Atrophy

[Jodismith929]

(locked, poster multi-id)

Hi! I recently turned 40 years old. Here is my story and question:

Around August of 2023 I began to have twitching in my left hand (near thumb), left triceps, and also in some random places. It’s not in my right calf (where the atrophy is).

In December of 2023 I had some pain during running on hills and then noticed my leg (entire right leg) was smaller than the left.

From this point forward I have had near constant discomfort in my right leg: tight calves, super tight anterior tib, and unstable ankle.

The atrophy was confirmed by PT and doctor of my ankle and calf and most of my right leg.

I’ve seen my regular doctor, foot doctors, physical therapy for a year, and a nerologist.

I’ve had MRI of lower leg (below knee), foot, EMG of right leg and left leg (September 2024), NCS of right and left leg. All have come back clean.

I do not show any UMN signs like brisk reflexes or clonus according pT and neurologist.

I do have an autoimmune condition psoriasis.

A few few questions:

1. Should I worry about ALS with a clean EMG? Even though twitching still happening and atrophy still present?

2. If atrophy was from ALS would I have clinical weakness in the right leg by now? It feels off but I can still do things. Been this way for 1.5 years.

3. After 1.5 years of this would I be unable to walk if it was ALs?

4. Should I get another EMG?

Thanks for your help!

Note: it was suppose to say the twitching is now at the right calf which is where the major atrophy is.

 

[lgelb]

When you say psoriasis, do you mean psoriatic arthritis?

Has the PT improved anything?

Did you have an ultrasound of the lower leg to check for clots?

 

[Jodismith929]

I have diagnosed psorasis but they are not sure if I have psoriatic arthritis or not. I do have some of the symptoms like psoriasis in the nails.

PT has not really improved anything, I only go a couple times a month at most once a week and it’s mostly soft tissue work.

I have not had an ultrasound. Should I?

Do you think with a clean EMG and no UMN involvement or clinical weakness I am clear of ALS? Would I have clinical weakness if the atrophy was from ALS for this long?

 

[lgelb]

Yes. Atrophy caused by ALS implies that the nerves that move the muscles are dying/dead. If that were the case, weakness (defined as the inability to do things) would follow in close proximity, if it hadn't preceded it as happens in most ALS forms.

As for the ultrasound, the doctor that has examined the leg would obviously know more about how possible a clot is, but especially if there's been a change in texture/appearance/feeling since it all began, I would consider it potentially something to rule it out. An ultrasound can also see certain kinds of inflammation/infection at a different level than the MRI would show. You might even have a congenital anomaly that the running unmasked.

You don't mention having seen a sports orthopod -- the podiatrist is one thing, but that might be worthwhile as well.