Pain and atrophy are late stages of als. Once the neurons in the brain die and the limb no longer receives the signal and the limb can no longer move does the atrophy and pain start. I really think it is a carpal tunnel thing going on. If you don't want to go to the dr, go to a store like walgreens and buy a wrist support/splint and try that for a while. If it improves then more than likely it is carpel tunnel.