Range of variations in motor unit potentials during reinnervation after traumatic nerve lesions in humans.

Abstract

Successive stages in the reinnervation of denervated muscle fibers following a complete or partial motor nerve lesion in humans were analyzed with the concentric needle electrode during voluntary contraction. Motor unit potential (MUP) patterns were displayed by coherent EMG, in which the potential triggers an oscilloscope sweep and a digital delay line enables the early part of the MUP to be displayed. After a complete nerve lesion, MUPs showing the response of as few as one to three muscle fibers can be observed. MUPs become highly polyphasic as more muscle fibers are incorporated. Marked latency jitter and intermittent blocking of components as well as the occurrence of linked potentials result in complex patterns that may be confused with a "myopathic" pattern of brief small spikes if conventional observation of free-running sweeps is used alone. After a partial nerve lesion, the healthy motor axons achieve extensive collateral reinnervation of the denervated muscle fibers whereby linked potentials of various latencies are added after the original MUP. Adequate understanding of these characteristic features can help clarify some current issues in electromyography. The mechanisms by which long-latency linked potentials and desynchronized components are produced during remodeling of motor units in the course of regeneration involve a number of factors such as slow conduction along regenerated axon branches, ectopic motor end-plates, insecure neuromuscular transmission, and muscle fiber atrophy.