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About 5 months ago, my fiance started experiencing weakness in his right hand. Loss of dexterity may even be a better way to describe what he was experiencing. A few weeks later he started to experience the same in his left hand. Then his right foot began to feel stiff in the morning and he isn't able to curl his toes on the right the same as the left.

He then began to experience muscle fasiculations in some parts of his body- which has now increased from once in a while to constantly throughout the day. Also, his knuckles have been cracking a lot.

At the onset of weakness in his hands he had an EMG done- the DR. told him he had Ulner Nerve Entrapment and needed surgery right away. Then he started to experience muscle fasicultions and became suspicious of ALS. Prior to the fasculations increasing, he had a second EMG which showed some in his feet but didn't pick up anywhere else. The Doctor said they weren't fasicultions that would be from ALS. Literally 10 days after the 2nd EMG the fasiculations greatly increased!

We just saw an ALS specialist but he is not sure what's goin on. Is it possible to have nothing show up right away? Should he get another? We have looked online to try to figure out what this could be but the only thing that matches his symptoms is ALS. Is it possible that the EMG's were done too early and they are not picking up denervation?
 
If your ALS specialist has told you that he is not sure what is going on, then he certainly does not think that ALS is the problem. It does not sound like the EMG has caused him to suspect ALS. You should leave it to the dr to sort out and try not to diagnose your fiancé via the Internet. There are literally hundreds of neurological conditions, some very difficult to diagnose. Some of these illnesses take time to " evolve" and patience is required, by both the sufferer and doctor.

The pattern of symptoms and progression does not follow the usual pattern of ALS and both UMN and LMN signs are required to be diagnosed.

I think you need to take it as a very good thing that your neurologist does not think it's ALS.
 
What does the ALS specialist say about the ulnar nerve entrapment that the first neuro found? Did he/she verify that problem or does he/she disagree with the finding (and, by extension, the need for corrective surgery). Beyond the problems with his hands, there really isn't anything that points toward ALS.

We have looked online to try to figure out what this could be but the only thing that matches his symptoms is ALS.

This is a very bad thing to do. Diagnosing ALS and the other MND's is a process of elimination. Many diseases share certain symptoms with ALS and each of those diseases must be ruled out as a possible cause for your fiancee's symptoms before ALS or other MND can be ruled in.

Is it possible that the EMG's were done too early and they are not picking up denervation?

Very unlikely. The ulnar nerve entrapment diagnosis from the first neuro accounted for the abnormalities found on that EMG and the weakness in the hands. Besides, you haven't related any abnormal findings from the various clinical neurological examinations that your fiancee has been given, so it's doubtful that any of the ALS-specific signs appeared during those exams. Fasciculations are known by the company they keep, and your fiancee's fasciculations seem to be in benign company at present.

I know that it is difficult, but the best thing the two of you can do for yourselves is to let the doctors do their job and wait for the results of their diagnostic regimens. Trying to guess the diagnosis that they are going to come up with, based on snippets of information and 'Net research to fill in the blanks is fool's errand won't get you a true answer quicker, but it will give you lots of unnecessary stress.

Good luck to you.
 
Cracking knuckles, for one, is not a sign of ALS. A person cracks their knucks to relieve pressure between the joints.

Secondly, relax a little bit. :) I know this is happening fast...but the healthcare system unfortunately...does not work as fast as our symptoms come on. Believe me..I have been fighting for two years for a solid and agreed upon diagnosis from my doctors..and my symptoms have progressed for two years...but that doesn't seem to rush the process any faster. The fact you have already gotten the tests you have, and see the neuro already shows you are on the FAST track.

Lastly, there are thousands and thousands of neuro diseases out there that mimic each other. Unfortunately for technology...when you type into a search engine those symptoms it will come up with the most prominient and most viewed result first. It doesn't get down to the rare diseases...or hardly heard of diseases. Just doesn't happen that way. Let your dr. do the work and enjoy the time as you have right now. Best of luck to you.
 
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