Question about arm weakness.

[person]

Hi to everyone.I have this weakness in my left shoulder/forearm/expecially the thumb since a month (can't say it progressed much since I stressed it a lot with forced movements etc,still I can hold things etc but with more fatigue than the other arm)and going to have an electromiography on monday.My questions/fears are :

1)Could it be too early?

2)I heard that an electromiography can be clean/normal if the weakness depends on the Upper Motor Neuron (which I read on the nwt is not noticed in the emg) so I fear that it could be useless/not telling me anything.

3)Any tips/hints on how to distinguish bewteen UPN weakness from LMN weakness even if it starded since only a month?

Sorry for my poor english and tnx if you answer.

 

[Alyoop]

Dear Person
I will try and answer your questions

If your Doctor has determined that you require an EMG, then do not worry if it is too early ( too early for what)?
I do not really understand that question.

An EMG will be normal if your weakness is caused by UMN issues, but again I do not fully understand. An EMG is not done to just diagnose ALS, but can show a host of different results from hundreds of different disorders, many of which cause weakness. Therefore you having an EMG to help with a diagnosis is not useless.

If you had UMN weakness, then on examination you would have other signs, such as clonus, hyperreflexia, spasticity.
LMN weakness is caused by the motor nerves not working correctly, which causes muscles to fail, leading to atrophy, weakness and eventually the muscles can disappear completely.

It seems unlikely that you have anything like ALS as it would not present in that manner.
It's too early to worry about LMN v UMN. Just leave it up to your Doctor to explain things and interpret the findings.
Best of luck with the EMG, I hope it goes well for you. I am sorry if I have not fully understood your questions.

 

[person]

The point is...I never visited a doctor and I am pointing directly to the emg.The reason was because I knew that in very early stages of ALS one may pass all the neurological strength/reflex exams while if the weakness is due to LMN death the emg shows it immediatly.So I ended thinking that when it comes to weakness is never too soon for the emg but can be too soon for the neurologist to recognize it.My idea was 1)ruling out weakness caused by lower motor neuron and then if the weakness/does not return to normal 2)visiting a neurologist that by the time will be able to recognize real weakness/altered reflexes.Btw I cannot feel for now clonus,rigid muscles or spastricity.

 

[Alyoop]

OK. Well . Its absolutely nuts to have an EMG if a Comprehensive and thorough Neurological examination by a neurologist does not indicate it. Your reasoning is erroneous, if not ridiculous.

You have everything around the wrong way. If you had weakness caused bt LMN problem then you would know about it! You are wrong in saying that in the very early stages of ALS you would have a normal neurological examination. If it was normal then you would be sent away and certainly not have an EMG. If it was normal then you would not have the tragic and devastating disease, ALS.

Why would you put yourself through a painful and invasive procedure, to see if you need to go and see a neurologist? I am sorry but this is beyond anything I can comment further on.
Aly

 

[trfogey]

person,

One month is probably a little soon to be worried about weakness if there is a possibility of injury, either from trauma or repetitive stress. That having been said, here are some answers to your questions.

1)Could it be too early?

Depends on the cause. What do your doctors think is causing your weakness? Not what you think -- what your doctors think

2)I heard that an electromiography can be clean/normal if the weakness depends on the Upper Motor Neuron (which I read on the nwt is not noticed in the emg) so I fear that it could be useless/not telling me anything.

The upper motor neurons are in your head, not your arm. Did you have an injury to your head that started this weakness -- something like a stroke?

To answer your specific question, an EMG cannot detect problems with upper motor neurons, but there are a set of other symptoms that go along with UMN problems. You haven't mentioned having any of those symptoms. so they and UMN problems probably don't apply in your case. Your doctors are probably using the EMG to look for something like a trapped or impinged nerve in your neck or arm to explain the weakness. It's very common.

3)Any tips/hints on how to distinguish bewteen UPN weakness from LMN weakness even if it starded since only a month?

There are other symptoms that go along with both UMN and LMN problems. Those are the symptoms that the doctors use, along with the EMG, to decide whether the weakness is caused by a problem with the motor neurons.

You haven't told us enough of what your doctors have already said about what's troubling you and you seem to be fishing for a predetermined answer. We don't have enough information from you to give you more specific answers than I've given here, so decide what you feel comfortable telling us and add that to the thread in a reply.

Good luck.

Edited to add: If you haven't seen a doctor about your problem, how are you getting a referral for an EMG? Other than that question, I agree with Aly -- what you are doing and how you are going about it makes no sense at all. Do you always put your knickers on over your pants?

 

[person]

Why this sounds so crazy to you?In one month I have not lost so much strength to not pass neurological exams and have not stiff muscles or other sympthoms apart weakness or better very very easy to get tired arm/thumb.The only way to find If I have LMN problems is the EMG.

And you say :

"If you had weakness caused bt LMN problem then you would know about it!"

How?

 

[Alyoop]

You need to let a Doctor test you for real Clinical weakness. You cannot do it yourself. A feeling of weakness, heavyness does not always mean Actual weakness. Believe me. I have had 3 years and more of Drs and examinations.
What I am trying to say is you shouldnt have an EMG without seeing a Doctor to examine you and determine if it is neccesary or not.
You may have a simple injury, that will come right. Its only been a month. Way too soon. Do you realise that an EMG HURTs?

You need to do things in the correct order. Well in most of the world

Injury/ problem......does not go away............See a Doctor............examines you............Determines if you need further testing (blds, xray etc.........orders tests.......gets results.......decides treatment plan.

If you have these problems there are tests that would be better than an EMG so early on, for example an MRI or neck Xray. But these things are for Doctors to determine not the patient. unless you are a Doctor, then you should not be allowed to just have an EMG because you think you need one.

You would no about the weakness, because you would not be able to do something, like open a jar, or even lift the jar off the table. Not be able to unbutton your shirt. Cant comb your hair etc etc.

 

[person]

Man...to be honest this is the 5th weeks I am going to spend in complete darkness trapped by fear/certainity I have ALS.Do you think some pain from the emg scare me?I would get my arm cut to pieces if it would resolve my dilemma.And no man I had no injury/accident or whatever and it was almost sudden.I felt a strange sensation of weakness a month ago and never left me if not it got worse but I cannot tell it 100% sure since I forced the muscle doing some unnatural crazy things or put it to immobility for two days and now I cannot recognize if it is getting worse or not;for the over exercise or for whatelse.If I continue like this I will have an heart attack so I put aside some money in these weeks and now within the next 90 hours I will get to know if at least I can rule out the LMN death option.

PS : you are telling me that if it would be a LMN problem I would not be able to do those simple task?I heard weakness is very gradual and can take months to get to that point.I am still able to launch a pen in the air close and disclose my punch two times and grab it but if I play videogames after 1 minute my left thumb stars feeling tired and this never happend,I used to play hours without noticing anything.Or If I eat chips the movement from the chips to mouth repeated gets me tired almost immediatly.All this all of a sudden,without reason and for a month.Plus I have been suffering from fascicultations in the last 6-7 years.

 

[trfogey]

Why this sounds so crazy to you?In one month I have not lost so much strength to not pass neurological exams and have not stiff muscles or other sympthoms apart weakness or better very very easy to get tired arm/thumb.The only way to find If I have LMN problems is the EMG.

And you say :

"If you had weakness caused bt LMN problem then you would know about it!"

How?

Your doctor would have told you. If you had gone to him to start with. Like you should have and still should do.

What makes you think that you have LMN-caused weakness? Weakness in the arm can be caused by dozens, if not hundreds of possible causes. What else do you have going on with you that you looked up on the Internet and led you here?

Edited to add: You're very dramatic and we're all impressed with your passion -- not so much with your medical knowledge or your Internet search skills though. How old are you?

 

[person]

I have no cervical problems/headache or neck pain.No injuries or whatever.Fasciculating for years and all of a sudden arm/thumb weakness with no reason.It was hard to not jumo to conclusions.

 

[person]

I am going to turn 27 next month.

 

[Alyoop]

Take your money and see a Doctor. You are again missing the point. Trfogey and I are NOT saying you have nothing wrong. We are saying you need to see your Doctor first! It's just the way you are going about this that is wrong. You could easily be wasting your money. ALS is rare, especially in your age group. There are hundreds of things it could be, but we have both said that already.
You need to be checked out by a registered Doctor, not an EMG and not the Internet. You are too young to have a heart attack as well!

 

[person]

Ok maybe I am stubborn but tell me : apart from the pain/money wasting (both things I don't care) what could go with me going to do the emg monday?

 

[person]

I meant what could go wrong* (can't find the edit option)

 

[trfogey]

I have no cervical problems/headache or neck pain.No injuries or whatever.Fasciculating for years and all of a sudden arm/thumb weakness with no reason.It was hard to not jumo to conclusions.

Have you ever heard of repetitive stress injuries? Things like carpal tunnel syndrome or tennis elbow, even gamer's thumb. They are caused by doing the same thing over and over again, which stresses a particular body part beyond its physical limits.

Most of the time, RSI shows up as tendonitis or other painful problems, but not always. Sometimes, the injury or swelling related to it can pinch a motor nerve. Often, the first sign of a pinched motor nerve is a sudden weakness in the muscles that the nerve controls. Relieve the pinch soon enough and the nerve recovers, and the weakness goes away. Wait too long and maybe the damage becomes permanent. It would really be a shame if that happened to you.

Get off the Internet and go to a real, flesh-and-blood doctor. Most importantly, listen to what that doctor tells you to do. You have spent five weeks trying to shove a square peg into a round hole and now you are so frightened and frustrated that you can't even explain what's wrong with you.

Stop playing Internet doctor. Go see a real doctor. Find out what's really wrong with you. If you have any questions at that point, come back here and we might be able to help you sort them out.

Good luck to you.