Muscle wasting around the wrist (is this ALS?)

[Tootiredofthis]

Hi,

I am having a lot of troubles in last 2 and a half months.

My EMG showed the following:

- Carpal tunnel syndrome in both hands (left worse)
- Electrical silence in relaxtion
- Denervation potentials fibrillations and PDP in small amount in m.abductor digiti minimi sin.
- Chronic radicular lesion C8
- Signs of neurogenic TOS on the right

Today I noticed something really scary. It looks like muscle wasting just around my wrist in both hands, left worst.

Right hand constrict:

http://oi49.tinypic.com/11kh02c.jpg
http://oi48.tinypic.com/2ilbpe9.jpg

Right hand relaxed:

http://oi50.tinypic.com/ibeu14.jpg

Left hand constrict:

http://oi46.tinypic.com/ddgoys.jpg
http://oi46.tinypic.com/331kbrl.jpg

Left hand relaxed:

http://oi45.tinypic.com/2aaamh3.jpg

Does this looks like muscle atrophy caused by ALS? My left thumb trembles a bit in certain positions, but I don't feel I have any weakness so far.

 

[Tootiredofthis]

I wish I could scratch those pictures off my post. Turns out my brother has the exact same thing, so it's probably nothing to worry about.

In order to get some replies, I'll elaborate on my case.

It all started 2 and a half months ago with non-als symptoms - my hand were falling asleep when I went to bed, I could "feel" the nerve when I squeeze my hand, I had widespread tremors (still have some today), my right knee was stiff & painful for a couple of weeks, and many others subtle symptoms which made me think it was MS. However, my neuro thinks MRI is not required so MS still isn't excluded.

After physical therapy, my carpal tunnel syndrome got better and it's manageable now. I went to several different doctors - GP, Neuro, physiatrist and even a psychologist. They all say "it's from stress, bad posture, working on computer" etc.

Apart from EMG, all other tests were OK, including a test in the neuro office.

However, around 3 weeks ago I felt very rapid fasciculations in my feet, more in left one. I could see it moving really quickly and that lasted for about 24 hours, constantly. Low dose of diazepam made it go away at that time. From then, I see fasciculations on other parts of my body and it seems they never go away, but change places and aren't really noticeable until I SEE them. I think I got used to them.

I don't have an appointment with my neuro for several weeks, so if anyone could shed some light on my EMG/ENG report, I would be more than grateful. I will try to translate it to English:

"EMG showed normal insercion activity, electrical silence is detected in relaxation. Denervation potentials, fibrillation type were detected and PDP in small amount in m.abductor digiti minimi sin. Manual contraction showed AMP which are changed neurologically, proximal neurogenic lesion type, with mild to moderate reduced innervation sample.

ENG showed neurogenic type M answer with long distal latency on n.medianius dex. and n. ulnaris dex. with preserved motor conduction speed and borderline value for n. ulnaris dex.

Conduction speed:

n.medianius dex. 57.3 m/sec. Distal latency 3.6m/sec
n.ulnaris dex. 55.6m/sec. Distal latency 3.0m/sec
n.medianius sin. 62.8m/sec. Distal latency 4.2m/sec
n.ulnaris sin. 52.8m/sec. Distal latency 3.5 m/sec. Elbow-axilla 74.5m/sec

EMNG showed signs of mild to moderate chronic radicular lesion C8 right, without signs of actual axonic something (can't translate), and signs of compressive neuropathy n.medianius (carpal tunnel sy) in both hands, in right hand mild and in left hand mild to moderate as well as signs of neurogenic TOS on the right."

I am 28 years old, if that helps.

 

[wright]

Those EMG findings and your story are absolutely consistent with carpal tunnel and a C8 spinal nerve problem, which is why that is your diagnosis. What more do you want?

I'm going to assume you're trying to put your EMG findings (which are not findings of someone with ALS) together with your twitching. Sorry, they are completely unrelated.

If you're "too tired of this" then accept the diagnosis that your signs and symptoms clearly indicate and "be done with this"

 

[Tootiredofthis]

Thanks a lot wright, I cannot express how much your words mean to me. I'll try to take it easy from now on.

 

[wright]

You're very welcome. I wish you peace.

 

[Tootiredofthis]

I talked to my neuro recently and she said she would like to see me again, as I still twitch and my left arm gets increasingly tired after simple tasks. For example, when I put both of my hands in the air about 15 seconds later I feel increasing pain in my left shoulder and generally my left arm gets fatigued easily, in regular everyday tasks. The feeling is like I had a gym workout, but it lasts all the time. It only subsides when I am resting/lying down. I'll let you know how it went, as I have an appointment tomorrow.

 

[notme]

With a compressed C8 I'm not a bit surprised. I'd see a neurosurgeon instead personally

 

[Tootiredofthis]

C8 problem is on the other side, where my pinky is affected for last 2 months (postural tremor).

 

[nikolab]

Nemas ALS,

video sam ranije ovaj post al nisam obratio paznju ko ga je postavio,kad gle moj poznanik..........

"wright" ti je sve rekao,inace on je expert za EMNG i profesor na faksu..............

Mogao bi da iskljucis malo komp i da se malo sredis ............. :!:


pozzz


Nikola

 

[Tootiredofthis]

Thanks again for kind words Nikola.

I just came back from my Neuro. I will do more blood tests ( parathormon, Ca, Mg, Cu) and abdomen-liver ultrasound. She said if those results are OK, we can rule out all neurological causes. She tested all reflexes on the upper body and my knees as well and they are all normal with no fasciculations.

When I mentioned ALS, she told me that came to her mind as well, but if that would be the case, she would see it on EMG and my reflexes would be abnormal. However, she did notice slight atrophy in both of my hands. She also said she put a lot of thought and research into my cases at her home.

Thanks again for advice and patience. Bless you all.

 

[nikolab]

Super !



Enjoy now !



:lol: :lol: :lol:

 

[Tootiredofthis]

Rest of the blood tests and ultrasound turned out OK and my symptoms are getting worse. Left hand is shaking more and arm feels fatigued and aches with simple tasks, like right now when I type. My neuro told me to come back with the results which I did, and we had an interesting conversation.

She said no way it's ALS, but when asked why was there fibrillation potential in my EMG and she couldn't tell me.

I also pointed that my EMG was done almost 3 months ago and I haven't had fasciculations back then.

Then I asked how could she know that's not ALS if they only tested my arms and nothing else with EMG. She said she expected totally clean EMG and that's why only my arms were tested. After all these questions she decided to refer me to the best neuromuscular specialist in the area for a second opinion and another EMG. Now all I need is courage to schedule that appointment :|

 

[vickim]

You do what you have to do to get the answers you seek. It takes time , months even years, so patience is a must. Have you had a mus cle biop spy? I have had 3 emgs and it was the mus cle biop spy that gave me my diag nosis, so don't hang all your hopes on emgs. all my emgs were abnormal.

I wish you luck and peace. Hugs

 

[ottawa girl]

Vicki,

Wright, I believe, read results recently and said they were consistent with carpal tunnel. I think the on the ground doctor said the same. I also suspect Nikolab mentioned that too, but not sure cuz he wrote in Serbian.

I can tell ya, if my doc. suggested carpal tunnel, I'd be dancing, not second guessing.

 

[Tootiredofthis]

@Vicki - No, I didn't have muscle biopsy.

@ottawa girl - I definitely had CTS at that time. Three and half of my fingers were numb back then for weeks, every time I go to sleep. I don't doubt that at all. After physical therapy for 10 days, home exercises for about a months (and still every day) and better posture, it went away. I know I sound like a nut job (and I pray I am), but if there is possibility of ALS, I would like to do a couple of things while I still have my mobility and that's the main reason why I am second guessing my neuro, who didn't impress me at all.