mrpet
Member
- Joined
- Dec 8, 2015
- Messages
- 23
- Reason
- Learn about ALS
- Country
- US
- State
- Oregon
- City
- Portland
Hi there,
A brief update on my background:
- Started fasciculating in late November 2015 (14.5 months ago)
- Still (!) highly anxious about ALS
- Had left foot weakness diagnosed by neuro (using EMG and NCS) in mid-October 2016 as Peroneal Nerve Neuropathy - did 3 months of exercises and now the weakness has resolved (confirmed by clinical assessment by neurologist - foot seems fine now)
- In early Jan 2017 I started having the sensation of a "heavy" shoulder
- Did strength testing using weights without warmup in mid Jan, which caused a couple of days of mild pain in left shoulder
- Did more strength testing using weights in late-ish Jan (ie about a week later - c.22nd Jan) again without warmup, left shoulder was extremely sore for 4-5 days with restricted range of motion
- Left shoulder was noticeably weaker when I did the strength testing, especially the second time even more so (e.g. could hold 30lb dumbell out in front of me for 3-5 seconds in right arm but barely 1 second in left arm)
- Saw neuro again in beginning (1st) of Feb. He reported that he did not detect "significant" weakness (although to me you could see in the strength tests there was a mild difference between left and right shoulder tests).
- He did EMG same day on left shoulder and arm, starting with deltoid and working down (he didn't test infra/supraspinatus as far as I could tell) - EMG was normal with no spontaneous activity or other abnormalities. He stated there was "no concern" for ALS. I asked him if he was comfortable not testing the trapezius, and he said he didn't need to.
- Saw Orthopedic surgeon one week later re shoulder and he got me to push and pull my arms in all sorts of ways. He diagnosed me with very mild (he said 5%) weakness in my left infraspinatus and supraspinatus based on his clinical tests. I asked the ortho if I should have had an EMG on trapezius, he said that definitely was not required (he did not diagnose weakness in my trapezius or deltoid).
- He did an ultrasound on rotator cuff which showed no tears but slight bursitis (inflammation). His diagnosed me with strain of rotator cuff and gave me 6 weeks of rotator cuff exercises to do.
- I have or I am noticing more twitches around my left shoulder blade now than before - I don't know if I'm just more hyperfocused on it now or not.
My question is:
- Would the EMG of the my left deltoid and muscles lower (including biceps) have shown abnormality (eg fibs/psw) if the weakness was in the infraspinatus and supraspinatus
- I note three things:
1. that the infra/supraspinatus are innervated by C5-6, just like the deltoid and biceps (among others), so any nerve root lesion in C5-6 would expected to have been seen in other muscles innervated by these nerve roots
2. I also note that I have been fasciculating for a year, so if there was a pathological process in place I would expect it to be widespread by now
3. There was about a month from my first perceived "heavyness" in my left shoulder to the EMG - I expect enough time for wallerian degeneration (if any) to have spread from the infra/supraspinatus muscles to the deltoid
Many thanks!
A brief update on my background:
- Started fasciculating in late November 2015 (14.5 months ago)
- Still (!) highly anxious about ALS
- Had left foot weakness diagnosed by neuro (using EMG and NCS) in mid-October 2016 as Peroneal Nerve Neuropathy - did 3 months of exercises and now the weakness has resolved (confirmed by clinical assessment by neurologist - foot seems fine now)
- In early Jan 2017 I started having the sensation of a "heavy" shoulder
- Did strength testing using weights without warmup in mid Jan, which caused a couple of days of mild pain in left shoulder
- Did more strength testing using weights in late-ish Jan (ie about a week later - c.22nd Jan) again without warmup, left shoulder was extremely sore for 4-5 days with restricted range of motion
- Left shoulder was noticeably weaker when I did the strength testing, especially the second time even more so (e.g. could hold 30lb dumbell out in front of me for 3-5 seconds in right arm but barely 1 second in left arm)
- Saw neuro again in beginning (1st) of Feb. He reported that he did not detect "significant" weakness (although to me you could see in the strength tests there was a mild difference between left and right shoulder tests).
- He did EMG same day on left shoulder and arm, starting with deltoid and working down (he didn't test infra/supraspinatus as far as I could tell) - EMG was normal with no spontaneous activity or other abnormalities. He stated there was "no concern" for ALS. I asked him if he was comfortable not testing the trapezius, and he said he didn't need to.
- Saw Orthopedic surgeon one week later re shoulder and he got me to push and pull my arms in all sorts of ways. He diagnosed me with very mild (he said 5%) weakness in my left infraspinatus and supraspinatus based on his clinical tests. I asked the ortho if I should have had an EMG on trapezius, he said that definitely was not required (he did not diagnose weakness in my trapezius or deltoid).
- He did an ultrasound on rotator cuff which showed no tears but slight bursitis (inflammation). His diagnosed me with strain of rotator cuff and gave me 6 weeks of rotator cuff exercises to do.
- I have or I am noticing more twitches around my left shoulder blade now than before - I don't know if I'm just more hyperfocused on it now or not.
My question is:
- Would the EMG of the my left deltoid and muscles lower (including biceps) have shown abnormality (eg fibs/psw) if the weakness was in the infraspinatus and supraspinatus
- I note three things:
1. that the infra/supraspinatus are innervated by C5-6, just like the deltoid and biceps (among others), so any nerve root lesion in C5-6 would expected to have been seen in other muscles innervated by these nerve roots
2. I also note that I have been fasciculating for a year, so if there was a pathological process in place I would expect it to be widespread by now
3. There was about a month from my first perceived "heavyness" in my left shoulder to the EMG - I expect enough time for wallerian degeneration (if any) to have spread from the infra/supraspinatus muscles to the deltoid
Many thanks!
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