30 year old with abnormal EMG

[Xander]

I have been struggling with symptoms for the past 9 months.

I returned from Europe in October 2023 after suffering a cold. I started to notice that my left foot felt off. It did not feel numb or have any paresthesia's but something felt different. (I now interpret it as stiffness) I started to notice worsening coordination with my right hand as well. My foot feels spastic with repetitive motion and will flutter. went to a neurologist who did not find any clinical weakness but referred me to an EMG. There was difficulty getting into an EMG and I did not receive one until February. At that time I was feeling fasciculations throughout my body. I had recently started feeling weakness in my right thumb with grasping and pincer grabbing objects. I started to have other symptoms with concerns for tightness in my cheek anc difficulty with singing. An ENT showed that my focal cords were fully functional.

At the EMG appt the doctor was going to evaluate my left foot where my symptoms started but asked for my right hand to be tested due to the weakness. I received an unilateral Right sided EMG. The results were "mildly abnormal" with scattered fasciculations, a few increased insertional activities, and chronic denervation on my R first interosseous muscle. My regular neurologist said I did not have ALS and they believed that my right hand was from an injury I received.

I later found documents showing that the injury was on my left hand and I have misinformed my neurologist. However, hearing that I did not have ALS I felt great relief. My fasciculations went away as well as my concerns about my voice. I had no more anxiety. I still had weakness in my thumb.

Earlier this month I started to work out again and either before or after starting I noticed my left foot had gotten (feelings of stiffness) worse while right thumb has remained the same. I am having heightened anxiety again but have not had the return of fasciculations. I spoke with my podiatrist friend who noticed that I had an abnormal gait on my left side and it looked that I was compensating for weakness. She believes it is from a tight calf muscle however the majority of my stiffness is on the anterior side. I noticed my left foot tends to bend inward at rest and the big toe is slight raised and digs into my shoe at rest. I am searching for a new neurologist now as I have moved cities for a repeat EMG hopefully bilateral to include my left foot. I notice the awkwardness of my gait when I walk as well.

To summarize I have had 9 months of constant mildly stiffness and weakness in my left foot and weakness in my right hand. With some spasticity with repeated motion in my foot. With worsening gait. I do not have any pain or paranesthesia's. I do have anxiety related to it with some prior symptoms that were anxiety related (fasciculations and concerns about voice) that have resolved. I had an EMG which was abnormal and demonstrated chronic denervation of R first interosseous. I was told I did not have ALS but that was without EMG of left foot and them believing that a right hand injury was responsible for the symptoms (which did not occur I had a left hand injury).

I can post my EMG results if needed. I would love hearing opinions from people with experience as I pursue a new neurologist. Should I be worried?

 

[lgelb]

By all means post them for context, but whatever your injury hx was believed to be (and you may even now be forgetting something old), if you had ALS-specific abnormalities on EMG, they would be noted.

Many EMGs are conducted omitting the primary symptomatic area because they are looking for neuromuscular disease in which abnormalities in multiple regions are seen, as per the criteria for an ALS dx.

As well, L foot/R hand onset would be unusual. But it's easy to test the hypothesis that your L foot issues can be improved with physio, which any PCP can order, as you await any further testing.

 

[Xander]

Thank you for your response. Here are my EMG reports.

 

[lgelb]

As the report states, this is not an EMG that points to ALS, a wonderful thing. Given the distribution of mild abnormalities, I would think about trying therapeutic massage and also look closely at how you sit/work/sleep in respect to your use of your R hand and lying or putting pressure on your R side.

As to your L foot, bear in mind that if one side is feeling squishy, it's not unusual for your body to respond by expecting the other side to take up the load. Since your podiatrist friend has noticed a gait abnormality, it only makes sense to get a PT evaluation, and you could also discuss any possible ergonomics improvement there.

 

[Xander]

Thank you for your insights.