Clinical Weakness

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Joe Samuels

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Hello guys. I had a 'clean EMG' about about 3 weeks ago. I did not have clinical weakness at the time, only perceived, but now I have genuine clinical weakness in my left thumb. I cannot even flex my thumb, hold a bottle, pinch grip, or press down on a simple spray bottle.
If this is ALS, the EMG would have been done too early because my EMG was supposedly clean in my left arm/forearm area and now I have developed genuine clinical weakness that is detectable by others. My thumb simply feels paralyzed and I have no idea what to do. This feels nothing like the perceived weakness that I had. My thumb doesn't work now. I'm so terrified and confused.
 
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ShiftKicker

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Past thread here: Question About EMG Results

Hi there-
It seems you're unable to believe your neurologist and your clean EMG that you are cleared for ALS, and the folk here really are unable to reassure you. It might be best you visit with your doctor and let them know you are unable to let your worry about having ALS go and speak with them about what your next steps might be. We can't assess clinical weakness, nor can we provide you any sort of meaningful help other than to ask you to keep rereading the "Read Before" and go see your doctor.

This subforum exists to provide some basic information, but we request folk work with their primary medical caregivers once they've been cleared, as we are not the ones you need to convince you have ALS if you still think you have it despite a clean EMG and clearance by a neurologist. I really hope you track down what your trouble is, but all things so far point away from ALS.

Please take care
 

Joe Samuels

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Thank you for your replies. I can no longer use my thumb in a certain direction. It's definitely not subjective. It has no push strength whatsoever. It is limp when I try to press down.
I do have another question.

Is clinical weakness progressive? or do you wake up one day and have little to no use of your thumb or another part? If it is progressive, how long does it take to develop to get to clinical weakness?
How quick can clinical weakness be? Can you be fine one day in a muscle (thumb), and the next day or two you are clinically weak in that muscle (thumb) as in not have any sort of strength to flex or bend it, or even push down on simple spray bottles or buttons?

Also is it possible for my EMG in that arm to be clean a month ago, and now develop clinical weakness due to ALS?
 

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Yes, weakness is progressive but often the various stages are not apparent as such. You should let your primary care doc know about your thumb so it can be tested by a hand specialist if needed. The odds are still very much in your favor against a real reason for fear.

We cannot answer how fast everything might go in ALS because it is different for each person and we don't want to worry anyone. I can say that impaired thumb movement in itself is not a typical onset. So my working theory would be that you have a more thumb-specific problem, or something else entirely different from ALS.

Best,
Laurie
 

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You must go and see a doctor, clinical weakness will be diagnosed by them and they will discuss what it means.
Please stop until you get medical advice.
 

Clearwater AL

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Joe... enough !

First paragraph, first sentence....

"I had a 'clean EMG' about about 3 weeks ago. I did not have
clinical weakness at the time, just perceived,"

*An EMG Just three weeks ago I

Key words.."... just perceived,"

*Until you see a doctor... that's just what it is !

My opinion... if you continue to post before you see a doctor
I think you are taking some kind of enjoyment/testing out of this
Forum. You've posted 8 messages. You've been replied to by very
ALS knowledgeable members.

Until then...
 

Joe Samuels

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Ok thank you very much. I think it was a strain of some sort because my thumb started to move after a couple days. It was pretty scary! I do have some questions regarding EMGs and ALS in general as a disease.

- So obviously, there is a first moment that ALS starts/enters someones body.
- In that first moment, will the disease enter parallel? I've heard that ALS is a parallel disease so whatever is happening on one side, is happening to the other. (EMG wise) Which is why most EMGS are done on only one side of the body I've heard.
- So perhaps on the first day that ALS enters someone's body/muscles, will the first ever signs of it be on both sides of the body?
- So if a muscle in the right arm was the very first muscle that started to have changes when ALS starts in someones body, will the changes be shown in the muscle in the left arm? Or does it take time to spread to the left arm or the other side of the body as a "parallel" disease?
- So the moment ALS is in someones body, is it detectable by an EMG? But if it was to be the first day of ALS to be in someones body, the EMG would only pick it up in that muscle in that limb, and nowhere else, even if ALS is a disease that is shows whatever is happening on one side is happening on the other?
I hope this question makes sense. Thanks.
 

Nikki J

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Lower motor neuron weakness is not detectable to the patient or clinically until a significant number of motor neurons die. So if your symptoms are potentially lmn like weakness and twitching if it is ALS it will show On an emg. If the emg is normal then the symptoms are not lower motor neuron in origin. It is untrue that ALS develops in parallel. If limb onset it starts in one limb. The second limb has an equal chance of being the parallel limb or the other limb on the original side.
if ALS is confined to one limb then it is possible that other limbs could still be normal though it is common in ALS to find emg abnormalities in asymptomatic areas. However you had complained of symptoms in your left upper extremity and had an emg there so why are you asking?
 

Clearwater AL

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Joe, you have done too much reading of old Threads on this Forum.
You’ve been on site almost everyday, I’ve followed some of your
many many searches going back years ago. Just two examples…

“Don’t wanna burst any bubbles” - March 26 2010… 11 years ago.
“Not sure it is ALS.” - March 22 2013… 8 years ago.

It’s almost like you are trying to convince yourself you have ALS.
For what? After getting a clean EMG just a few weeks ago.

You've started two Threads... questions then replies.

I often make this suggestion… copy and print your post above and
go over it with your Neurologist.
 

Joe Samuels

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Thanks for your reply Nikki J.
What do you mean by "if ALS is confined to one limb"? Do you mean that as a type of ALS that doesn't spread? Or are you referring about beginning stages of ALS where it affects only one limb? Or emg changes are shown in only one limb? Because I thought if it affected one limb, other limbs show EMG changes as well? Or that's only when it isn't really really early into the disease?

- I'm asking because I'm having symptoms on my right arm which are completely different from the symptoms on my left arm. I think an injury caused my symptoms in left arm, but my right arm has completely different start of symptoms that are different from my left.

- I have twitching that is spreading from my right arm/hand, arm, chest, rib, neck, jaw and even the right side of my face and ear. There is also limpness and weakness and loss of dexterity in my right hand and arm.
The twitching isn't even like the twitching that was happening in my left arm. It's almost constant, and very fine and tickling. The weakness also isn't perceived like the on in my left arm.

- So I'm concerned, that if this is an extremely early-stage ALS that is just starting in the right arm , it wouldn't have been caught on the EMG that was done in my left arm.
 

Clearwater AL

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In case you missed my post before yours...

"I often make this suggestion… copy and print your posts above and
go over them with your Neurologist."

Also which may be helpful... what Neurological facility did your EMG?

PS. According to your first Thread the EMG was extensive, leg, thigh, arm
and hand.

And., your first Thread was closed with...

"Closing the thread so you can get on with your no-ALS life, while considering PT. All the best."
 
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Joe Samuels

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My neuro is really busy and Ive tried emailing him, but he doesn't answer so I thought maybe some of you guys could help answer some of the questions :)
Oh no, the EMG that I posted was only done in 5 muscles in my left arm.
I went to a neurologist who performed EMGs and it was done by him in his office. But the paper didn't include fasciculations which I wondered why.
 

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Please realise you are expecting the terminally ill, paralysed, and on breathing machines to answer you instead? Please, go make an appointment with your neuro and discuss your concerns there.
 

Clearwater AL

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Just going by what you wrote....

"He stuck the needle in my lower leg twice, then thigh once. Then he stuck the
needle twice in my lower arm, then my hand."

???

Think about this... there may be a reason he doesn't answer.

As concerned as you are... call on phone and request another appointment.
 
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