Fasciculations, Hand Atrophy & Curling Pinky Finger

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ConcernedSympt

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33 year old male and grateful to have found this forum. I greatly appreciate your help in advance. I woke up about 6 months ago with twitching of my quadricep in my leg. Over the course of the following days, I started to twitch in many other places - shoulder, calfs, eyelid, and eventually even my fingers and toes started to wiggle or move on their own. I have had two EMGs, an MRI, and no real diagnosis, but my twitching has gotten much better but still feel the occasional "pop". There was one point about a month ago where the twitching in the bottom of my feet were so intense I could see "waves" through the arch of my feet.

Approximately one and a half months ago, I was riding my bike through a doorway and clipped my right pinky finger (ouch) between my handlebars and the doorway frame. It definitely hurt, but seemed to get better over the following week or two. - Then about 1 month ago, I noticed that that exact pinky finger started to "curl in" to the rest of my fingers. (it now sits under my ring finger when I close my hand). Additionally, on the outside of that same hand, on the back of my hand by my pinky finger, there's a crater, like a sunken in spot. My pinky still has full function, and I can still grab a pull up bar and hang from it with just that hand, etc - but I have noticed soreness on the backside of that hand. The soreness happens even when I am just looking down at my hand and moving it from left to right at the wrist.

I have read some cases in the "recently diagnosed" forum, about folks who have had negative emgs and then sometimes even 3 or 4 emgs later, 3 years down the road they test positive for als.

My Questions:
Is this possibly ALS, or 100% yes, or 100% no?

Do you think I should push for a 3rd EMG?

Does Atrophy or Weakness come first? (and is this absolute, meaning is it always one before the other, or does it vary?)

Aches and Pains, I feel some aches/pains in my pinky and forearm as well as my wrist - mainly depending on how I move them. Does this sound more like some sort of injury?

I understand this might be anxiety induced, but given these recent pinky finger issues after 6 months of body-wide (intense) muscle twitching, it does feel strange that my pinky finger started to curl in and then receive a "dent" that is on the backside of my hand on the other side of my pinky finger, (noticeable by my loved ones not just me). ALS sounds like a very complicated disease to me and so I really appreciate your help.
 

affected

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Sorry you are having these concerns.
No one is going to say 100% anything, but truly you must have trawled hard to find the threads you report.
Please read this through carefully, it is our official position.
Return to your doctor, pour out your concerns so they can be fully addressed.
I truly hope you find answers soon, but you need your doctors to do the work, not google.
 

Clearwater AL

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Concerned, you've had two EMGs... it would help us if you would post
the Summary/Conclusion found at the bottom of your most recent EMG.

"I understand this might be anxiety induced,..."

I'd give that far more consideration than ALS. But do post the S/C if
you wish.
 

ConcernedSympt

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Both EMGs were completely normal with no odd findings. One of the doctors mentioned they could see a few fasics but nothing alarming. I think the "divot" on the backside of my right hand along with the pinky finger curved inwards along with the muscle fasciculations for the last 6 months is what is most concerning. The EMGs were both on the same side of my body as that pinky finger, though when they did my hand, they did the muscle closer to my thumb vs the one near my pinky finger.

It still feels worrisome as I am scared that the divot is from muscle atrophy as it's definitely noticeable, as well as concerned that it could turn into a different emg result if I go back to get a third emg.

Any overall thoughts on my situation? I have another followup appointment scheduled in a month but the waiting is challenging.
 

ShiftKicker

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Hello there-

This sub-forum can answer basic questions, but can't really be used as a place to solicit diagnoses. You can find a list of conditions that share some of the symptoms that bring people here and a very extensive explanation of what ALS is and is not, here: Read Before Posting.

We really do expect folk to work with their doctors to get to the bottom of their issues as we are not a medical resource, just a place for people who have been affected by a diagnosis of ALS/MND to come for support and very specific resources for ALS. If you are struggling with anxiety leading up to your appointment, there are a variety of online supports for that, as well you can approach your medical care providers for resources. You deserve support as you work with your doctors to track things down, but I'm afraid that's not what this forum is geared towards.
 
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lgelb

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You had a crush injury. It is very common for consequences such as a damaged nerve, tendon or ligament, or a small bleed or clot, to reveal itself at a delay such as one month as you report.

I would suggest you see an orthopedic surgeon to rule out something treatable. S/he might recommend hand therapy. But there seems no relationship with that and the widespread twitching that essentially means nothing.

As Tillie says, we seldom say "never," but I don't see any reason to return for a third EMG unless a clinician recommends one, nor any reason to worry about ALS.
 
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affected

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If you had read the post I directed you to, (which took terminally ill people many hours of their precious time to create), you would have seen that dents and divots are not atrophy.
You might want to get a new doctor if you truly cannot trust the one you have, but continuing to ask here for confirmation of your fears that all the medical evidence is wrong, is not going to be constructive for anyone I'm afraid.
I wish you the very best as you work with doctors to solve this.
 

ConcernedSympt

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I am now 6.5 months since the body wide muscle twitching and I had a third EMG and it is still normal, but on that same right pinky finger, on the back of my hand (Dorsal interossi, anatomy picture attached), I now have very noticeable atrophy. The Muscle in between my tendons on the back of my hand near that same pinky finger is completely sunken in. I went to see a hand surgeon and the doctor agrees that it looks like it's sunken in, but when he did strength tests noted there's no loss of strength.

All 3 EMGs over the last 6 months were conducted on the same side of my body (right), but that specific muscle in my hand was not tested... (all normal emgs).

I can still move my hand normally, but I have noticed that the "flexor digiti minimi" (2nd picture) muscle is very sore, as is my forearm along the ulnar nerve... it basically feel like I worked it out too much but I haven't.

Question:
1. In ALS, if atrophy occurs, is any soreness involved? Almost like a feeling you worked out the muscle too much, or pulled the muscle? (when I press on this "flexor digiti minimi" it is sore)

2. I know it's not typical, but could atrophy occur before noticeable muscle weakness?
 

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affected

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You have been cleared of ALS, so continuing to ask the terminally is really not appropriate.
Answers
1 no, not at all - read the post I keep directing you to
2 nope, you are clutching for straws

Please, discuss this with your doctors.
 

johnny5

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Think of this. There are around 85 million motor neurons in the average person's body. ALS will kill them off, sometimes by handfuls every day, other times a few at a time. Either way, these connect to muscles, and muscles are what keep your body moving, how your body manages movement, weight, and things like balance. When the muscles disappear, the joints are affected because muscle keeps them fit, balancing the weight they bear, so yes it can cause pain. The question is how fast and which joint. Some pALS will wake up one day and parts will not move. For example, your thumb does not move or you wake up with a foot drop. While others of us slowly lose strength and mobility, gradually getting weaker and weaker until we can no longer stand or walk anymore ... It all depends on how fast we progress. My brother went in 3-4 months (bulbar), while I have been declining for 7 years (limb).

EMGs talk to the Neurologist about denervation and reinnervation. Denervation is what ALS does, it kills motor neurons. Reinnervation is what your body does as it tries to recover from the loss of nerves/motor function. Surrounding nerves attempt to take over for the lost nerves. It tells neurologists that ALS is a possible diagnosis when they find de/reinnervation, but cannot prove ALS is the cause because many different conditions will mimic ALS. Until all of them are ruled out, your neurologist cannot "rule in" ALS. By now you know there is no test that anyone can take that proves ALS. But at this point, without denervation and reinnervation, the odds of you having ALS are like the odds of winning the lottery.

You are clutching for straws. You need to get answers, yes, but those will only come through talking to doctors, trained professionals. If they told you that it is unlikely that you have ALS, the next question is what it is. You already know what it is not.
 
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ConcernedSympt

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Last question - I decided to do a quad workout and do wall sits today... I haven't been in the greatest shape lately... So I only did 4 sets of wall sits for about 80 seconds each.

Keep in mind I had a clean EMG 16 days ago... but 3 or 4 hours after my workout, I flexed both quad muscles and there is a rippling effect of twitching across each one of them... It literally looks like waves of nerves are firing through the whole muscle only while I hold the flex of the muscle, and then when I release the muscles they stop completely.

This is different than the twitching I have had for the last 7 months - all of those twitches have been involuntary - though they have definitely happened dramatically in my quads, stomach, back, eye, arms, calfs, feet, hands, etc.

My last question - Is this new twitching in "waves" that's occurring only during when I flex the muscles cause for concern??
 

lgelb

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First we were keying on the hand/pinky, now we have the quads...and in neither case, a functional impairment. There are all kinds of reasons for what amounts to mildly hyperactive or jittery muscle fibers, if you will, from dehydration or too little sleep on up (and including "no reason") but again, that is not ALS. As others have said, keep in touch with your doctors, but there is no reason for you to be here.
 

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nope, still not going to be ALS.
please do go back to your GP and get help working out what is next, but let this go. again, returning to the terminally ill at every scare is not appropriate now.
 
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