BlueCross BlueShield of Tennessee Medical Policy Manual

Surface Electromyography (sEMG)

DESCRIPTION

Surface electromyography (sEMG) is a non-invasive procedure involving the detection, recording and interpretation of the electric activity of groups of muscles at rest (i.e., static) and during activity (i.e., dynamic). The procedure is performed using a single or an array of electrodes placed on the skin surface over the muscles to be tested. Recording can also be made using a hand-held device, which is applied to the skin surface at different sites. Electrical activity is assessed by computer analysis of the frequency spectrum, amplitude, or root mean square of the electrical action potential. Surface electromyography is occasionally used as an aid to diagnose neuromuscular disorders, determine the need for surgery in individuals with low back pain, and assist in evaluating the prognosis of disorders involving muscle lesions. The technology has also been utilized to monitor the effects of rehabilitation programs and evaluate muscular function in occupational and sports programs.

Needle electromyography is an invasive procedure that records the electrical activity of individual muscles and is considered a more reliable technology.

Paraspinal sEMG, also referred to as paraspinal EMG scanning, has been explored as a technique to evaluate abnormal patterns of electrical activity in the paraspinal muscles in individuals with back pain symptoms such as spasm, tenderness, limited ROM, or postural disorders. The technique is performed using electrodes placed on the skin surface, with recordings made at rest, in various positions, or after a series of exercises.

Note: This policy only applies to the application of surface electromyography to the skin and does not apply to electromyography studies of the anal or urethral sphincter or needle EMG.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION  

There are no available data that determine clinical utility. The evidence is insufficient to determine the effects of the technology on health outcomes.

SOURCES

American College of Occupational and Environmental Medicine (2019). ACOEM practice guideline. Diagnostic tests for low back disorders. Retrieved May 13, 2022 from https://acoem.org/Guidance-and-Position-Statements/Guidelines/Diagnostic-Tests-for-Low-Back-Disorders.

Bandpei, M., Rahmani, N., Majdoleslam, B., Abdollahi, I., Ali, S., and Ahmad, A. (2014) Reliability of surface electromyography in the assessment of paraspinal muscle fatigue: an updated systemic review. Journal of Manipulative and Physiological Therapeutics, 37 (7), 511-521. (Level 2 evidence)

BlueCross BlueShield Association. Evidence Positioning System. (7:2023). Paraspinal surface electromyography to evaluate and monitor back pain (2.01.35). Retrieved August 10, 2023 from www.bcbsaoca.com/eps/.  (20 articles and/or guidelines reviewed)

Cabral, E.E.A., Fregonezi, G.A.F., Melo, L., Basoudan, N., Mathur, S., & Reid, W.D. (2018). Surface electromyography (sEMG) of extradiaphragm respiratory muscles in healthy subjects: A systematic review. Journal of Electromyography and Kinesiology, 42, 123-135. Abstract retrieved June 10, 2020 from PubMed database.

Ciesielska, J., Lisinski, P., Bandosz, A., Huber, J., Kulczk, A., & Lipiec, J. (2015). Hip strategy alterations in patients with history of low disc herniation and non-specific low back pain measured by surface electromyography and balance platform. Acta of Bioengineering and Biomechanics, 17 (3), 103-108. Abstract retrieved January 13, 2016 from PubMed database.

Hu, Y., Kwok, J.W., Tse, J.Y. & Luk, K.D. (2014). Time-varying surface electromyography topography as a prognostic tool for chronic low back pain rehabilitation. The Spine Journal, 14 (6), 1049-1056. Abstract retrieved August 2, 2018 from PubMed database.

Maranesi, E., Fioretti, S., Ghetti, G., Rabini, R., Burattini, L., Mercante, O., et al. (2015). The surface electromyographic evaluation of the Functional Reach in elderly subjects. Journal of Electromyography and Kinesiology, 26, 102-110. Abstract retrieved January 13, 2016 from PubMed database.

National Association of Spine Specialists (2020). North American Spine Society evidence-based clinical guidelines for multidisciplinary spine care. Diagnosis and treatment of low back pain. Retrieved August 10, 2023 from https://www.spine.org.

Subbu, R., Weiler, R., & Whyte, G. (2015). The practical use of surface electromyography during running: does the evidence support the hype? A narrative review. BMJ Open Sport & Exercise Medicine, doi: 10.1136/bmjsem-2015-000026. (Level 2 evidence)

Szyszka-Sommerfeld, L., Lipski, M., & Wozniak, K. (2020). Surface electromyography as a method for diagnosing muscle function in patients with congenital maxillofacial abnormalities. Journal of Healthcare Engineering, 2020: 8846920 doi: 10.1155/2020/8846920. (Level 5 evidence)

U. S. Food and Drug Administration. (2004, January). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K031995. Retrieved September 28, 2009 from http://www.accessdata.fda.gov.  

U. S. Food and Drug Administration. (2007, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K063447. Retrieved November 3, 2016 from http://www.accessdata.fda.gov.

ORIGINAL EFFECTIVE DATE:  4/1981

MOST RECENT REVIEW DATE:  10/12/2023

ID_BT

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