Tiredness and perceived weakness

[RickyR]

Hi

I am a previous poster (previous threads here and here) looking for some advice. Approx 7 months ago I began with widespread fasciculation, mainly concentrated in my calves and feet. I also suffered mild cramps in my feet. Long story short, after much delays I finally saw a nuero 3 months ago who said, due to lack of atrophy and weakness, she had no major concerns of MND and said likely BFS or exercise related fascis. She did however request an EMG, more for my reassurance than any of her own concern - this is in 2 weeks time.

However a few weeks ago, I started to feel a slight weakness in my upper right arm, particularly around my bicep and shoulder. This has remained. There is no distinguishable loss of power, but I can’t hold that arm up as long and there is an ache when I use it. I cannot support things for long and it trembles much faster than my left. I should add that I continue to do weight training (nothing major) and swimming and there is no noticeable loss of performance. However the tiredness of the muscle, coupled with a slightly weaker grip in that hand (which I’ve had for over 6 months) concern me, when coupled with the body wide twitching. I also have hyper reflexes in both legs but not in my arms, which the nuero attributed to me being born premature.

My question is, is this kind of perceived weakness how ALS could possibly start? And if they EMG my legs (which is where the issues mainly started), would this potentially pick up ALS if it has started in my arm?

I should add I have not experienced any failure or loss of function, just a feeling of weakness and mild aching in that arm.

Thanks in advance for any replies.

 

[lgelb]

Unlikely and yes.

Feelings of weakness, shaking, and aching can apply to the onset of many conditions (including a transient virus, not getting enough sleep, stress, etc.) but not ALS so much.

Bodywide twitching also argues strongly against ALS.

It may be worthwhile to have someone knowledgeable assess your lifting form just to make sure you are not doing or not doing anything that could damage the R arm. I'm sure you know this, but a neutral spine is really important. On the other hand, you may've already damaged it and in this case, your form may look fine.

You might also double-check your positioning while in a vehicle, working, watching TV, and sleeping. For example, sometimes you can put undue pressure on the shoulder and that can cause weirdness in the upper arm.

Remember that fascics/cramps in your feet may have nothing to do with your R arm. But if that arm continues to bother you, and the EMG is negative, an orthopedist may be the logical next port of call.

 

[RickyR]

Many thanks for the reply, I appreciate it. My immediate thought was that the issue is caused by a tendon issue, however I’m not getting any pain etc when I lift. It’s just a low level ache and generally not feeling as strong, which is why I’m concerned it may be neurological.

I have one question which I would really appreciate being educated on, as it’s something I don’t fully understand. When talking about muscle weakness in ALS, does a muscle slowly deteriorate and get weaker over time, or just suddenly stop working one day? So for example if my bicep was affected, would it begin with part of the muscle dying gradually begore it stops working completely, or would the whole muscle suddenly no longer function?

Apologies if that is a silly question, I just don’t fully understand what is meant by progressive weakness and how ALS can be picked up on an EMG without weakness being felt or failure having occurred (which seems to have been the case with some PALS on this site)?

Thanks in advance

 

[Nikki J]

Clinical weakness/ failure doesn’t occur until about 70% of the relevant motor neurons die which is why emgs can see the issue earlier.

To illustrate this and progressive weakness. I started in my ankle ( could not step sideways without falling. ). I had a research emg scheduled shortly after this. It showed in the relevant muscle for my ankle but also in surrounding muscles that felt fine including my calf which was the next affected ( foot drop) then my leg started collapsing ( quads). So progressive weakness as more and more muscles are affected. However the function of each muscle went suddenly. Motions that require more than one muscle to happen may work for a while but poorly until the other muscles go too

 

[RickyR]

Thanks Nikki, that makes sense. So am I right in thinking then that if there was ALS present in a limb, there would likely be at least some loss of function / motion, before any sensory feelings (ie aching) would be felt?

In general terms, does this process happen over weeks or months? I’m concerned that because of the other symptoms I’ve experienced for almost 7 months, that there may be weakness present that I’ve not yet felt, which will be picked up on the EMG. This issue with my arm is concerning as it’s new, when coupled alongside the other symptoms, although I fully appreciate there may be various causes for this.

Thanks

 

[Nikki J]

How fast it moves from one muscle to another is completely dependent on individual progression rates. There are people who go from fine to paralyzed dead in a few months. I know one person who has had only one leg involved ( glacially progressing ) for 14 years. They are so unusual that their case was written up and presented at a conference and researchers are asking for dna samples to study but even they started with failure ( foot drop) not aches or fatigue