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wildcat1411

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I am a 28 year old white male. After playing basketball 5 months ago, I developed severe pain in between my traps (more towards the right), and it hurt to turn my head to the right. Shortly thereafter, I developed numbness in my index and middle finger (aware these aren't ALS symptoms, but bare with me). Fast forward 2 weeks later, and I lost virtually all strength in my right triceps and pectoral muscle, to the point where I couldn't shoot a ball into a basket from 3 feet away. There was (and still is) visible atrophy of both muscles. Muscle size and strength were entirely preserved in my right biceps, shoulders, hand and all over the rest of my body.

A cervical spine MRI was done a month after the instigating incident, and it showed right-side mild to severe foraminal narrowing at C6-C7, and mild right foraminal narrowing at C5-C6. While this might explain some triceps weakness/atrophy, my neurologist seemed hard-pressed to attribute disc issues at these levels to my right pectoral muscle and the clearly visible atrophy that was noted.

Fast forward to today, and my right triceps/pectoral are still atrophied; it seems that I've regained strength over time (I can now shoot 3 pointers almost without any trouble), but it isn't up to par with my left. All good right? I'd chalk it up to the disc degeneration if my symptoms continued to improve in this manner.

Problem is, I now experience severe right triceps fasciculations to a point where the twitch will literally jut my right arm forward. I'm starting to notice widespread, diffuse fasciculations all over the rest of my body. I am also experiencing random, severe cramping in my right triceps and right forearm if I move them too quickly. The tip of my index finger is slightly numb, but the numbness in my middle finger completely went away. I am currently not experiencing any pain. My right bicep appears to now also be slightly smaller than my left, but I haven't noticed any weakness there yet.

I had an EMG done last year on my legs due to fasciculations in that area; evidence of an acute myopathic process was found in my left quadriceps, which confused the doctor given the visible fasciculations (but none found on needle examination). I ended up doing nothing with those findings, and continued on with my life as there were no noticeable functional impairments at the time in my legs other than subjective feelings of fatigue. I also know that EMGs aren't necessarily 100% accurate and depend on numerous factors, including the examiner themselves, so I decided to let it fly for the time being.

At this point, I'm confused as all hell. The fasciculations + clear muscle atrophy are obvious LMN signs, but my presentation seems somewhat atypical of ALS presentation unless we're talking Flail Arm Syndrome. I'm curious to hear the community's thoughts on this.

Thank you very much in advance.
 
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Bestfriends14

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The same answers you got a year ago for your non-ALS symptoms apply today. No ALS, and that's good news. You've clearly ruminated about this disease for over a year when you've been told you don't have it. It's best to let it go and move on and be grateful for your young, healthy life.

Good luck to you and take good care
 

wildcat1411

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Thank you very much for your reply and well wishes!

The funny thing is, I actually haven't ruminated about this disease at all since my EMG last year; even when I dramatically lost strength in my right arm a few months ago, I chalked it up to disc issues, and ALS wasn't even on my mind. It wasn't until these widespread (and frankly, violent) fasciculations began in the past few weeks that I started to reconsider what was going on. The sudden unilateral onset + muscle wasting + diffuse fasciculations really got me thinking about this all over again.

Last question before I stop bugging everyone: based on your experience/knowledge, what is it about my symptoms (or lack thereof) that you think places ALS further down the list of possibilities? Is it the fact that I'm not presenting with pure muscle failure? Does atrophy usually precede or follow failure?

Thanks again!
 

lgelb

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I would get a second opinion on the current presentation of arm + the evidence of a myopathic process in the L leg -- you're in a hotbed of places to go like Rutgers or wherever you haven't been. Not because you should be worried about ALS, but because if you get a diagnosis of some adult-onset myopathy, myasthenia or another, or a conclusion that the L leg myopathy is stable, that might put your ALS/any other fears to rest and help you move on.

Atrophy usually follows weakness in ALS, but the greater point, to your question, is that when you've had weakness, it's gotten better. ALS doesn't do that. Flail arm has nothing to do with what you report, as it's a more proximal arm syndrome and the hallmark is wasting way beyond what you have. No basketball, trust me -- my husband couldn't pull on shirts within a couple of months.

In sum, we still won't see ALS here, but instead of hanging out here, you should be making an appointment to connect the dots and move on/ or if there are no connectable dots, establishing a relationship with someone in a neuromuscular center who can follow you if s/he think it's warranted.

Best,
Laurie
 
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