Interpret spontaneous activity together with the rest of the needle examination, because a single finding rarely defines the entire disease process. Grading matters because burden and distribution of denervation help track severity and chronicity.

Fibrillation potentials are spontaneous triphasic discharges linked to denervation and reinnervation; Positive sharp waves are graded on a 0 to 4 scale; A plus 1 grade means roughly one potential per screen at standard settings; End plate region activity can sound crisp and be mistaken for pathology; Grading helps document severity and distribution of denervation