Queen's University · Providence Care Hospital · Kingston, Ontario

Alasdair Rathbone

MD, FRCPC, CSCN(EMG)
Assistant Professor, Physical Medicine & Rehabilitation, Queen's University
Director, EMG Laboratory, Providence Care Hospital, Kingston, Ontario

Electrodiagnosis as the front door to neuromuscular disease: access, accuracy, and what happens next.

Academic and research site. This is not a clinical service and does not take patient enquiries or referrals.
About

I am a physiatrist and electromyographer, and an Assistant Professor of Physical Medicine and Rehabilitation at Queen's University. I also direct the EMG Laboratory at Providence Care Hospital in Kingston. I study how quickly Canadians get an electrodiagnostic answer, how accurate it is, and what should happen next. I hold Royal College certification in Physical Medicine and Rehabilitation and Canadian Society of Clinical Neurophysiologists certification in electromyography.

I supervise PM&R residents in the EMG lab and neuromuscular clinics, and teach clinical skills in the Queen's undergraduate medical programme.

My earlier research is in myofascial and chronic pain: the diagnostic criteria for myofascial pain syndrome, the reliability of trigger-point palpation, and ultrasound-guided procedures. I also practise adult chronic pain medicine in the community.

Research themes

Four questions the lab keeps returning to

Access to electrodiagnosis

No Canadian society benchmark exists for how long a patient with a given presentation should wait for EMG, and no Canadian study has paired presentation-specific acceptable waits with preferred appointment types. Our lab's internal triage work grew into a national programme to set those standards.

Case-finding for transthyretin amyloidosis in carpal tunnel syndrome

Carpal tunnel syndrome (CTS) precedes cardiac amyloidosis by years. The EMG lab sees these patients first. We are mapping the evidence for tissue and systemic amyloid in CTS, assessing current biopsy selection rules, and designing a prospective screening pilot.

Neuromuscular junction transmission in Guillain-Barré recovery

With a research collaborator, I am exploring whether immature regenerating junctions contribute to recovery plateaus. Repetitive nerve stimulation and single-fibre EMG could test this hypothesis, with possible implications for treatment.

Myofascial and chronic pain

A systematic review and meta-analysis of interrater agreement of manual palpation for myofascial trigger points (Clin J Pain 2017), a clinician survey on the diagnostic criteria for myofascial pain syndrome, and, as a co-author, a structured review of ultrasound-guided interventional procedures for trigger points. Alongside these, ICC.Sample.Size, an open-source R package on CRAN for sample-size estimation in reliability studies. An update of the palpation review using modern screening tools is planned.

Current projects

What is under way, and who I am looking for

Updated Sep 2026 Stage: instrument and ethics package in preparation

National survey of Canadian electromyographers: acceptable waits and preferred appointment types

PI: A. Rathbone · with a medical student trainee

A bilingual cross-sectional survey will ask Canadian electromyographers about maximum acceptable wait times and preferred booking formats by referral presentation. A companion census of the roughly 150 Canadian EMG labs will document actual waits, slot templates and triage methods. A consensus round will follow if the data warrant it. The survey builds on the Western Canada Waiting List Project and Naylor's scenario-based approach.

Looking for
  • Societies: endorse the survey.
  • Lab directors: forward the survey when it launches.
  • Electromyographers: review the draft instrument for face validity before ethics submission. We need six to eight reviewers across provinces.

Participant recruitment has not started. The survey opens only after Queen's Health Sciences Research Ethics Board approval.

Updated Sep 2026 Stage: full-text extraction

Amyloid in carpal tunnel syndrome: systematic review and critical appraisal

With a research associate · PROSPERO CRD420261415724

A registered systematic review examines amyloid prevalence at carpal tunnel release, systemic amyloid in CTS, risk factors and screening strategies (104 studies at full text). A companion critical appraisal examines the Sperry/Donnelly biopsy criteria (poster, Western Canadian Neuromuscular Conference 2026). It argues that the criteria were asserted rather than derived, that the second tier adds no positives, and that no guideline endorses them.

Looking for
  • International colleagues interested in geographic differences in yield: Japanese series report roughly three times the tissue-positive rate of North American series, and we would like to write about why.
Updated Sep 2026 Stage: design; grant applications 2026–27

Prospective CTS-amyloid screening pilot, Kingston

A two-phase verification design will run through the Kingston electrodiagnostic lab. It begins with universal cardiac screening during a run-in, followed by versioned, frozen rule-out rules with a random safety audit. The single-centre pilot will assess feasibility and estimate prevalence. Certifying safe withholding will require a multicentre cohort of one to three thousand patients.

Looking for
  • Cardiology and nuclear medicine partners: help design the screening pilot.
  • Biostatisticians: get in touch about the co-investigator role.
  • Future multicentre sites: discuss taking part in the larger cohort.

No patient recruitment yet.

Updated Sep 2026 Stage: narrative review in preparation; study protocol in development

Neuromuscular junction dysfunction in Guillain-Barré recovery

With a research associate

Poster at the Western Canadian Neuromuscular Conference 2026. The proposed study measures decrement and jitter serially during reinnervation. It aims to separate immature-junction physiology from immune injury, with pyridostigmine response as the clinical test.

Looking for
  • Potential study sites: discuss joining the multicentre GBS study.
Collaborate

I welcome enquiries from

Electromyographers and lab directors who want to shape national wait-time standards.

Co-investigators in cardiology, nuclear medicine, neurology, biostatistics and rehabilitation for the screening pilot and the GBS study.

Trainees (medical students, residents, graduate students) looking for a supervised project in electrodiagnosis or neuromuscular disease.

Pain researchers working on the reliability of musculoskeletal examination or the diagnosis of myofascial pain.

The form is for collaboration and academic enquiries only. It is not a research survey.

Publications

Full list on Google Scholar and ORCID

457
Citations
8
h-index
7
i10-index
Google Scholar, September 2026
Selected

Rathbone AL, Grosman-Rimon L, Kumbhare DA. Interrater agreement of manual palpation for identification of myofascial trigger points: a systematic review and meta-analysis. Clin J Pain. 2017;33:715–729. doi:10.1097/AJP.0000000000000459

Rathbone ATL, Tharmaradinam S, Jiang S, Rathbone MP, Kumbhare DA. A review of the neuro- and systemic inflammatory responses in post concussion symptoms: introduction of the "post-inflammatory brain syndrome" PIBS. Brain Behav Immun. 2015. doi:10.1016/j.bbi.2015.02.009

ICC.Sample.Size: calculation of sample size and power for ICC. R package, CRAN, 2015.

Registrations: PROSPERO CRD420261415724 (amyloid in CTS).

Presenting this season
Sep 24, 2026
NMD4C Research Showcase, Calgary. Flash talk: national EMG wait-time standards and CTS-amyloid case-finding.
Sep 25–27, 2026
Western Canadian Neuromuscular Conference, Calgary. Posters: Sperry criteria appraisal; NMJ dysfunction in GBS recovery.