Muscle Twitching

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DannyGatton1993

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Learn about ALS
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I'm a lifter. Oh September 28th I think I irritated my lower back as I felt a terrible ache after my hack squats and slight pins and needles in my left foot. Went to see an ortho who took an x-ray and found that I had some disc shrinkage in the L5/S1 region. I couldn't get an MRI approved so I've been doing physical therapy, which I think has helped.

Around October 7th I started feeling a light pricking sensation in my left foot and thought nothing of it until I started feeling that same prickling sensation occasionally in my hands and torso (a random little prick a few times an hour, nothing continual), so I went back to the ortho. The Doc saw no reason why I'd be feeling this sensation in my upper body so he ordered an EMG/NCS for my arms and hands. During this time I thought it might be Multiple Sclerosis, so that's one of the things the tech and Doc were looking for. This was done on 10/13.

The results came back with apparently only the concern of pre-clinical carpal tunnel. This made me feel pretty good for a day or two as the prickling sensation ceased shortly after, and I thought I could put my worries about MS to bed.

However, on October 15th I began getting these random muscle twitches in my legs and arms/hands. Doing the Googling led me to ALS, but in the last few days I was reassured by the fact that, after calling back and asking, the ortho didn't see any concerns for ALS on the EMG/NCS either. I had just done a leg strength analysis with my PT and he said I've got one of the strongest resistances he's seen so I wasn't super worried.

Cut to approximately a week ago when waiting for PT for my back I noticed a pretty large muscle twitch in my left calf that I didn't feel, and a few other smaller ones following. I was shocked that I didn't feel these. I noticed then that I couldn't flex my left calf from a seated position the way I can flex my right calf.

I'm now getting the muscle twitches in my legs (quads, calves, outside of knees), arms (triceps near elbow, inside elbow, sometimes the bicep - usually on my right arm), sometimes on my back and torso, and eyelid. These twitches come and go and are not constant, but I will feel a few twitches every couple of minutes. I've also noticed that my left bicep seems to be larger than my right. I'm still able to squeeze 135 lbs on my right hand on my grip meter, but I can do up to 145 lbs on my left hand. I haven't fumbled or dropped anything yet, and I can still type fine, but I'm dreading the idea that that is muscle atrophy.

I've scheduled an appointment with a neurologist, but the earliest one I could find was December 18th so I'm very, VERY nervous...

1) Does any of this sound like the beginning stages of ALS?
2) Despite the EMG/NCS being done by an ortho tech, is this 'clean'? It's worth noting that I was not experiencing the twitching around this time, just the sporadic prickly feelings. The twitching only came about a few days later.
 
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Hi there-

The EMG results you tried to attach did not post properly. If you could re-post, that would be great.

If you could also read here: Read Before Posting as it covers twitching absent clinical weakness, sensory issues, strength improvement with pt and why this points to something other than ALS.

Hopefully this info, along with your appointment in a little under 7 weeks with the neuro, will be reassuring for you.
 
Ah sorry, here are the EMG results.

Would it make a large difference if this was an orthopedic technician doing the readings? As far as I know the test is universal and it's the provider that would ultimately interpret the results.

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Your emg is 100% normal Textbook. You had a mild blip on the nerve conduction which isn’t the test for ALS ( emg is) and that was why they said carpal tunnel

I do not know what you mean by orthopedic technician. In Virginia emgs can be done by doctors and physical therapists but they both require special training to do so. The ncs ( shock portion) may be done by a technician but not the needle exam ( emg). Often physiatrists who are physicians who specialize in rehab do emgs. Is that what you meant? To bill for an emg one has to do at least 200 supervised emgs as well as didactic training
 
Thanks for the reply, Nikki. Yes, it was a Dr. here in VA who performed the EMG/NCS.

This had given me peace of mind until yesterday morning when I woke up and found my bicep twitching much more frequently than any other. While my twitches were generally body-wide and coming on every few minutes, my right bicep has been twitching pretty constantly throughout the day. I've also noticed that my right arm looks noticeably smaller than my left now. The bicep muscle on my left arm looks like a nice tall hill here my right looks considerably flatter.

I can still squeeze 150 lbs on my little hand dynamometer but it doesn't feel as stable/sure as my left hand which can squeeze a little more (155 lbs).

Could muscle atrophy really come on this quick? How long is a 'clean' EMG really good for? The neuro visit seems so far away now...
 
A lot of people come here first with widespread twitching that localizes. Often, it's not clear why. Your hand function is obviously still excellent, with a tiny variation. Always good to double-check how you sleep, how supportive your bed/pillow are, etc.

Yes, a clean EMG less than a month ago, that included the R bicep in fact, demonstrates that whatever is happening with the arm is not ALS. Motor neurons don't die in quantity that fast.
 
I was able to find a neurologist near DC who could see me much sooner. She saw nothing alarming from my presentation but referred me to another Dr. to do an NCS/EMG for my legs just in case since I've also been having a little bit of balance issues with my left leg.

Just got back from that appointment and the Dr. said there's nothing to worry about, everything is fine. He even retested my right hand, bicep, and triceps and everything looked normal, no ALS (at least for right now, who knows in the future).

Thanks to everyone for their responses! I'm going to follow up with the neurologist, but for now I can breathe easier and finally start thinking about life beyond a week from now.

Doing my Googling into this disease, watching testimonies from PALS, and seeing how many people (like myself) fret about this disease has opened my eyes to just how serious this affliction is, and how public attention is still relatively low.

Does anyone have any recommendations for research centers or charities I can start donating to? In the grand scheme of things it's not much, but I'd like to help in any way that I can.
 
I hate to come back, but there's been a new development I'd like some advice on. A few days after my last post my left pointer finger started twitching pretty frequently. A few days later (11/21) I had an EMG for my left arm and the doc said everything looked fine aside from the fasciculations. This put my mind at ease and I learned to live with the twitching.

However, over the past week the muscle below the pinky on my left hand (hypothenar eminence) has been feeling... off. It feels stiffer, a little achy, and my pinky feels a little weaker compared to my right hand. I stopped to look at it for a few seconds and I noticed the part of the muscle that ends at the wrist is twitching pretty frequently, and I can hardly feel it.

My question is this: the doc tested my abductor pollicis brevis and 1st dorsal interosseous on my left hand. I had 'Fasics +1' on the 1st dors but the other was completely fine. However, the hypothenar muscles are on the other side of my hand. Is it possible that there is indeed denervation occurring but the doctor didn't test that muscle so it was missed?

Another neuro visit to just ask this question would be so far away.
 
The hallmark of ALS on EMG is certain abnormalities (more than fascics!) in muscles that you think are fine, as well as those you think aren't. And we are still talking about the hand itself, just a different part of it, so it's even less likely that there would be way different findings a couple of inches away.

That no abnormalities besides fascics were found is very reassuring. I would get on with your life. If you wish to donate to ALS research, a very generous impulse, I would look over the list of ALS-related projects that have received NIH funding and pick one (public or private) that speaks to you. You can filter on state using the L-hand menu.
 
Thank you so much for the reply, that eases my nerves. Unless anyone has something else to add I'll give it a few weeks and hopefully it'll get better and go away.

Thank you for the list, I'll look over the list and donate what I can. Anything I can do to help.
 
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