Atrophy + Twitches (UPDATE)

[DoctorR2D2]

I'm sorry, I'd like to adress this as an update, but my previous thread was close. (For anyone new. 25 y.o. male oral surgeon from Mexico)

I've been having some issues with my 4 limbs (twitching most noticeably). I was operated on a herniated lumbar disc, that was crushing my left s1 nerve, as it was showed on an MRI and EMG. It's been a month since the operation and my symtpoms just seems to get worse, specially on my hands.

My right hand got noticeable atrophy on the thenar eminence. It twitches, but the fasciculations are very fine and I don't feel them, but are pretty visible some times (they're on the base of my thumbs). I've seen to lose some dexterity on my both hands, but most noticeable on the right. Also weakness on the 4 limbs. I got really scared the other day when for a brief second I couldn't pickup my right arm. I've visited a neurosurgeon, and he didn't think I was clinically weak, but still wants me to get a 4 limb EMG since the twitches has been around for a month or so. (I will get the EMG in a couple or days or so :-| )

Any of you guys noticed any changes like this on your hands or so? I'll provide you with some photos. And I'll update with the EMG results. I'm scared, I looked at hands like mine and every single one of them were of ALS patients. Wish me luck and thanks in advance as always.

 

[KarenNWendyn]

Pictures generally don’t help us much, but from what I can see, your hand looks normal. What would be worrisome for ALS would be progressive failure, like inability to make a pinch, fasten buttons, pick up a coin, etc.

Since you’re having an EMG this week, please wait to post until after you have the results. Until then, there are many other things that can cause your symptoms with ALS being at the bottom of a long list and highly unlikely.

 

[DoctorR2D2]

Ok, thanks Karen. Yes I can still do all of those things I guess.
Fair well, I'll post the EMG until then, so please don't close the thread.

 

[ThroughThatValley]

Hi there.
Four limbs weakness (percieved) points away from MND. Twitches are irrelevant without the hallmark presentation that is real weakness.
If the motoneuron unit feeding your thenar muscle wat dying off and the latter already presentating real atrophy your hand function would be badly impaired. You cannot have MND atrophy without picking up that something is VERY wrong with the strenght of that particular area. Still able to pinch fingers against thumb? You should be fine.
Keep us posted.

 

[Clearwater AL]

DoctorR2D2, to help put your mind to rest concerning your hand.

One of the supposed early indicators of ALS is Split Hand Syndrome.
It starts with atrophy of the muscle between the thumb and first finger.

Then a separation between the middle finger and ring finger begins
to develop.

From the pictures you have posted, the muscle between your thumb
and first finger… is fine.

Take that off your worry list.

 

[Bestfriends14]

Bingo! Al hit the nail on the head. You being able to hold all your fingers like that does not show ALS. No ALS means no atrophy. When my husband tries to hold his left hand like you're holding yours, his pinky and ring finger split off from his middle finger and the rest of his fingers. Plus, his hand shakes badly when holding anything, and his pinky and ring fingers curl inward. He cannot clip his nails using that hand either. So, why do you think you have ALS again?

I certainly hope you are more level headed with your dental patients.

 

[DoctorR2D2]

@Bestfriendstilltheend

My concerns are because of maybe it could be an early presentation of the disease. I'ts pretty worrisome to me that coincidentally most of the fasciculations are in that sunken or atrophied area of the base of my thumb. The fasciculations get worse after I've used the muscle.

But I'll try to cope with the anxiety. My EMG appointment is on Monday April 1st.

 

[DoctorR2D2]

@ThroughThatValley

Thanks, what it keeps me nervous is that most of the twitching have focalized on that area. Specially after I've used the thumb. Thank you for your useful response.
And yes I'll keep you guys informed

 

[DoctorR2D2]

@ Clearwater AL
Thanks for your quick and useful response. Yes, i've read of that sign too, but since my thenar eminence is starting to look odd in comparison with the other one....
I'll have to wait to the EMG next week. But I'll truly hope you're right. Best wishes.

 

[ShiftKicker]

Please come back after your emg to let us know how it goes. If you wish to discuss your impressions of your symptoms, please note them down for the neurologist you are seeing, as they are the best person to tell you what, if anything they may mean.

 

[Bestfriends14]

According to your last thread, your fasiculations were everywhere: legs, arms, thighs, shoulders, plus you perceived yourself as having voice issues. You also had a clean EMG. So, are your fasiculations localised or widespread? Both of your posts point to widespread, therefore, it sounds anxiety related. R2, you don't have ALS and your EMG on the 1st will back that up. I look forward to hearing the good news of no ALS after the 1st.

 

[DoctorR2D2]

Yes, I still have fasiculations in pretty much the 4 limbs (upper arms, hands, tighs and calves), but they've started to get localized on my supposedly atrophied muscle, and also in my thumbs lately, that right thumb gets stiff too. I've also noticed I get weakness just from holding my cellphone in my hand. :/

The EMG is in two days, but I guess is gonna be a long wait to get the actual results. Thanks for your kind wishes @Bestfriends

 

[DoctorR2D2]

I've got the EMG done. I'd like to point out 3 things, for DIHALS to notice in case some read this in the future, to get a full picture, in case some of your DIHALS symptoms resembles mine.

1 I didn't get a nerve conduction study along. I don't know why, maybe it's because I pay this off my pocket. (I guess the NCS it's not that important anyway...right?)

2. Another thing to notice is that I won't get a chart with the usual "Fibs" "PSW" "Poly", just graphics and pure text report

3. The study itself was done by technicians, I've noticed some of you American folks got your studies done by your doctors themselves, this is not the case. The case will be only reviewed and signed by a neurologist with a neurophisiology subspecialty.

That been said. Results will arrive in 4 days at noon, I'll pray for the best.

 

[ThroughThatValley]

Dear friend,
thank you for the feedback.
The waiting game is the worst. I'll advise you to try and relax until you hear back from the neurologist. Take it one day at the time, one hour at the time if needed. Focus on sport, outdoors, seeing friends and work.
Give the twitching a shrug when you feel them, don't pay attention to it. Stop checking your hands and compare the muscles in each one of them.
I'm pretty sure the results will clear you out from MND, but until then it's a tough wait, I know.
Hang in there.

 

[DoctorR2D2]

The EMG finally arrived a couple of hours ago, I'm in shock.
As I've stated before, this study doesn't have a chart like my previous EMG of the legs, Just the text report done by a neurophysiologist. The rest is just waves unreadable to me (I'll post one anyway)

I'm pretty scared from what I can understand (and from what I've read from DIHALS post)

I'll try to translate it the best I can:


TECHNIQUE:
4 limb electromyography was performed in the muscles:
trapezius (C3-C4), deltoid (C5-C6), brachial biceps (C5-C6), Extensor digitorum muscle( C6,C7,C8), first interosseous dorsal (C8-D1), rectus femoris muscle (L2,L3,L4), Tibialis anterior muscle (L4-L5), Extensor digitorum longus muscle (L5-S1) and medial gastrocnemius muscle, bilaterally, with a concentric bipolar electrode needle. We studied post insertional activity, resting muscle activity, also at light and maximum contraction, morphology, duration, amplitude and number of phases of the Motor Unit Action Potentials (MUAP).

FINDINGS:
Post insertive activity was increased in some muscles with a mixed pattern of recruitment. At rest, sponteaneus pathologic activity was registered, it was of the fibrillitions type, with proximal predominance, with early/premature recruitment, during voluntary contraction, of the small MUAPs , short and polyphasics, with nicks on them.

CONCLUSIONS.
Neurogenic-myopathic pattern or mixed pattern that indicates inflammatory myopathic lesion.
Correlate clinically, paraclinically, as well with previous studies and complementary studies for diagnostic integration.


I hope Dr. Karen and all the wonderful members on the site can help me out here. I'm scared as hell for the fibrillations found. What bothers me is that there's no info on what muscles where the pathologic ones,

Please help me.