Does this look like atrophy? please help

[wdagron]

I noticed that I've been twitchy lately, however my arms have not suffered the twitching, thought I notice my left forearm looks atrophied or ..well, you can see. Also my left bicep doesn't flex as defined as my right does (and I am a lefty) as yo ucan see. I have also had issues sleeping lately where, even if I am not laying on my left arm, it numbs up until I wake up and move it a little. I have had shoulder aches for a few days.. I don't know, I am just adding all the symptoms and it scares me, so I wonder two things..

1: Does it look like my left forearm is atrophic

2: Does it look like my left bicep is atrophic

3: Would I be able to flex my bicep like this if it were atrophic or would it be paralyzed?

4: I read up on here that, even though numbness is sensory and MND doesn't effect the senses, people on here seem to have numbness issues, especially upon waking, which is what I have...with the arm that looks atrophic.

thank you...

 

[Atsugi]

Don't see any problem. According to everything you wrote and photographed, there is no reason to be concerned about anything.

All in all, it seems like you've got a totally normal body. No ALS and no other problem, either.

 

[Vincent]

Have you ever seen someone's arm when it comes out of a cast after 8 weeks. It looks sickly, wasted, smaller than the other. That is because the muscles have atrophied, wasted away, from lack of use. That's what causes atrophy in ALS. It doesn't just show up out of nowhere. The nerve to the muscle has died and the muscle has lay limp for some time. So the short answer is NO.
Vincent

 

[wdagron]

Thank you for your response Vincent, I really appreciate you taking the time out to respond. I have seen a atrophic leg due to a cast, it is rather interesting. I have read though that, at least initially muscle atrophy in ALS is due to the ongoing process of denervation and later on secondary to disuse (?) I might be wrong in that though...

 

[wdagron]

Don't see any problem. According to everything you wrote and photographed, there is no reason to be concerned about anything.

All in all, it seems like you've got a totally normal body. No ALS and no other problem, either.

Sorry Atsugi, I did not see your reply initially, and thank you very much for your insight.

I do feel a little better about it, the thing that sucks about this disease is that it is hard to determine what is anxiety and what is not, what has been there the whole time and what is new.

The thing that scares me is that, at least recently, this arm that I photographed is also causing numbness in the mornings, and this is when I am not laying on it..I just have it draped over or some of my fingers are curled..I will admit that when that does happen, when I unclench or straighten my arm, the numbness ceases..but it is strange it happens in the first place. I did look up various ALS forum topics on the situation, and it seems that even though numbness is sensory, a lot of ALS sufferers have that issue in both late, or early stages.. and it seems to have some correlation.. so of course, it scares me cause it is just one other thing wrong with my arm that doesn't really point 'away' from ALS either..

 

[Atsugi]

W, let me describe a bit of ALS to you. You might already know all this, but just to be sure...
ALS is in the brain. It destroys certain nerves in the brain--the motor nerves of the voluntary muscle system. These nerves normally send the "go" signal down to the muscle so the muscle is ordered to move. But because ALS has destroyed that nerve in the brain, the go signal doesn't get sent, and the muscle never gets told to move. So that particular muscle will lay limp, useless, paralyzed.

Note that the "feeling" or sensory nerves, which carry sensory feelings UP from the flesh to the brain, are not harmed, not involved at all. So a person can still feel everything, heat, cold, pain, numbness, "weird," or whatever.

If you feel numb, frankly, so what? If you had ALS--or if you didn't have ALS--you can still feel all the senses. You just can't make a muscle move.

Don't worry if you feel something. Worry if you cannot DO something and there is NO associated feeling. Even then, there are a lot of diseases out there, not just ALS.

Also note that ALS is relentless. If it caused damage to a nerve, there is no way that nerve is going to be better the next day--or ever.

Finally, in ALS, after the muscle has been denervated and has been laying useless and unused for some length of time--months--the roundness and fullness of the muscle goes away, it flattens out and gets skinny. Eventually, your legs and arms will begin to look like those of a Holocaust survivor.

Exactly what symptoms make you think about ALS?

 

[wdagron]

Thank you for your response Atsugi. In response to your question "Exactly what symptoms make you think about ALS?"..

This all started about 3-4 weeks ago, initially with twitching which was fairly localized (left thigh) and within a day or two, was more sporadic from my calf, other calf. back, thigh, bottom of foot, palm, tongue etc.
The twitches were always felt, always visible..and usually occurred in about 1-2 twitches at a time..although I have had spats where I will be laying on my back and my thigh will twitch for 5 minutes and then cease. I have made sure to check out if they are also visible but not felt (since it seems that the majority of the people here have ongoing twitches that can only be spotted with close examination and are not felt) but I can not see that, nor can the neuro I visited elicit or see it. I can elicit it with extreme pressure or coughing (back muscle) for some reason.
As for my arm, well, I made the stupid decision one day to bite more than I could chew..in other words, I overworked my arm or something through excessive weight. This was about 2 weeks ago. Afterward my arm was so sore, so swollen, I could not use it for days...and everything...EVERYTHING was overly heavy. My other arm didn't even have a issue with this weight so I wonder why the dramatic difference in reaction to the same amount of weight? Well when I noticed what you see in the photos above, I panicked, and it seemed clear to me that the reason I overwork my arm with limited exercise was cause I have some atrophy or diseased muscle in my dominant arm.

Even today, weeks later, my shoulder and outer arm still kills me...like I layed on it bad all night even though I didnt, and I have numbness in my entire hand on that arm every night which I assumed was due to denervated/atrophic muscles causing secondary circulatory problems or nerve impingement cause there is nothing in there to protect the nerves.

I understood that ALS is not sensory, or doesn't directly affect the senses..but it does indirectly(?) I read many topics on here where many people suffer numbness, specifically upon waking that started or was exacerbated by their DX. As a example to show what I mean, here is a excerpt from a unfortunate story (not from this site, but is public via Google)

" Two years ago he noticed that he was losing the feeling in his toes as they just went numb one day. He had back problems and some nerve damage, so this happened sometimes, and we thought nothing of it. It would pass. It always did, but this time it didn't. After a couple of months like this, the numb feeling went away, but he was left with no movement in his toes. Then it began to move up his foot, and he lost the movement of his foot and began to use a cane to get around. They sent him to several specialists, and we were told that he had severe nerve damage in his spinal cord that could not be fixed. They told us to prepare for him to lose the use of his leg. For several months nothing changed. Then it got worse, and he started to lose the feeling in his other toes and foot. He soon lost the use of both his legs. He was now wheelchair bound. Then I started to notice that his arms were getting smaller. And I knew something else was wrong. He was sent to Indianapolis' IU Med Center for more tests. That day shattered my family. He was told he had ALS and was dying."

Which is why I worry..

The thing that is odd is, the fasciculations I do have , are rarely if ever in that arm..maybe one fasciculation per 2 days in that area. My wrists and fingers feel stiff, or slow, like I cant type or play piano as well or I play piano and my left hand tires out after a while..

Also, for the past 2 weeks I have had bulbar issues, specifically if I am actively walking and talking at the same time..or talk excessively. The back of my throat closes up and I start fumbling words cause my tongue feels slow and my lips aren't working right, I have then a lot of post nasal drip and get a sore throat. I do have a occasional twitch on the tongue, but no fasciculations at rest. I thought, maybe hypernasality which would suck cause that is almost exclusively indicative unless you are under 3 years old..but when I test my nasal emissions via mirror, I have none for any consonants or vowels other than M N NG..which is normal. I thought maybe Flaccid Dysarthria, but in theory that seems to be a ongoing problem for people, not one that waxes and wanes like mine..and I don't have breathiness in my voice and my vocal chords are fine. I am a Opera singer and can still do it fine with a vibrato with or without the tense throat complex. If I am sitting down, laying down or am walking around but not anxious.. then I talk fine.

I did go to a neuro who really did not seem too concerned given the fact my symptoms, specifically the twitching has been only a month (not sure why that matters seeing as any twitching passed 3-4 days is considered abnormal). I did not get a EMG or a MRI (apparently he did not think it was warranted). I passed all my reflex tests via arm, head, foot, leg, wrist. It wasn't absent, and it wasn't hyperreflexive..so I guess, at least in my arm, if it WERE atrophic or all the other things I worry about, I would likely at least have some abnormal reflexes or missing reflexes in that arm, right? Also my strength tests were normal, he did second guess my dominant arm for some reason..but then moved on...also, no clonus to be found.

 

[wdagron]

Also, can you 'overwork' a atrophic muscle? For instance, if said muscle in question was the bicep.. okay, the bicep is diseased, atrophic..or becoming such, can you cause that muscle to react to strenuous activity? Causing DOMS? (delayed onset muscle soreness) with swelling and stiffness? Or can you not 'work' out that muscle at all and the only muscles that will respond to overuse, etc are the other muscles around it that are not affected yet..

 

[WendyWooG]

Hi
My experience of atrophy is that it occurs after loss of movement after clinical weakness has occurred. The muscle wastes away because it's immobile. For example my first symptom was not being able to go on tiptoe on my right leg atrophy in my leg was not noticed til a couple of months later by my doctor.

The pictures you show still hav muscle definition, when my atrophy occurred the area flattened, smoothed out and lost definition. The area became loose I suppose is the best way I can describe it. But the only person who can accurately tell you if you have atrophy is your doctor, they are trained we are not. If your doctor is not seeing clinical weakness or atrophy then you should be reassured. What does your doctor say?

Wendy

 

[Lkaibel]

I think a key to actual atrophy is you don't have to ask yourself if it's atrophy. When my wrist was not in motion for awhile after a rough carpal surgery, I did not have to wonder if it looked smaller I KNEW it did. Real atrophy, whatever the cause really hits you and you think WOW, what is that?

 

[wdagron]

Hi
My experience of atrophy is that it occurs after loss of movement after clinical weakness has occurred. The muscle wastes away because it's immobile. For example my first symptom was not being able to go on tiptoe on my right leg atrophy in my leg was not noticed til a couple of months later by my doctor.

The pictures you show still hav muscle definition, when my atrophy occurred the area flattened, smoothed out and lost definition. The area became loose I suppose is the best way I can describe it. But the only person who can accurately tell you if you have atrophy is your doctor, they are trained we are not. If your doctor is not seeing clinical weakness or atrophy then you should be reassured. What does your doctor say?

Wendy

Thank you for your response, I very much appreciate your input. My neuro did not check for atrophy, though he checked the strength test. He doesn't seem concerned with ALS given my reflexes and strength tests were fine. I am not sure how reliable it is to put faith in reflexes without a MRI but iono lol.

The thing that scares me is that im obviously worried about my bicep, I overworked it a few weeks ago using the same amount of weight as the other arm and it absolutely killed my left arm to the point where I had muscle soreness and pain for 3 days after, and I couldn't hold a cell phone without shaking so much as a weight for a few days as well. Afterward, I would think that after the soreness (your muscle breaking down) it would bulk up and be stronger ..which is what is supposed to happen, but in ALS, overworking a muscle just speeds up the degeneration process since it can't repair.. so the fact my arm is still..well, as unimpressive looking and i'm still having issues..well it scares me, that my muscle has not repaired or strengthened..

Truth be told... I did try and curl those same weights again now and it does seem I can get more in and strain less with my left as opposed to before ..then again, still looks unimpressive and not toned..it's rather soft..

 

[wdagron]

I think a key to actual atrophy is you don't have to ask yourself if it's atrophy. When my wrist was not in motion for awhile after a rough carpal surgery, I did not have to wonder if it looked smaller I KNEW it did. Real atrophy, whatever the cause really hits you and you think WOW, what is that?

This is true, I have been eyeballing my body, every inch..which makes it very difficult to determine if something is new or something that has been there a long time..

 

[wdagron]

I do thank all of you for your replies thus far, I truly appreciate that you take the time out to read or try and reassure people who are fearful. Anxiety, stress, especially over a disease like this is debilitating in and of itself. I do have one more question, it is a rather simple one and it pertains to Bulbar onset/symptoms.

Like I mentioned above, with activity, or if I am reading or speaking something lengthy..my throat tends to stiffen/close up on me this is coupled with some clenching of the jaw, issues with some words (jumbled or slurred.. like the word 'rewards' will be 'weweards' though I can correct myself or I mix up letters or stutter). I 'feel' hypernasal, but only feel that way cause the tightness effects the back of my throat, and my left ear goes all wonky like I am underwater, and I have post nasal drip with it. My fiance doesn't hear the nasality and barely catches if/when I mess up words..even when I point it out to him. I will say "see, right now my throat it tight..doesn't it sound odd?" he goes "no, it sounds perfectly fine". Like I said, this waxes and wanes depending on what I am doing. I can go a whole day without issue and talk profusely if I am not really active. Also, I don't have fasciculations at rest with my tongue nor do I have visible atrophy or inability to move it anywhere. Swallowing and drinking are as normal as before. So my question is this..

1: When it comes to bulbar onset, is Post Nasal drip a sign? (it seems a lot of bulbar patients I have read suffer (initially) from post nasal drip which is freaking me out cause I figured it pointed away from ALS.