EMG question

[Wray2368]

I have had the feeling of weakness since 16’ this was primarily on my left side from face down to foot. I had the run of tests including two clean EMG reports. I was thoroughly satisfied that I was in the clear and had some sort of virus or sleep issue that caused the twitching and perceived weakness. However, my jaw tremor which happens every time I smile, talk, or use face muscles has not gone away and has become more noticeable. I also have developed for about a year right hand weakness. By that I mean I cannot fully extend my middle finger. When my wrist is bent. I was told at the time that the emg and NCV could pick up anything in the other hand/arm. Does anyone know if this is true.

The major reasons I am not completely panicking is that I am only 30 and have had a clean emg before. My question is about the emg and whether or not it would find something in the other hand. Also did anyone have such a long gap for diagnosis?

I am just trying to ease my mind as I am having difficulty with my right hand for sure, and the tremor is definitely disconcerning. One without the other seems like there are many benign explanations but paired together it makes me think something more sinister could be at work. Feedback is appreciated, as it definitely taught me a lot last time I was here.

 

[KimT]

The EMG would pick something up even before weakness occurs.

You're clear.

I would go back to my primary care and see what he/she says.

 

[Wray2368]

Thanks for the response, so it picks up anything for any of the muscles in the body then correct? So it truly doesn’t matter where the EMG was tested?

 

[ShiftKicker]

Mod note, prev posts here:
https://www.alsforums.com/forum/do-i-have-als-als/38334-better-understanding-localized-spasms.html
https://www.alsforums.com/forum/do-...ons-regarding-twitches-vs-muscle-shaking.html

As Kim has recommended, best course of action is to go back to your gp and start trying to work out what is causing your symptoms. An EMG would pick up issues long before you were aware of them, for the most part.

 

[Wray2368]

Quick update:

I had a scheduled appointment with the Neuro this week. The nurse practitioner mentioned that my jaw tremor was likely BFS. I was under the assumption that BFS was more of a spasm situation not a tremor. She also noted that I did have weakness in my right hand. I have an EMG scheduled for Thursday, but my question is does anyone know if BFS can cause actual clinical weakness? She also mentioned that I did not have any visible UMN signs, but is clinical weakness without spasms a UMN sign. Please advise.

 

[lgelb]

Clinical weakness without spasms is not a UMN sign.

BFS or any benign tremor, spasm or other involuntary movement can certainly manifest as perceived weakness because all that movement that is unintentional is making it harder to move intentionally.

Please refrain from posting further until you have results from your EMG that is scheduled for Thursday.

 

[Wray2368]

Thank you for the response, I greatly appreciate your time. Just for clarity sake, I promise to make this my last post, an individual would need to present with both LMN and UMN signs before an ALS correct?

 

[ShiftKicker]

Have a look here: The ALS Association for the criteria.

 

[lgelb]

PALS can be diagnosed clinically without showing UMN signs. But from what we've heard, there's no evidence you have either UMN or LMN signs.

Let us repeat: you have had 2 clean EMGs and I'm surprised you got someone to do a 3rd. But if you want to "ease your mind," don't hang out here with people who really have ALS. Hang out with people like you, that don't. It's a better group for you.

PS -- I can't extend either my middle fingers fully, i.e. make them look straight, either. Life goes on. As for the jaw tremor, I would only ensure that you've been evaluated for TMJ dysfunction, since a night guard could help.

 

[Wray2368]

i in no way wish to be contentious. But I have had a clinical exam that showed clinical weakness. The two EMGs prior was to test a different side of the body for perceived weakness. It is the same Neuro as before with the exception of it being a PA as opposed to the actual neurologist. I am just wanting to make sure that the PA is giving accurate information since I have never heard of a situation of BFS causing actual clinical weakness. Again I appreciate your time, but this has effected my ability to play with my kids and to do day to day tasks so I want to make sure I am asking the right questions to the physician, in hopes of getting a solution.

 

[lgelb]

We appreciate that this -- whatever it is -- affects your daily life. Our advice is, after this next EMG, to go back to the internist and regroup toward a dx that might or might not be neurological. If you don't give professionals leeway to consider all the options, you are unlikely to reach the truth.

The fact that the non-symptomatic side was done is not a concern. EMGs can show nerve dysfunction years before you show symptoms. ALS affects all the voluntary motor neurons.

 

[Wray2368]

I had my emg today. Tests came back normal but my clinical exam re-confirmed the hand weakness. I am going to go ahead and assume I am completely clear if ALS, but if anyone has any recommendations for a next step or theories I would be glad to listen. I am already scheduled for a follow up in 8 months to track progression. Again thanks for your help and time by answering my questions.

 

[Wray2368]

8 weeks not months.

 

[Nikki J]

As suggested see your pcp to decide the next steps. A normal emg ( and ncs?) would take a number of things off the table ( such as ALS) but perhaps an evaluation by a hand specialist might be appropriate

 

[Wray2368]

I had a follow up with my PCP and he noted a Jaw jerk, since I have been having issues with a fine jaw tremor for well over a year now. He is going to have me ask the neuro about it in my next visit. From what I have seen this is a UMN sign correct? Would this explain the hand weakness but clean emg? The clear emg would still clear me of ALS though right? I am just concerned that the neuro never jerked my jaw reflexes before since Inhave had such an issue with it.