48 Year Old Male With Tricep Atrophy

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Chuck1302

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Joined
Jun 23, 2019
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15
Reason
Learn about ALS
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00/0000
Country
US
State
MS
City
Tupelo
Hi everyone. First of all let me thank you for your continual answering of questions from people like me- that are worried they have ALS. I understand that most of you have become experts in this field from having ALS yourself or because you a caregiver to a loved one that has ALS. That you could take the time to still help others under either of those circumstances is most admirable. I tried to read through a lot of the threads already posted but symptoms vary so it's hard to find one that describes mine. So here goes-

About a year ago, I started having random twitches. My eyes, shoulders, legs, all over... They would come and go. One in my leg lasted about 4 days and was almost non stop. Then, as suddenly as it appeared, it was gone. During this time I started to google my symptoms and you all know what that lead to. I researched enough to know that BFS was probably the culprit given that I had no muscle weakness, atrophy, or any other symptoms.

Fast forward to the first of May this year- all of a sudden my left shoulder was in a complete knot. The pain went from the base of my neck/shoulder down the back of my arm, forearm, and I had pins and needles in my thumb, forefinger, and middle finger as well as twitches in my shoulder and tri throughout the day. The pain was very intense during the night and first thing in the morning. Once I got up and moving it became tolerable.

Went to my general physician and got a series of steroid shots, anti-inflammatories, and muscle relaxers. No help. Went for massage- the therapist could feel the knot in my shoulder and would work it out. For half hour or so afterwards, it felt pretty good but would then seize right back up. Finally, after a month, my shoulder returned to normal but still left some pain in my left tri and the pins and needles sensation in my thumb and two fingers and some random twitches.

I notice my twitches stop when I'm active and return when I'm at rest. They seem to stop as I drift off to sleep and only return after my morning routine. During this time I had gone back to google... I was concerned about the twitches and the pain left in my tri. I remembered that twitches mean nothing without atrophy so I decided to do a little dumbbell test. With a dumbbell in each hand, and in a standing position, I performed an isolated tri exercise where I bend my elbow 45*, dumbbell headed down towards my shoulder, and back up. My right could do 30lbs, my left only 15. Now I'm scared. I start examining my tri's in the mirror. They look the same. But, If I flex my right tri and feel it with my left fingers, it's hard. When I do the opposite with my left, the muscle is not nearly as hard. Not soft but definitely softer. In my mind, it's atrophy for some reason. And it twitches... Continual flexing makes it pretty sore and causes the pins and needles to start up in my fingers.

Then, a week ago, my gf and I are out to breakfast. I get up from the table and I notice both legs, upper thighs, just feel extremely weak. Like you had just done a ton of squats and had noodle-legs. I'm a slim guy, 5'11, 160lbs. I used to work out just to stay in shape, not a body-builder by any means. Not having worked out in a year or so I ran down to my basement to see "how weak" my legs really were. To my surprise, I squatted 205lbs. The most I've ever squatted when I was really working out was 245lbs so I was satisfied that's about what I should be squatting given my time off. But, my legs still fell weak and have random small twitches a few times a day.

I've gone back to my GP for a referral to a neurologist but we only have one neuro clinic where I live and they are extremely hard to get in with- a month or longer. Meanwhile I'm driving myself crazy with google. Google says the symptoms begin very slowly, hardly noticeable, etc- I'm sure you've all seen it. But I notice the sticky here compares muscle loss to that of losing your wifi connection- that the muscle either works and you don't have ALS or, the connection is lost, and therefore the muscle doesn't work and begins to atrophy.

I would really appreciate some of your guys expert opinion on these symptoms because waiting a month or so for neuro is just is extremely stressful. Thanks so much.
 
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Hi Chuck,

This doesn't sound like ALS to me. When I hear about localized shoulder pain that's worse at night and on waking up, naturally I'm going to think about your bed position and support, and wonder if it's time for a new mattress, overlay and/or pillow.

The perceived weakness when getting up from a table you were likely sitting at for a few minutes at breakfast makes me wonder about how much you stretched out after possibly lying in bed all night in a suboptimal way, or whether your sitting position put pressure on the same area that the bed does. And though your gf may sleep there too, no two people are the same.

I disagree with the notion that early ALS symptoms are hardly noticeable. Becoming unable to do something is rather noticeable and what sends people to the doc. I appreciate that your thighs felt weak when you got up from the table, but you were able to get up, and have you felt quite that way since?

As for the discrepancy in how much you could lift with your triceps and how developed the muscle is, I'm assuming you're a righty, but either way, it's not unusual to have a difference and with pain in that area, you could be holding back.

While you wait for your neuro appointment, I would re-evaluate your sleep surface and seated position (the culprit could also be a chair or couch), and ask your doc for a PT evaluation for your L arm, and labs to look at things like blood cell counts. Also in re steroid shots, just a note for future readers that too many too frequently can cause joint damage, so there is need for caution with that approach.

Best,
Laurie
 
The problem in your neck, left shoulder, and arm sounds mechanical. Physical therapy and massage is the treatment of choice for this. Localized atrophy occasionally results from mechanical problems. No one is perfectly symmetrical.

Twitching is common, nonspecific, and meaningless in the absence of muscle function failure which you have not described.

Ditto what Laurie says about the perceived weakness in your legs.

None of this sounds anything like ALS.
 
If you've somehow hurt your shoulder, that could translate to weakness and atrophy. I played a lot of sports and lifted but never realized I had a torn rotator cuff until I injured my neck and my doctor did an MRI on both my shoulder and neck (years ago.) My rotator cuff had a 50% tear and my c-spine had herniated disks at c-5/c-6. The pain and weakness was intense. PT, massage and traction finally got me back on the golf course.

I don't think anything you posted sounds like ALS and I also don't think you have benign fasciculation syndrome either. Lots of people twitch. In ALS twitching is usually very localized at first and in BFS it is constant and extremely widespread.

Just the fact that you had perceived leg weakness and squatted 205 debunks clinical weakness in your legs. I used to easily squat my weight. Now I can't get up from a squat with no weight.

I have another suggestion. Go to your doctors and stay off Google.
 
Thank you all so much for taking the time to respond. I really do value your responses- much more than what I can read on google.. LOL I know better than to google symptoms and vowed to my gf that I never will again! She's a saint and I have just about driven her as crazy as I have myself over the past few weeks.

I was being rational about most of what I read on google until I noticed the lack of strength and softness of that tri. I can't curl as much with my left as my right, naturally, but it's only a few lbs and my left bicep is still as hard as the right. That was the point where I started to freak out.

Thank you all again for your responses. It has definitely helped ease my mind a bit. Until I can get in with neuro I'm going to start some light PT, continue with massage, and stay off google! I'll report back once I have some info from neurology.
 
I finally got scheduled with a neurologist on July 9th. I have a question about twitches- I never notice them when I’m active. And I do try to notice sometimes trying to see if I I still have twitches when active or if I just don’t notice them due to whatever activity I’m doing. But I do notice about 5 minutes after being still, they start. Lots of random ones- could be anywhere. May just be one or two twitches then on to somewhere else. But this past week I have noticed consistent twitches around both ankles and sometimes the bottom of my right foot or toes on either foot. Again, all I have to do is get up and they stop. I don’t have any hand or foot weakness that I can tell. I guess my question is, do als twitches stop with activity or continue constantly?
 
Twitching is irrelevant. Even among people with ALS, not all of us notice twitching, and everyone is different. What’s more relevant to a diagnosis of ALS is failure to perform basic everyday muscle functions such as pinching, fastening a button, ability to stand on toes or heels, etc. If everything works, then the twitching doesn’t matter.
 
Got my EMG today, all clean. The neurologist could see a few fasciculations during the needle/nerve test but said they were benign. Reflex, balance, and strength tests were all normal except the lift tricep, neurologist could detect the weakness there. He is scheduling an MRI, he suspects a pinched nerve in my neck. Thank you all for your support when I was panicking. I feel kinda silly now for overreacting- I'll never, ever google any symptoms again, that's for sure!
 
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