New EMG?

[Titanium]

Hi
I'm 33 YO Male thin but athletic.
- since almost 12 months I feel some strange involuntary move in my tongue and ring in the ear.
- since almost 7 months fascics in my inner right foot began and shortly spread all over my body but it is still most intense in initial location.
- I'm pretty active person but since 7 months ago I fell shaky shortly after starting physical activity. And I'm not as sharp as I used to be in my moves and things I used to do with my hands.
- Deep tendon reflexes brisk on both knees...
- Also my feet response intensely to any un expected minor physical contact. It is bilateral.
- I do press unconsciously on my outer side of foot while standind. I notice this and correct It, but this correction doesn't last more than a minute! Looks to me some compensation for innerfoot weakness where some atophy is visible. This problem appeared since less than a year ago...
- And some right knee joint pain and stiffness I beleve could be due to weakness of muscles in that area.

An EMG conducted 4 month ago BUT only on 7 muscles: Quadriceps, Tibialis Anterirors, Biceps (all both sides), and under my chin, ALL CAME CLEAR (even in the time being conducted there was no twitches present in those muscles).
Since the muscles examined were not the ones bothering me all the time I suspected that the exam results would not be reliable enough. And now 4 month after EMG my twitches are worse and foot weakness more noticable and some visible atrophy and sometimes minor pain on my right foot slightly above my toe. (Image attached)

Since some people say conducting EMG and finding PSWs & Fibrilations is kind of art and needs patience, SHOULD I INSIST ON ANOTHER EMG ON MUSCLES NEAR ATROPHY SITE? (Maybe by someone else!)

REGARDS

 

[ShiftKicker]

Past posts here: https://www.alsforums.com/forum/do-i-have-als-als/42578-my-emg-conducted-right.html

 

[KarenNWendyn]

I responded previously. I still don’t think the story suggests ALS and I think the EMG was fine. So it’s very unlikely you have ALS.

Since you are concerned about ongoing changes in your foot, I would suggest returning to the neurologist for reassessment. Rather than focusing on this being ALS until proven otherwise, it’s more appropriate for the doctor to look at all the data with an open mind to try to determine what’s going on. S/he will decide if a repeat EMG is indicated.

 

[Titanium]

Thank you Karen,
Yes you helped me with your precious info about 4 month ago. I'll do what you said and will get neruo appointment as soon as possible.
Meanwhile, I quitted caffeine intake altogether and reduced my physical activity dramatically as result my twitches lessened, but just three days of mild work was enough to trigger twitches worse than ever! Besides, back then I have had no sign of atrophy, but now I have this thing on my foot. I even didn't know there are muscles on the foot near toe almost between toe joints. What is the name of that atrophied muscle and what does it do?! (PLEASE TAKE A LOOK AT THE ATTACHED IMAGE)
I can feel that I automatically do not put weight on my inner foot while standing...
I also have trouble gaining weight which lookes like a common problem with PALS.

So:
-Does it look atrophied to you too?
-What is that muscle?

Again thank you for your time...

 

[lgelb]

The hallmark of ALS on EMG is abnormal findings in muscles that are not bothering you. So there is nothing wrong in testing those other muscles.

As for the "art" of EMG, if someone is certified by the ABEM, which you can verify [well, whatever the Iran equivalent is], hopefully they're at least minimally competent.

 

[KarenNWendyn]

Your feet do look different. But it’s is hard to judge atrophy from pictures. Atrophy is best evaluated by having a doctor examine you, testing for strength and feeling the muscles.

I have atrophy in my feet, but they look different than yours. I can’t stand on my toes or heels , wiggle my toes, or move my feet from side to side. You really need a doctor to examine you.

There’s a good possibility your foot issues stem from a localized nerve or joint issue.

Good luck.

 

[Titanium]

Dear Karen and lgelb,
Many thanks for your reply,
I visited a neurologist again,
She conducted a more careful and thorough EMG and concluded that it is all clean, and since my symptoms are worsening she ordered a MRI and blood work for some enzymes and electrolytes. I guess their results will be ready next week and I'll seek your opinion then after...

I really appreciate your invaluable accompany and advises.

 

[Titanium]

Hi again,
My MRI report is all normal, and meanwhile my left foot that was showing atrophy signs and has constant intense fasciculations now is paifull and my knee is clicking.
My left arm has very strange heavy feeling when rising.
I'm wondering what could possibly my blood work show to justify these symptoms...
LYMY? (very rare in my country)
Vitamin D & Calcium? (Why so focused in my right foot exactly where it is atrophied?!)
Despite clean EMG, these questions doesn't let me rule out ALS in my mind...

 

[codyclan]

A clean EMG DOES rule OUT ALS. Focus your energy elsewhere.
Best wishes,
Tracy

 

[lgelb]

I would ask about physical therapy for the foot, and the therapist can also monitor it with you.

But Tracy is right, the answers are where you are.

Best,
Laurie