Dirty EMG

[kd88]

Hello to all, I am 36 y.o male. Reading this forum for 4 months already but never registered because twitching is not hallmark of anything from what I've read.
So, my twitching began in Jan 2025, becoming a hotspot for 2-3 days, than reduced, than new hotspot and again.
I did first EMG of lower limbs in Feb, it was good.
That did EMG of upper limbs in March (except right hypothenar muscle.), it was good.

This month twitching reduced a little, but have perceived lightweigtness in left limb and swallowing issues (like a globus or tight thoaght) both can be unrelated.... but I've noticed some muscle wasting on the left FDI (maybe it was there? I don't know) and hypothenar "spasms" with dents on the right hand.
Today I've done EMG+NCS of both upper and lower limbs.
Doc started from my right hypothenar and was really worring and even feared:
Quantitative EMG Abductor digiti minimi, Ulnaris, C8 T1:
Parameter Value Fibrillations +
Positive sharp waves (PSWs) +
Fasciculations None
MUP Amplitude Significantly increased
MUP Duration Significantly increased
MUP Polyphasia Pronounced
Type of interference pattern Not investigated
Muscle pattern Normal
She told if she will find any other muscle with the same picture I will need to visit local ALS clinic.
But other muscles appeared pretty normal.
She still was confused and in DX wrote: possible nerve compression in C8 and orderd neck MRI.

Im pretty sure that I have no neck issues, but will do MRI ofc...
If MRI will be clear - Just need to wait until it pops in some another muscle and thats it?

I'm just don't know what to ask..is this EMG values are look like ALS? Answer is obvious..
Maybe would like to listen who had something similliar?..
Nobody will give DX with only one muscle..but Im crushed because feeling that it can't be anything else..

 

[lgelb]

No one is diagnosing ALS from abnormalities in one muscle, as you say. But I don't know why you would say that it can't be anything else, when the hallmark of ALS is specific abnormalities in multiple muscles in multiple regions as well as demonstrated clinical weakness.

You don't always know if there is a problem with a nerve in your neck -- it's not like you would always feel pain there or anything. But even if the MRI is clear, no, that doesn't mean a ticking clock for ALS.

Let the process play out, but I don't see any reason to worry about ALS from what you have said.

 

[kd88]

Hi and thanks for your reply,
I've also trying to reassure myself thats was found only in one muscle, but this one is so dirty...I mean, when other people are trying to reassure somebody's EMG they are telling: If you would have ALS they you will see increased MUAPs with FIBS, acute denervation .. and all the things I have in my EMG in this muscle ...
Forgot to mention there were 10 Fibs and 8 PSWs in it...did't see this high values at any EMG among others..

 

[Nikki J]

The number is dependent on how long they spent on the muscle. As noted ALS is characterized by wide spread findings even in asymptomatic muscles. I had a very early emg with extremely isolated weakness and had typical findings in that muscle but also in unaffected surrounding muscles. The emg doctor spent some time testing until she reached normal muscles

 

[kd88]

Hi again, my updates.
Yesterday had an appointment with very skilled on EMGs neuro.
results in this muscle were little bit different:
Parameter Value Fibrillations None
Positive sharp waves (PSWs) None
Fasciculations None
MUP Amplitude Increased
MUP Duration Increased
MUP Polyphasia Mild

This doc was not concerned regarding ALS, told that on left hand I have mild cubital syndrome (which is seen on NCS), on the right hand I have only one muscle with neurogenic changes, which seems also related to my posture while work. (I'm software developer).

Also today came back my NfL bood work which is 5.7 pg/ml whith normal range < 13 pg/ml.

Should I stop worrying now? Read some stories when ALS was misdiagnosed with cubital\capral syndrome, thats the last thing which can't relieve me.

 

[Nikki J]

Yes.
Those people with ALS and carpal tunnel/ cubital syndrome had that AND ALS but what happened is they didn’t have the workup you did so once the ncs showed an explanation for their symptoms the explorations stopped