40 y/old male with questions

Fernando · 03-26-2010, 10:22 AM

Hello

40 y/old male here. Not sure if I need to be and hoping I dont, as we all are.

Noticed I couldn't push the buttons through my shirt recently. Some minor twitches here and again but nothing over the top.
Saw my PCP who refered me to a neurologist. He performed a nerve conduction along with an emg. I was given the results on the spot and was told there were no abnormalities.

Can als sneek past the emg?

Thank you for listening (reading) Look foward to your responses

Fernando

Fernando · 03-26-2010, 10:43 AM

Pardon me, I failed to mention the reason I ask this. I came across an article that stated at first it may be difficult for a specialist to be sure that you have ALS- when early minor symptoms first develop. However, the diagnosis usually becomes clear as the typical symptoms and signs of the disease gradually become worse.

This is the first symptom I have and asside from the twitching on ocassion, the only symptom,

Again Thanks

rose · 03-26-2010, 11:11 AM

Fernando,

Is the problem with buttoning a coordination problem (rather than strength?) How is your fine motor coordination, did the neurologist have you tap your fingers to your thumb, was there any slowing with this?

All of my questions have to do with upper motor which is not measurable with EMG.

If you continue to have trouble, or develop more problems, seeing a neurologist who specializes in neuromuscular disorders would be a good idea.

Good luck to you, and I hope you don't belong here either.

Fernando · 03-26-2010, 12:05 PM

Hi rose, Thanks for looking at my post. Yes The Dr asked me to touch all my fingers to my thumb, one by one. There is clear weakness in my finger, I cant move it. The thumb has no strength. This was the only failed test, which I suspect led him to do the emg.
I saw reputable Nuromuscular specialist in Fl.

Al · 03-26-2010, 12:11 PM

Usually if you have weakness caused by ALS it will show on an EMG. You may have something neuromuscular going on but it doesn't sound ALS like at this time. Did he tell you to come back in 3 or 6 months?

AL.

Fernando · 03-26-2010, 12:38 PM

Hi Al,

Thank you for reading. Yes, the neurologist did ask me to come back in 3 months for a repeat emg.

Ive just read a sticky posting here about emg and weakness. I enjoyed it and gathered some good information. If an emg can show damage to the nerves at the time of weakness, then why would he repeat the emg? My impression was, I should be out of the woods after the emg.

Al · 03-26-2010, 12:53 PM

They may want to do a more thorough test if you have more symptoms or any progression. If not then they may look in different directions or tell you not to worry, it's not anything that will kill you.

AL.

trfogey · 03-26-2010, 01:16 PM

If an emg can show damage to the nerves at the time of weakness, then why would he repeat the emg?

Maybe to make sure that the EMG remains normal if there is any progression in your condition. The EMG detects many types of problems in the muscles, not just those associated with motor neuron disorders.

You should broaden the scope of your Internet research. There are many conditions that can cause your symptoms.

Zaphoon · 03-26-2010, 04:43 PM

"Can ALS sneak past the EMG?"

No, unless an idiot was performing it and didn't know what to look for or the equipment was not working properly.

olly · 03-26-2010, 05:26 PM

hi fernando.
if like rose said it was due to umn involvement the emg would not pick it up.
some with als start with just umn signs/symptoms were an emg would be clean but go on to develop lmn involvement.
having said that umn disease/pls starts either as limb onset(most commonly legs) or even less common bulbar.
how was your physical exam like your reflexes?
it can take time for a diagnosed,hang in there.

laurel · 03-26-2010, 06:08 PM

Fernando I would still get a referral to a neurologist specializing in neuromuscular disorders. My husband has CIDP and is treated monthly with IVIG, but he has a permanently atrophied right hand, forearm, and foot drop due to improper diagnosis from a neurologist. He did EMG and nerve conduction tests said they were negative when my husband went to him with complaints of hand weakness. He returned in six months--same story i.e. come back in a year. Hubby went back and then was diagnosed with carpal tunnel and was booked for surgery. Hubby had the surgery and lost even more usage and the atrophy became profound. He went to a specialist referral clinic and the doctor there said "You've never had carpal tunnel. You have some kind of progressive muscular atrophy". He went back to the neurologist who repeated tests and now said he wasn't sure what was going "maybe ALS, but I'm sure". He was then referred to a neuromuscular disorders clinic and was diagnosed fairly quickly with CIDP which is treatable. However with the 2 years or so of dilly dallying with the first neuro. he wound up with permanent atrophy and limited use of the right hand and has the drop foot problem as well.
Laurel

laurel · 03-26-2010, 06:12 PM

Just a correction to the above post (I don't know how to edit once a post is sent). The neurologist said, maybe ALS, but I'm not sure". Good luck Fernando and let us know how things go.
Laurel

LatinoLoco · 03-27-2010, 03:57 PM

Fernando,

do you have any tingling and/or numbness on the hand? Any pain that could perhaps be explained by arthritis of the thumb basal joint? You had an EMG and nerve conduction so I'm assuming that would have picked up Carpal Tunnel....There may also be nerve pressures in the neck that can cause thumb weakness. No visible atrophy? Hope you find some answers.

O.

Zaphoon · 03-27-2010, 08:21 PM

If you were to have ALS, it would mean you have lower motor neuron death which the EMG would have picked up. You can't sneak this sort of thing past something as sensitive as an EMG (again, unless you had a monkey for an EMG tech).

Do a happy dance! Live long and prosper!

Fernando · 03-30-2010, 10:50 PM

Hi,

Thanks to many for reading my post, mostly for your reply. At this point, I still have no answers, which is, of course annoying me. I have read all your statements about emg and saw the post about emg being gold standard. Zaphoon, you're a funny dude, The Tech was definately not a monkey, LOL.
If the neuro wants to reevaluate the emg in 3 months time, is that to reevaluate als?
Also, could someone tell me, is there a timeframe where atrophy would be visable once there is weakness. Is it right after?
I realize this question may be complex but Im giving it a shot.
I notice there are a few posts that are causing distress and if mine should, please, I understand, you are going through your own struggles. Its fine if I dont hear back. thank you.