Should i be worried and pushing for more tests?

[Joanna888]

Hello everyone, 30 yo woman here.

To start, I had an EMG of my upper and lower limbs. I initially went to the doctor for tingling and numbness in my left hand and twitches all over my body which have recently increased. I’ve also had cramps in both feet (calves and thighs) for the past 2 weeks but no weakness at all.

Lower limbs EMG was normal and needle examination as well (attached).

As for my hands it showed this (attached)

- the left motor median study show results of very low CMAP amplitude,

- and Bilateral truncal involvement lesion of the ulnar nerve at the elbow level of moderate intensity. This nerve entrapment (compression mechanism) across the elbow is shown by a conduction motor bloc of 20% bilaterally

The rest was normal, and so was the needle examination.

My doctor explained that the nerve entrapment is cubital tunnel syndrome and needs surgery. But he didn’t explain the low more response in the left median nerves, and only said that it would be reassessed later after recovery from the surgery. I asked him if the motor response could be related to the entrapped ulnar nerves in my left elbow but he was doubtful and didn’t provide any more information.

I would also like to add that i am generally an anxious person. My father died suddenly 2 months ago and i was the one who performed CPR. And i’ve been dealing with a lot of stress and anxiety, so maybe this could explain the cramping and twitches. However, i live in a 3rd world country and we need to push a bit for medical attention, therefore i don’t want to be dismissing any medical issues that i should be focusing on.

So my question is mainly related to the combination of twitches with the low motor response in the median nerve of my left hand. I don’t know how worried i should be. Should i be concerned and pushing for more tests?

 

[lgelb]

The median nerve is involved in chronic carpal tunnel syndrome, which is very common. Sometimes splinting, resting the arm, and a different sleep position can help, but sometimes surgery (which could be combined with the ulnar surgery) is needed.

It is always good to get a second opinion on these kinds of surgeries if possible because much can be done with hand therapy these days as well and even if you have surgery, physio afterward is important to a good outcome.

Still, since yours is evidently only one arm, and with acute onset, trauma (like a fracture that is putting pressure on the nerve) should be ruled out. So I would try to get an X-ray of that forearm to be safe, especially if you're left-handed.

Twitching all over can be a response to what you are feeling in your arms. It is not a sign of ALS.