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Is Musculoskeletal Ultrasound Complementary or Alternative to EMG in Clinical Electrophysiology Practice?

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Electromyography/nerve conduction study testing is used to diagnose various muscle and nerve problems in clinical practice. Neuromusculoskeletal ultrasound uses sound waves to produce images of muscles, nerves, and tendons. Recent advances and popularity of ultrasound as a point-of-care tool advocates combining EMG and ultrasound in the clinical assessment of neuromuscular disorders. This leaves us with questions. Is the neuromusculoskeletal ultrasound complementary to the EMG/NCS testing in the clinical electrophysiology practice? Can MSK ultrasound change or confirm the EMG findings and change the overall patient plan of care? Adding both tools to clinical electrophysiology practice can be of great value in confirming multiple diagnostic findings. While EMG/NCS is the gold standard in testing nerve and muscle integrity, nerve problems can be secondary to musculoskeletal problems. MSK ultrasound can help in identifying the musculoskeletal pathology mimicking neural pathology.

Learning Objectives:

  1. Discuss basic principles of EMG/NCS and musculoskeletal ultrasound.
  2. Demonstrate findings of EMG and ultrasound when they are used in combination in clinical practice.
  3. Integrate clinical relevance of the combination of both tools to optimize patient care.
  4. Report on the common combination of both tools in clinical practice.

Beshoy Ghaly


Dr. Ghaly is an ABPTS Board Certified Diplomate in Clinical Electrophysiology. He is also Registered in Musculoskeletal Sonography (RMSK) by the Alliance for Physician Certification and Advancement (APCA) and holds The Point-of-Care Ultrasound Musculoskeletal Certificate (POCUS). He performed and interpreted thousands of EMG/NCS & diagnostic musculoskeletal ultrasound studies in both; physical therapy and medicine practice settings, including the highly specialized orthopedic surgery field. Dr. Ghaly is an APTA-Credentialed Clinical Instructor, presented in professional conferences & published multiple journal articles related to the field. He proudly serves the Academy of Clinical Electrophysiology and Wound Management as an elected Nominating Committee Member and an appointed Nominating Committee Chair of the Neuromusculoskeletal Ultrasonography Special Interest Group (NMSKUS- SIG). He serves as an item writer for the Clinical Electrophysiology Board Exam through the ABPTS Specialization Academy of Content Experts. He is an active member of the American Institute of Ultrasound in Medicine & the American Physical Therapy Association. On a personal note, he is inspired by the incredible success & life stories of Elon Musk, Martin Luther King Jr, Helen Keller & Mahatma Gandhi.

Dustin Arthur


Dustin  is a physical therapist and associate electromyographer with Profession Rehabilitation Associates in Richmond, KY. He is also co-owner of Integrity Diagnostics also in Richmond, KY. Dustin is board certified by the American Board of Physical Therapy Specialties in Clinical Electrophysiology and has performed thousands of electrodiagnostic evaluations in multiple settings including general practice, orthopedics, podiatry and neurology. He is currently an active member of the Specialization Academy of Content Experts as an item writer for the clinical electrophysiology board examination. Dustin has given multiple presentations on focal neuropathies and proximal nerve pathology. He earned his Doctor of Physical Therapy degree from the University of Kentucky in 2012.

Mohini Rawat


Dr. Mohini Rawat is a Physical Therapist in private practice. She received her Doctorate in Physical Therapy from MGH institute of Health Professions in Boston and her Master in Biokinesiology degree from the University of Southern California. She is board certified in Clinical Electrophysiology and Orthopaedics by ABPTS. Dr. Rawat is registered in musculoskeletal sonography by APCA and is also an item writer for RMSK exam. She is a member of the Specialization Academy of Content Experts as an item writer for Clinical Electrophysiology Specialty. She is president of American Academy of Musculoskeletal Ultrasound. She is Fellowship director of the Musculoskeletal Ultrasound program at Hands-On Diagnostics. She is faculty for courses in musculoskeletal ultrasound and clinical electrophysiology in PT program in NYC area and other continuing education courses. She is chair of the Academy of Clinical Electrophysiology Wound Management Neuromusculoskeletal Special Interest Group and chair of the nominating committee of Imaging Special Interest Group of Academy of Orthopaedic Physical Therapy. She is editor of a textbook in musculoskeletal ultrasonography and has contributed chapters on imaging in other books. She has published articles and presented numerous musculoskeletal ultrasound courses, webinars and lectures in multiple professional conferences and organizations including an invited instructional course lecture at American institute of Ultrasound in Medicine and American Academy of Orthopaedic Surgeons annual meeting.

Ryan Boggs


Dr. Boggs is an assistant professor in the Department of Physical Therapy at Daemen College in Amherst NY. He earned his Doctor of Science in Clinical Electrophysiology degree from Rocky Mountain University of Health Professions where he investigated retrograde axonal atrophy in patients with carpal tunnel syndrome. He is currently the At-Large officer for the Neuromusculoskeletal Ultrasound SIG and the research committee chair of the electrodiagnostic SIG of the ACEWM. A certified vestibular rehabilitation specialist by the American Musculoskeletal Institute, Ryan has taught continuing education courses in concussion management and frequently lectures on the topic of clinical electrophysiology and biophysical agents. Additionally, Ryan has given multiple scientific presentations and has published multiple times on musculoskeletal ultrasound, red flag-screening, and differential diagnosis in Journal of Orthopaedic and Sports Physical Therapy, Journal of Primary Health Care, and the International Journal of Telerehabilitation. He earned a Doctor of Physical Therapy degree and a Bachelor's degree in Natural Science with a minor in biology from Daemen College.

Course Instructions

  1. Click on the Contents tab to watch the course recording.
  2. Click the Take Quiz button to complete the assessment. Learners will have 3 attempts to pass and must answer at least 70% of questions correctly.
  3. Click Fill Out Survey under the Evaluation listing to provide valuable course feedback. Scroll down on all questions as there may be answer options that expand past the size of the window.
  4. Click the View/Print Your Certificate button under the Certificate listing. You can view/print your certificate at any time by visiting the APTA Learning Center and clicking the CEU Certificate/Transcript link on the left-hand side of the page. 

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