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In addition, satellite potentials, separated from the main motor unit action potential by an isoelectric interval, ﬁre in a time-locked relationship to the main action potential. These potentials usually follow, but may precede, the main action potential in the same location and therefore will become apparent. These will likely only be evident in this manner, as without a trigger and delay function they may appear as different motor units. The trigger and delay function is an extremely valuable tool in performing motor unit analysis.
This variation in frequency gives the discharge its characteristic ‘dive bomber’ sound. Myotonic discharges are found in the following conditions: myotonic dystrophy, myotonia congenita, paramyotonia, hyperkalemic periodic paralysis, polymyositis, acid maltase deﬁciency and chronic radiculopathy and neuropathies. Myokymic discharges are groups of spontaneous motor unit potentials that have a regular ﬁring pattern and rhythm. They are seen in two forms. In the continuous form they are seen as single or paired discharges of motor unit potentials that ﬁre at rates of 5–10 Hz.
Abnormal ﬁndings, due to a dysfunction of the neural input to the muscle, can lead to the development of myokymic discharges as well as cramps, neuromyotonic discharges, tremors, multiples and fasciculations. The more common types of spontaneous activity will be described below. Because of their small amplitude, the gain on the EMG machine must be set to 50–100 microvolts for the potentials to be visualized. Positive sharp waves (PSWs) are muscle ﬁber action potentials that can be recorded from a muscle with impaired muscle innervation or from an injured portion of a muscle.