Cramping, Fasiculations, Weakness - Normal EMG

[cvan]

Hello. I'm concerned I may have ALS.

These are my symptoms and progression...

3/14 - fasiculations start mildly in legs (mostly calves)

3/19 - fasiculations get very severe and happen any time I rest my legs in the evening or before bed.

3/25 - fasiculations happen all throughout body (more mild in upper)

4/5 - tension in index finger and middle finger on left hand (they are basically stuck together now) I can still seperate them but they are constantly under tension and pulling towards each other

4/7 - numbness sensation around right ankle starts with some toe twitches on occasion

4/12 - fingers in left hand cramp almost everytime I use them and get stuck in a straight position. Lack of mobility

4/15 - fasiculations in legs get more minimal

4/15 - stiff muscles throughout legs and hips

4/17 - mild twitching in ring finger on left hand starts (on and off)

4/21 - twitching in left ring finger starts and won't stop (always going when at rest) jerking and twitching in tricep and elbow area sporadically

I had an EMG done on 4/20 for all upper and lower limbs before my ring finger started twitching so bad. The EMG resukts were normal. My left hand definitely feels a little weaker though and will not stop cramping. There are some dents in my hand that I didn't notice before and there's definitely way less muscle than in my right hand. I'm just nervous because my grandmother passed away from ALS and I know EMGs are not always accurate in the early stages as I've only been showing symptoms for about a month and a half. I am 33 and I know it's rare but any advice? I also had the EMG done by a technician and not a neurologist.

 

[Nikki J]

The only people besides physicians who can do emgs in PA are physical therapists and the interpretation has to be done by an MD. What were the credential letters on the report? Ncs are usually done by techs not emgs

if your clinical exam did not show any abnormalities then the emg was not too early

advice ?follow up with your md

 

[cvan]

Their credentials were MSPT ECS

I was seen by a physicians assistant in a neurology office.

 

[lgelb]

An ECS is a Electrophysiological Clinical Specialist, a specialty designation for PTs that means they have passed an exam and have years of experience in NCS/EMG. They are fully qualified to perform a screening EMG.

 

[cvan]

Thank you! I went to the ortho today and he seems to think that persistent cramping in fingers everytime I try to grip or lift anything heavy is likely something neuromuscular. It's been going on for a month and my index finger and middle finger want to pull together with constant twnsion. I havent noticed any muscle waste. I can't use my hand very well and I'm also getting cramping on the underside of both feet and a numb less in my right ankle and toes. I'm not sure where to go or what to do next. Everyone I talk to seems to think this is textbook ALS. I'm trying to convince myself it may be anxiety but I have also had widespread twitching at first and now it's more persistent in my right leg and left hand where the other issues are. I'm just scared since my grandmother passed away from ALS. I'm thinking I should get another emg soon?

 

[lgelb]

I have the same advice as Nikki. "Everyone" is not a neurologist. The picture you report is not that of ALS, even before you consider the clean EMG.

What was the plan proposed by the neurologist that reviewed the EMG? There is no reason to think of another one that I can see. Nor does your grandmother's death (sorry to hear about that) have anything to do with your risk or treatment plan given what you have stated.

 

[cvan]

Thank you for taking the time to respond! I really appreciate it and I've just been so worried. I'm also getting twitches in my cheeks and chin now which is just pushing me over the edge even more. The neurologist recommend that I follow up with an orthopedic and they basically told me to go back to neuro. Some of these symptoms are new since I saw the neuro the first time. I'm trying to schedule another appointment now. The ortho just scared me when he mentioned the cramping is generally neuromuscular. He also said it sometimes takes a couple months for EMGs to be effective. I really do appreciate the support as this has been an emotional two months.

 

[Nikki J]

It takes a while for emgs in the setting of traumatic injury which is a different process than ALS. It makes sense that an orthopod would have experience of emgs done for injuries rather than neuromuscular disease. Cramping is non specific just like twitching I am sorry you have been so scared

 

[cvan]

Starting to worry about my balance. I notice the muscles above my knee moving more and more to maintain my balance when standing. Still mostly concerned about my left hand pulling inward with tension and my fingers cramping every time I grip something. I'm going for another EMG on the 22nd. Does anyone know if they can check the entire hand? Last time they only stuck the needle into one muscle by my thumb but that's not where the tension and cramping is. Sorry to be on here again. Just looking for help.

 

[Nikki J]

I don’t think so anyway the emg doctor knows where to check and it often isn’t where you think. My initial ankle issue was from a place in my leg and the emg showed issues in muscles that were not affected clinically for several months. Let us know when you have emg results

 

[cvan]

Just got back from physical therapy. She diagnosed me with foot drop symptoms even though im not dragging my foot yet (numbness along top of foot and toes/ankle) and spastic muscles in my fingers. My initial onset was fasiculations in my legs and became widespread about two weeks later. My right foot and left hand started giving me trouble around the same time. Another week later. I know it's generally unlikely for ALS to present that way. Am I correct in saying that? Also, I'm hoping that the emg will pick up even if my foot hasn't become fully foot drop yet. I'll share my emg resuukts after I get them on the 22nd but spasticity and footdrop isn't good if I'm negative for MS from my understanding.

 

[lgelb]

Many conditions, from old injuries to adult-onset muscle diseases, both more common than ALS, are associated with foot drop and/or spasticity. Even if your new EMG is abnormal, the cause of your issues is unlikely to be ALS, especially given bilateral features and your clean EMG in April.

Foot drop and numbness are not the same thing, either, so maybe something was lost in translation.

 

[cvan]

Thank you so much for providing some clarity! I'm praying for good news on the 22nd and I'll be sure to provide an update once i get it from my Neuro! My fasciculations have been much less severe over the past few days. Just a small twitch or pop in different areas of my body from time to time.

 

[cvan]

Hey everyone! Just circling back in hopes that it helps some of you all out there. I had my second EMG today. They only did the left side hand and right side foot where I've been having issues. The neurologist recognized a "winged scapula" and said that was the only muscle waste found. He recognized the cramping in my hand and seemed stumped but told me I would need to set up more time to discuss with him in the office to get to the bottom of it. He only checked a few muscles but said the EMG was normal. He said to follow up in a future visit since there's a family history but right now there is nothing concerning for the tests.