of the muscle produces increased tension between the tendon and the bone which produces either direct discomfort and pain or an increased tension in the joint producing a bursitis. The second symptom suggesting Piriformis syndrome would be pain directly in the center of the buttocks. This pain can be elicited with direct compression over the belly of the buttocks area. The third symptom suggesting Piriformis syndrome would be a sciatic neuralgia, or pain from the buttocks down the back of the leg and sometimes into different portions of the lower leg.

This video provides a view into a Piriformis injection procedure. There is a brief overview of landmarks used to find the injection site, clinically. There are lines drawn for illustration purposes. Clinicians don’t generally need to draw on patients. The Sciatic nerve is highlighted as a spot to avoid. Ultrasound demonstrates what the Piriformis Muscle looks like, and it’s position is verified by contraction and relaxation. Myoguide is an important tool for this procedure as you can see. EMG audio and raw EMG is a great indicator of where you are. There is also a good view of what the integrated EMG (iEMG) bar graph and EMG RMS indicator looks like on the Myoguide display screen. The deeper you progress with the needle, the more difficult it is to see on the ultrasound. Myoguide EMG guidance is an essential tool.

Injection Procedure: The trigger point locations are normally found by physical examination and manual palpation. Piriformis is so deep that palpation is impossible. Diagnosis from physical examination and patient history determines the course of action. The injection site is determined by anatomy and familiarization with anatomical landmarks. The entry point for any injection is pre-determined before the needle EMG guided injection procedure is ready. It is quite difficult to find the optimal injection locations without Myoguide, as there is a subtlety related to the depths where hyperactive muscle fibers reside. Myoguide allows the clinician to see and hear the EMG signal, providing confirmation that the needle is indeed in the best location. It is of benefit to be able to see the EMG signal, as it provides information about activity that EMG audio alone cannot.

The video demonstrates the value of Myoguide in finding the injection site, as indicated by a significantly increased level of EMG activity. Myoguide illustrates the various muscles entered along the way to Piriformis. The anatomy tour in this video is an outstanding illustration of how well trained these Physical Medicine and Rehabilitation (Physiatrists) specialists are.

Myoguide Stimulation Location in Hand – Case 1

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Multi-focal sites, such as the hand, can require the use of stimulation to identify the correct injection sites. EMG itself cannot separate the different fingers, as they all emit EMG signals. Stimulation will invoke a twitch response and identify the finger. The video demonstrates the value of Myoguide in finding the injection site, as indicated by the twitch response. Once more, you will also notice the ease of use. Stimulation location is essential in these areas. The site is located by palpation during finger movement. Once the hypodermic needle electrode is in, the patient is asked to move the finger in question. The site is reinforced as EMG is evoked when the movement is initiated. Stimulation through the needle will confirm the injection site is related to that finger by evoking a muscle contraction. Stimulation parameter can be changed easily with several pulse widths, frequency of pulse presentation, and constant current level. This particular patient encounter required 4mA at 500uS pulse duration, presented at 1 pulse per second. Stimulation evokes movement of the finger, as a twitch response, and is achieved at a very comfortable stimulation current, and was presented continuously in order to simplify the clinicians work. You can see the bright yellow panel light illuminates when actively stimulating.

Myoguide Stimulation Location in Hand – Case 2

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Multi-focal sites, such as the hand, can require the use of stimulation to identify the correct injection sites. EMG itself cannot separate the different fingers, as they all emit EMG signals. Stimulation will invoke a twitch response and identify the finger. The video demonstrates the value of Myoguide in finding the injection site, as indicated by the twitch response. Once more, you will also notice the ease of use. Stimulation location is essential in these areas. The site is located by palpation during finger movement. Once the hypodermic needle electrode is in, the patient is asked to move the finger in question. The site is reinforced as EMG is evoked when the movement is initiated. Stimulation through the needle will confirm the injection site is related to that finger by evoking a muscle contraction. Stimulation parameter can be changed easily with several pulse widths, frequency of pulse presentation, and constant current level. This particular patient encounter required 4mA at 500uS pulse duration, presented at 10 pulse per second. This allowed a smoother movement of the finger, as a twitch response, to be achieved at a very comfortable stimulation current, and was presented continuously in order to simplify the clinicians work. A bright yellow panel light illuminates when actively stimulating.