EMG Question

[Elbowtwitch]

Thank you to everybody for your time. I truly appreciate the time of the people on this board, and I will make this as brief as I can while hopefully including all relevant info:

• I have had BFS for about 10 years. Twitching started in 2011 but after 2 clean EMGs I stopped worrying about it. Get twitching here and there with hot spots lasting up to two weeks.
• October 2021 - start noticing right elbow pain at the gym.
• Late November 2021 - noticed twitching in inside of right forearm on thumb side a couple inches below the elbow. No sensory issues. Told it is flexor carpi radialis. Did not think much of it but it has been going 24 / 7, all day every day since. Sometimes I can feel it and sometimes not, but if you look at it for 10 seconds (usually much less) you will see it, although usually very slight. Probably 100x/minute (resting or flexed) including as I write this over three months later. FAR different than any past BFS episode. Have also had increased twitching that I can feel in other areas (mainly right bicep and bilateral scapular), but would not think those unusual absent forearm issue. Saw GP in late December. She was not worried but gave referrals to neuro and ortho. Blood labs all normal.
• Early February 2022 tests
  • Cervical MRI shows slight degeneration at C5-C6 and C6-C7 but otherwise normal. Nothing that would cause twitch. Elbow MRI shows tennis elbow and mild bursitis with effusion.
  • NCS shows mild carpal tunnel down by the wrist but that's it. Nothing that would explain twitching.
  • EMG (which I paid for out of pocket; performed by Dr. but based on his online bio, I think an osteo but not a neurologist; it was the first place I could get into) comes back all normal. No innervation, denervation, PSWs, or fibs. Normal recruitment. Tested right arm in 8 places from hand to shoulder, as well as under tongue. The only thing that was unusual is that when he put it in the twitching muscle, it was literally like "white noise" there was so much activity. Other areas nearby had some of the popcorn sounds too. He did not want to say much, but I specifically asked him if he saw innervation, denervation, or PSWs and he said no. So I asked "that means no MND, right?" He would not just say no, all he said was that the tests only showed carpal tunnel. I asked if he saw the fasciculations and had an idea of the cause, and he didn't really answer. Heard him tell the NCS tech "no Hoffman's, but if whatever is causing it is early, that might come later." Seemed like he just wanted to get me out of there. Get the report and as noted above, EMG portion shows everything is normal, but I notice that the EMG has no "FASC" column that I see on just about every EMG report I've seen. Nor does he even mention the fasciculations in the narrative portion.
• Been doing PT for elbow. Therapist noted slight weakness in right bicep, which is pretty painful when flexing hard or straightening all the way. Have also began to notice slight weakness and pain in wrist. Not really improving thus far but no "failures" or anything like that.
• Got into insurance neuro a couple weeks later. Normal clinical reflexes and strength. She is not exactly sure what is going on, but her working theory is some nerve deep in elbow (not detected by NCS) is being irritated by elbow issues and causing twitching since my BFS history shows I'm prone to that anyways. Follow up next month. I asked her about the EMG report's complete omission of any mention of the fascics and she thought it was odd but did not really have an explanation for it.

While I am a bit concerned this is not really improving, I know many of my symptoms point away from MND and am accepting docs' diagnosis (and grateful for it) that this is likely all stemming from elbow injury. So, I am doing everything they ask, and am not here asking for a diagnosis. But since probably the most definitive thing ruling out MND is a clean EMG in the symptomatic limb, and a lot of people on this forum are very knowledgeable about EMGs, I just had a couple questions: (1) is it unusual to omit the "FASC" column, or any mention of fascics anywhere in the report when they are clearly observed? Any reason for doing so (if you know)? And (2) is it possible to have a doctor performing an EMG who is so inexperienced or unqualified that they would give "false normal" or "false clean" results? The place I went to holds itself out as specializing in performing these tests, and they certainly charge what a specialist charges, but as noted I don't think the administering doctor was a neuro. Sorry for the lengthy post, and thank you again for any feedback.

PS I can post the (redacted) report if it would be helpful.

 

[affected]

Hey, to your questions:
1. twitching means nothing, so don't worry about that column
2. not really, ALS has classic patterns on EMG

You haven't progressed in symptoms from your diagnosed BFS for 10 years to ALS and it's not likely you will, especially with all these clean clinical exams.

I think you need to very honest and open conversation with your doctor around why are convinced you are going to develop ALS.

This post might help you even more as it means we don't have to keep saying the same things over all the time.

Important - READ BEFORE POSTING! Answers to common concerns about possible symptoms

We will try to answer reasonable questions. We are not here to argue with you. If you announce that you ”know” you have ALS when the doctors say otherwise, or you have not bothered to see a doctor, your thread will be closed. It is not our place to try to convince you you are wrong. Neither...

www.alsforums.com

 

[Elbowtwitch]

Thank you very much for the response Tillie. I tried to be clear that I am not convinced that I am going to develop ALS. Have been very honest with all docs, and all tests thus far were ordered by them (paid cash for EMG because it was much quicker), so I'm certainly not chasing a diagnosis. Latest symptom is ongoing for months and very different from prior symptoms, and accompanied by weakness observed by the PT. You are right about the clinicals with the docs though, so point well taken.

I tried to keep my inquiry very narrow as to the issue with the EMG report (and probably included too much background). While I understand twitching by itself is not an issue, I assumed the column had some function since it is typically in reports, and neither doc really explained it. Nor did I see it addressed in the sticky which I have read several times, or in forum searches. I apologize if this was addressed elsewhere and I did not see it. The last thing I want to ask of the people here is to answer repetitive questions. Thank you again, and prayers to your family and you.

 

[affected]

EMG shows everything is normal.
I'd suggest if you are worried, ask you doctor why the column is missing, that would make the most sense. You paid for it after all, you can ask that.
Honestly, if you are not convinced you are going to develop ALS after twitching for 10 years, just go start living, please. I wish you the very best.