Dull ache in my right shoulder

[Matt929999]

Hello everyone, I would like to thank everyone in advance for being so helpful on this forum. I am having several symptoms that I would like to run by everyone if I may.

I am a 35 year old male in relative good health, no medical history of anything major, I work in home improvement painting carpentry etc.

My symptoms began around 6 months ago in November. While working a job painting I noticed a dull ache in my right shoulder. Thinking it would go away I pressed on, it got progressively worse however and the pain took an entire month to subside. During that time I did not sleep at all (the pain was worse at night) and I started to have twitching in that shoulder/bicep/forearm. In early January the pain finally subsided and my ortho prescribed pt and said it was most likely an impingement in the shoulder.

From that time until the present I’ve noticed the following: Twitching has spread out of that arm into all parts of my body. Face/tongue/legs/feet/hands/butt/abdomen/back. (Oddly enough not so much in the injured arm anymore) I have also been told by my ortho that my rear delt has atrophied along with my forearm on the right side, also noticed that arm is a bit weaker than the left (odd because I’m right handed) my left calf has been bothering me as well, pain some days tightness it also looks smaller than the one on the right, my tongue is as though it’s not working properly (feels tired, sore sometimes, muscles below it feel about the same) will twitch in the side if I tent my cheeks. Also have had transient pain throughout my body

I saw a neurologist last week and he preformed exam testing in his office, said it all looked good, he looked at the atrophy and my tongue but did not seem concerned? I mentioned to him my concerns about ALS and he said we can do an EMG to ease my concerns but he doesn’t feel ALS is my issue. There were no appointments before June first however so I’m waiting now.

I had an MRI of my c-spine and shoulder yesterday ordered by my ortho, the results of which I will hear about on the 11th this month.

Guys I’ll level with you, I have a lot of balls up in the air right now and it’s really scaring me. I’m hoping for the best everyday I go through this and it’s really hard. My biggest question is can this atrophy be caused by my shoulder injury months back? I’ve been doing pt since Mid January and the muscles around the atrophied ones seem to be strenghtening, but not sure if the atrophied muscles are getting better. This is all so different from how I usually feel and I’m trying to cope, however I’m loosing my hope bit by bit. Sorry for the novel here but if anyone can lend me some knowledge and or advise going forward, I would be very greatful. Thank you all.

 

[KarenNWendyn]

Hello Matt. For starters, please read this:
https://www.alsforums.com/forum/showthread.php?t=26591

An injury can cause all sorts of localized atrophy in the surrounding muscles, and it can take months to recover strength. Recovery may or may not be 100%.

Don’t worry about the twitching. Twitching is common, nonspecific, and meaningless.

Pain also points away from ALS.

The most reassuring thing here is that your neurologist wasn’t concerned about ALS. I wouldn’t be either. It sounds like your evaluation is still in progress. Keep working with your doctors to get answers, but I wouldn’t focus on ALS.

 

[Matt929999]

Hi Karen, thank you for getting back to me so quickly. Your thoughts on my situation certainly mean a lot to me as I sit here in worry. I’m trying to keep my mind off of ALS, however it’s becoming more difficult as time goes on . Hopefully the MRI will show the cause of my shoulder/arm issues. Also I read the sticky you told me to read , lots of great info there. Thanks again.

 

[Matt929999]

Another question inconveniently popped into my head after my first post. When my neurologist does the emg of my atrophied shoulder will he be able to tell if the atrophy is injury related, or a result of MND/ALS ? Is there a distinguishable difference in the readings? Sorry I am not familiar with these tests. Thanks for helping me with this guys.

 

[KarenNWendyn]

Yes, ALS gives a very specific pattern on the EMG related to denervation and reinnervation. Additionally, other muscle areas in ALS will show similar findings.

 

[Matt929999]

Understood, thanks again Karen, this stuff is a bit confusing to me and I don’t want to go into my tests with incorrect info in my head. I sure you saw the part in my initial post about my tongue/face issues. Although I don’t slur my words (have been asking my wife if she hears it) my tongue feels tired, my lips and chin will twitch after use sometimes and the muscles under my chin are tight or weak feeling (can’t place it). On the side and front of my tongue I notice twitching if I press it out or to the sides then return it to its original position. Eating and swallowing are ok but talking is a chore and a stress currently. Does this sound like bulbar onset? Sorry to be a bother. Thanks again.

 

[lgelb]

Hi Matt, obviously we can't diagnose from afar but one possible explanation for your sudden shoulder pain followed by atrophy is brachial neuritis.

Your other symptoms could be referred pain/anxiety/lack of sleep.

I don't see any reason to worry about ALS, but you're going through the right process to find anything treatable. Try to act as if (i.e. stop asking your wife about your speech), live large, stretch, walk, hydrate, and see how far that takes you while you are going through tests.

Best,
Laurie

 

[Matt929999]

Thank you Laurie, I certainly will take your advise. Very much appreciated.

 

[Matt929999]

Yes, ALS gives a very specific pattern on the EMG related to denervation and reinnervation. Additionally, other muscle areas in ALS will show similar findings.

 

[Matt929999]

Hello everyone. I got lucky and had my emg early (2 days ago). I will post a copy once it gets to me. Long story short the neurologist tested my atrophied shoulder and forearm,and found no signs of anything in those muscles (no nerve damage, or fasicullations). Also he tested my leg, as well as my neck muscles because I mentioned my tongue issues ( he said there was nothing abnormal there either). As I am happy with those results, I have a few questions I would like some help with.



While I was being tested I felt no twitching at all (although later on after the test my normal twitching resumed). My question here is even if there was no twitching at the time of the test, would he be able to see als issues? Or do I have to be twitching at the time of testing in order for the emg to find problems.

The neurologist opted to test a muscle in the right side of my neck instead if the tongue. Is this conclusive when it comes to bulbar issues?

He only tested the one side of the neck ( said if there is a problem in the tongue) it would show up on either side). Is this correct ? Could someone elaborate on this a bit.

Thank you all so much in advance for the help it’s certainly appreciate.

 

[Nikki J]

It matters not at all that youweren’t twitching. Really.

And yes testing one side and the neck is absolutely fine for bulbar/ tongue. There are three places to test and which one is up to the personal preference of the doctor. They only have to do one of them to assess

Congratulations! Best of luck finding out what is wrong and happy it isn’t ALS

 

[Matt929999]

<quoted text removed>

Thank you so much Nikki for the speedy reply. Was worried about him only testing the one spot since my tongue issues really bother me. I’ll post my emg when it comes so you or someone else can break it down for me. I’m not savvy with those sort of things at all. Again thank you.

 

[Matt929999]

Hey everyone. Still waiting for my emg results (apparently they take a while to process). Mean time a couple of questions popped up. Still trying to figure this all out.

Does bulbar onset generally present with body wide Fasiculations, or are they just present in the tongue head... ? I ask because my tongue is bothering me and I still have twitching all over.

I have a bit of reflux, also feels a bit like there’s something stuck in my throat. I haven’t spit up anything (water or solids) but it’s concerning.


Just to be thorough I plan to be tested at one of the als clinics here in NJ or PA. Does anyone know any free testing centers near my location NJ? I have insurance but it’s not good with out of network providers.

Thanks for all your help.

 

[KarenNWendyn]

Wait for your EMG results. I’m sure they’ll reassure you that you don’t have ALS. See your primary care doctor about possible reflux concerns. I’m not going to answer your questions about bulbar ALS because you don’t have it, and any answers we give you will just fuel your anxiety.

 

[Matt929999]

Thank you Karen for your response. I certainly have anxiety over my symptoms and this is why I ask the questions I have (not trying to be a bother). Again thanks so much for taking the time to respond.