Question about hand weakness

[Mddorsey]

So I'm a 31 year old male that has been experiencing some weakness/tightness in my right hand and forearm for the past month or so. Ive also felt aches in my right foot and tightness in my right calf.

I've read the sticky post for new users and I understand that any pain symptoms point away from ALS. I definitely haven't experienced any clinical weakness either. I already have a neuro appt set up in 2 weeks just to make sure everything is ok.

My question for the board is, can there be muscle aches and tightness in other parts of a limb in reaction to weakened muscles elsewhere? For example, if my hand were experiencing early weakness, is it normal to feel aches/tightness from surrounding muscles that aren't used to being used for certain things? Does this make any sense?

Thank you for any help and advice--it's much appreciated.

 

[Atsugi]

Mddorsey, you question makes sense. But clinical weakness is the key.
Are you still fastening buttons on your shirt? Holding coffee cups? Can you do a squat without falling over? Walk on your toes and heels?

A primary doctor should be able to do a very brief but surprisingly comprehensive physical exam for weakness.

The odds of getting ALS are tiny. There are so many other things that could be the problem. Don't jump from common symptoms to a rare disease.

 

[Mddorsey]

Thank you for the response. The work everyone does here is truly admirable. I can't thank you guys enough.

So I had an an exam on Friday with a neuro. She performed a Nerve conduction on both hands and arms and said they looked fine other than a slightly slow velocity on both arms in one nerve. Which she said pointed to possible carpal tunnel. She then performed an EMG with the needles only on my upper right arm--bicep area--and said it passed.

She seemed so unconcerned that I was taken aback and now wish I had been more thorough and asked questions.

Anyway, my question to anyone who might know is that if my right hand is the primary source of my symptoms (weakness and fatigue) would an emg of the upper arm tell the doctor everything or should I have asked her to perform one on the hand itself? I'm well aware thanks to the board here that a clean EMG is the gold standard but just am not sure if I in fact had it done properly.

I'm going to give her a call tomorrow and ask these same follow up questions but I know there are a few people with great expertise on here and they may have a simple answer for this.

Thank you again for your time and efforts.

 

[BlueandGold]

Was this a neuromuscular specialist or a general neurologist? If you had specific weakness in a particular hand and if there was accompanying atrophy, the EMG should have included the specific area that you were experiencing weakness in. However, if this was a neuromuscular specialist and he/she did not note clinical weakness or atrophy, you should celebrate the results.

Vince

 

[Mddorsey]

Thanks for the reply Vince. It was only a general neuro. I passed the physical exam and show no visible atrophy to her eye so she immediately dismissed my ALS concerns. Which is why I think she didn't do the EMG on the hand itself. I wish I had pushed for that now looking back on it.

 

[BlueandGold]

If you don't exhibit atrophy or clinical weakness, you have nothing to worry about. Mine started in my left hand and the weakness and atrophy were obvious. No worries.

Vince

 

[Mddorsey]

Fair enough Vince, thank you.

I guess my fear is that I'm experiencing weakness before it becomes clinical/atrophies and only a proper EMG would rule that out. I'll bring that to her attention.

I appreciate the insight!

 

[affected]

Please go back and read the sticky again to allay your fear.

Clinical weakness is the key, which you are not experiencing.

The good news is that EMG would have shown ALS by testing in your arm. An EMG will show ALS very early, well before you even know other parts of your body are being affected.

Carpal tunnel explains your symptoms pretty well, and is a common disease. You need to stop focusing on ALS which is a very rare disease that you have no symptoms of.

I know people read the sticky and then say 'yes but wouldn't I still have this or that'? But this is you trying to convince yourself. We wrote the sticky very carefully and it is our official stand. We know ALS really well and are very happy to have answered you about your concerns. I know it's frightening, but it's great news that you have no ALS symptoms and no evidence of it on exam.

Good luck

 

[Mddorsey]

Spoke to my neuro and she insisted that she was able to get a proper read on my hand nerves by doing the EMG in my bicep area. She said doing an EMG on my hand wouldn't change the results. I've seen some
Conflicting info on this matter within this forum but I'll trust my neuro for now.

 

[Atsugi]

... I'll trust my neuro for now.

Good idea.

What little I think I know about the EMG is this: The EMG is not like an X-ray, which only sees the part being tested. The EMG, instead, sees the electrical activity as it is conducted from the brain to the rest of the body.

So if the EMG is good anywhere, it means the motor neurons in the brain are not being destroyed. If the EMG is bad, more readings may be needed to ascertain the type and location of trouble.

Would appreciate any criticism, correction, or expounding explanation on the above.

 

[Mddorsey]

One more follow up for the experts. Forgive me for my next query, I'm not trying to give anyone the run around or come up with my new symptom. If you go back and look at my original post, I mentioned feeling calf tightness at the start in addition to my hand weakness. When I saw my neuro last week she basically ignored my calf after I passed the basic clinical weakness exams. So while that tightness hasn't gone away, I followed her lead and mainly focused on the hand issues.

Now fast forward to this weekend, I had to do a couple of 2-3 hour drives in the span of like 15 hours. On the 2nd trip I experienced what I can only describe as really bad muscle fatigue in my right calf from simply operating the gas pedal. It just felt exhausted. I mostly rested it the following day but after driving home from work last night, the short 25 minute drive brought it all back. It's not a sharp pain. Best way I can describe it is a dull ache and the muscle feels absolutely exhausted.

So two part question---can ALS make a muscle feel exhausted as an early symptom before any clinical weakness? The sticky would tell me no, correct? And follow up question is does the disease ever present itself in two different places at once during the onset? From what I can tell, limb onset usually involves one limb only and then it moves from there. So feeling symptoms in my leg and hand at essentially the same time so early in the process would point away from ALS? Or are there exceptions to that rule?

I'm genuinely not trying to waste anyone's time. I hope those questions make sense. Thank you.

 

[Nikki J]

In my experience no there is no feeling of muscle exhaustion at onset. It was simply puzzlement that the muscle did not work. And yes it starts in one area so simultaneous onset in 2 separate area would point away from ALS

 

[Atsugi]

Nikki is absolutely correct. People with new onset ALS don't complain about feelings of weakness, exhaustion or fatigue in their muscles. The muscle just fails, with no clue why. In my wife's case, she just suddenly fell down while squatting, because her foot muscles didn't adjust to keep her from tipping over.

This is because the disease destroys the motor neurons in your brain, and doesn't affect any sensory nerves, so there's no feeling.

Also, ALS destroys motor neurons in serial fashion, one after the other. So Nikki's answer is correct that new onset ALS doesn't start in two diverse places at once. Once my wife's foot was paralyzed, then her calf failed, then her quad, then the other leg, and then the hands, and the disease moved upward until it got to her eyeballs.

Your doctor knew your calf was OK simply because you walked into the exam room. Doc's are pretty smart people.

Congratulations on your non-diagnosis. I hope you and your doctor can get the real problem soon.

 

[Mddorsey]

Thank you for the direct answers. You guys really are incredible for doing this kind of work for worried people. I'll make a donation to the site.