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btdyq5

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Hello everyone!

I realize the "I have twitching! HALP!" questions are Legion on here, and if my symptoms and situation aligned pretty closely with the typical BFS picture I wouldn't post. Unfortunately, however, from the info I've been able to gather my symptoms and situation are a bit out of the norm for a BFS patient and I figured it merited a post. Any insight or info that anyone can provide would be greatly appreciated!

Background: 32 year old fit male w/ a somewhat anxious disposition and a 2 week history of all day long twitching in the left deltoid muscle. I initially attributed this to simply working out a bit too hard at the gym, but then I took the subsequent 2 weeks off of all training and the fasciculations have continued, and in fact worsened. I also get maybe a handful of twitches in other locations throughout my body over the course of the day, but nowhere nearly as frequently or steadily as the left delt (i.e., maybe 2-3 calf twitches/day, 2-3 instances of fingers 'jumping' per day, etc.)

I have no evidence of clinical weakness as far as I can tell, although the muscle is slightly sore, and in fact I just went back to the gym for the first time this evening and was able to crank out multiple sets of 8-12 reps of dumbbell side lateral raises with 25lb dumbbells, so I presume I'm objectively ok on the weakness front. I'm relatively muscular and the problematic shoulder looks quite symmetrical and (for lack of a better term) cannon-ballish, so I imagine atrophy would be a long shot as well.

My primary concern regarding this symptom stems from the fact that the twitches that occur seldom happen at rest, and they seem to be reliably induced by the earliest initiation of engaging the delt muscle. More specifically, if my hand is held down by my side there is no twitching, but then as soon as I begin to lift my arm straight out to the side I get strong twitching all over the delt muscle until my arm reaches an approximately 30-45 degree downward angle, at which point the twitching stops most of the time and remains neutralized all through the rest of the range of motion as I continue to raise my arm up past 90 degrees and all the way until I'm pointing at the ceiling. Then as I arc my arm back downward along the same path I get the twitching once again as my arm reaches about 30-45 degrees and all the way down until my hand is pointing downward again. The twitching also acts up a lot when I'm typing on the computer and, thus, presumably engaging the muscle at least to a minor extent.

Additionally, and I don't know to what extent this is relevant, I had a mildly abnormal EMG in early May 2017 (testing done due to paresthesias in my forearms) that indicated:

EMG Interpretation: Mildly abnormal study
-Right ulnar neuropathy at the elbow, based on mild slowing of the ulnar motor response across the elbow.
-No involvement of sensory fibers
-No evidence of acute or chronic denervation
-This finding is consistent with mild focal demyelination

Now this EMG test was done for a different purpose and the abnormality that was discovered was in the right ulnar nerve, whereas my twitching symptom is in the left deltoid muscle, but this was 5 months ago.

Do either the mildly abnormal EMG or the fact that the twitches occur predictably and reliably in the earliest stages of muscle contraction point in any way towards ALS/MND or any other condition? Should I bring this to the attention of my neurologist or is does this seem indicative of just BFS?

Thank you so much for reading!!
 
Your EMG is not indicative of ALS.

And you led with our view on twitching.

Plz talk to your neuro, if only for your own relief.
 
Thank you very much for your prompt response!

"And you led with our view on twitching"
So the slightly non-textbook BFS presentation of fasciculations occurring in tandem with beginning to activate the muscle doesn't really hold any significance? Seems all the info I've come come across suggests the typical BFS presentation is fasciculations in primarily relaxed muscles, but I do recognize that there's a lot of variability in the presentation of pretty much all conditions.

"Plz talk to your neuro, if only for your own relief"
I will do just that. Thank you again!
 
I would add the abnormality you cite was not on the actual EMG ( needle portion of the study) but on the NCS portion. What we worry about in ALS is seen on the EMG and specifically acute AND chronic denervation. You had neither and from the report it appears the EMG was normal. You had a very slightly abnormal Nerve Conduction Study
 
Thank you very much for the EMG/nerve conduction distinction!
 
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