ALS or other Neuro? EMG and strange symptoms.

[Woodsman31]

Make 31 non-smoker, non-drinker, active lifestyle.

In early October I ended up in the ER for left arm pain/weakness and chest pain, high blood pressure, and mild tachycardia (120-140bpm). Blood tests, chest x ray, ultrasound, and angiogram all came back fine. They couldn't find anything wrong so doctors said likely anxiety/panic attack, “possibly” vascular issue. I was then referred to a vascular for possible TOS. Two weeks later I developed weakness in my left leg along with increased muscle fatigue on my left side and intense migraine. Went back to the ER where they took more blood and this time a head CT, apparent normal findings. Vascular ordered an MRA to look more in depth and insurance denied and said we needed an EMG/NCV done to rule out nerve issues first.

While waiting the next three weeks I developed insomnia, night sweats, muscle twitching/ rigidity and spasticity throughout most of my body. The muscle twitching has subsided for the most part aside from when I'm falling asleep but I developed these muscle tremors whenever I go to do certain movements. All of my movements feel extremely “stuttered?” I also developed a twitch where I'm having a single gasp of air and then forcefully swallow and my tensor tympani in both ears contract. Along with this what I can only describe as my head feeling loose? Lifting objects and weights like shoulder shrugs would cause intense tremors in my upper chest/neck area that you could see I was visibly shaking from. These have gotten better with more exercise it seems. However when i move my arms i still feel them slightly in my chest area and neck still is trembling in certain positions. Most notably when I bend over and move my neck up and down it feels as if it's trembling/tremors specifically when letting it down.I have been attributing these weird symptoms to the extreme sedentary state I was in for about two-three weeks of time compounded by anxiety and insomnia.

So I ended up getting the EMG/NCV at the neurologist the other day. It was only for the left leg and left arm (in accordance with the requests by the insurance company). The emg was dirty in some aspects and clean in others. From the elbow down It shows issues that lean toward carpal tunnel syndrome with some nerve entrapment at the elbow. No issues found above that. What confused me was the leg had an NVC issue in the tibial nerve with prolonged latency and the superficial peroneal nerve had slowed velocity. The EMG for the leg appears normal? The neurologist explained the most likely reasons for my arm nerve issues but said the leg was fine despite the abnormal findings. Searching the internet kept bringing up conversations of people talking about MS, ALS, Tremors, ect. and of course i was sucked down the rabbit hole.

I'm wondering if someone can make sense of my study and interpret it for me to understand and lead me away from thinking my issues are ALS related. Also any ideas on the body tremors and such? Not sure where to go from here.

Thank you for your time.

 

[lgelb]

I would ask about hand therapy for the carpal tunnel/ulnar issues both in their own right and because it's possible that there is some kind of nerve irritability that is affecting your leg. A PT can also help you think about ways to do carpentry that involve less repetitive motion.

But the really good news is that your sensory and motor neurons in your leg do not show any damage (I am not counting the peroneal and ankle findings because these commonly both come down to sitting too long/incorrectly -- it's worth it to check your positioning whenever/wherever you sit), so as the report and your neuro noted, there is no reason to worry about ALS or anything like it.

I would also track your sleep with a wearable if possible and ask your PCP about a sleep study. If you breathe or move abnormally in sleep, that could cause many of the issues you describe.

 

[Woodsman31]

Thank you for the quick reply. I see a hand specialist tomorrow afternoon to discuss the different options in treating the hand. My thumb has noticeable atrophy and my grip strength has weakened, but due to working out most of my life the weakness is still more strength than most have regularly so the docs weren’t taking it serious till this emg. It Sits around 130lbs on a dynometer where it used to be around 185lbs. so it worried me seeing a progressive weakening over the past year along with the fact that I’ve slowly transitioned to being right hand dominant.

Then these other muscle symptoms sent me into reaching out to this forum to see if anyone else experienced something like this.

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