Multichannel surface EMG: basic aspects and clinical utility.

The generation of the surface electromyogram (sEMG) is described with regard to the properties of the single muscle fiber action potential as source, the physical aspects of volume conduction and recording configuration, and the properties and firing pattern of motor units (MUs). The spatial aspect of the motor unit action potential (MUP) is emphasized in relation to the results of high-density, multichannel sEMG measurements. The endplate zone, depth, size, and position of MUs can be estimated. The use of muscle fiber conduction velocity measurements in channelopathies and the changes in pathological fatigue are described. Using the unique patterns of spatial spread of MUPs over the skin (MU fingerprint), MU classification and the determination of firing moments is done noninvasively. Clinical applications of high-density sEMG measurements are reviewed. Emerging possibilities provided by MUP size and fingerprint measurements in neuromuscular disease and motor control are discussed. We conclude that multichannel sEMG adds unique, and sometimes indispensable, spatial information to our knowledge of the motor unit.