American Association of Neuromuscular & Electrodiagnostic Medicine

View all recommendations from this society

Released February 10, 2015; updated July 12, 2018

Don’t do a four limb needle EMG/nerve conduction study (NCS) testing for isolated neck and back pain after trauma.

Although techniques such as needle EMG and NCS can be helpful to diagnose pinched nerve in the neck or back (cervical or lumbar radiculopathy), four limb needle EMG/NCS is not needed and is not considered appropriate testing but does increase costs. Four limb needle EMG/NCS is, however, rarely needed to evaluate patients for ALS, polyradiculoneuropathy, or multiple mononeuropathies.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Professional Practice Committee (PPC) of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) developed this list of recommendations. The PPC includes both neurologists and physical medicine and rehabilitation (PMR) physicians who come from varying practice settings and also includes the AANEM’s representatives to the American Medical Association (AMA) Current Procedural Terminology Panel and Relative Value Update Committee. The PPC members identified areas to be included on this list based on the greatest potential for overuse/misuse, quality improvement and availability of strong evidence-based research/support in the literature. The committee’s recommendations were discussed at an AANEM Board meeting that included chairs from AANEM committees. The PPC reviewed the feedback from this group and voted on the final Top Ten recommendations. These were then approved by the AANEM Board of Directors.

AANEM’s disclosure and conflict of interest policy can be found at


Braddom RL, Spitz L, Rivner MH. Frequency of radiculopathies in motor vehicle accidents. Muscle Nerve. 2009 Apr;39: 545-7.

Ovadia D, Steinberg EL, Nissan MN, Dekel S. Whiplash injury – a retrospective study on patients seeking compensation. Injury. 2002 Sep;33(7): 569-73.

Steinberg EL, Ovadia D, Nissan M, Menahem A, Dekel S. Whiplash injury: is there a role for electromyography studies? Arch Orthop Trauma Surg. 2005 Feb;125(1):46-50.