Forearm Muscle Pain and Fatigue

boko9223

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Hello, I'm 36 and wondering if my symptoms indicate the possibility of MND. My symptoms are recent much increased twitching, especially in my fingers and forearms, after 15 years of body-wide twitching; and the following other recent symptoms (within last few months): constant muscle pain in both my forearms, especially after using them or putting pressure on them, some associated nerve pain at times; body-wide muscle fatigue, especially for the left hand, with muscles shaking when I use them; hoarseness of voice and discomfort after singing; increased phlegm, so that I have to keep clearing my throat, which seems to be part of the hoarseness problem; tiredness; insomnia; palpitations. Doctors so far have found no clinical weakness, and all my reflexes are normal, including Babinski sign.

I'm reluctant to get EMG for various reasons, but are my symptoms enough that I should do it anyway? Or should I be looking for things more like myositis, long covid, or fibromyalgia/chronic fatigue?
 

affected

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I'm wondering what your doctor said about getting an EMG?
You don't have a single ALS symptom, and I am thinking that your doctor may have told you this after that normal examination.

What is your doctor suggesting they feel is going on and what diagnostic path is best for your situation?
 

lgelb

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15 years of twitching isn't an ALS prelude, nor does your current condition sound like one.

A rheumatology evaluation, presuming your PCP agrees and has done all the standard labs/exams, could be on point.

After that, long Covid might be a consideration as well.
 

boko9223

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I have seen multiple doctors and they are all telling me to get an EMG. They don't seem to know what it is, but they said that it is unlikely at my age that I have MND but that they want to make sure. Also they really like EMG's because they help diagnose multiple things. The problem is I really don't want to get an EMG due to a very slight risk of complications and also small risks of false positive or negative, plus it hurts and it's stressful, and I don't handle either that well. I guess I'm not much of a risk-taker.

I'm awaiting CK blood test results. I wanted to rule out myositis with more antibody and enzyme tests, but they want me to get EMG first. Sigh. So, I have one scheduled in 13 days. I will report back if I decide to get it done. An option I have is to see the neurologist that would give me the EMG for a consult first, but the doctors thought it best I get EMG first to not delay things. I appreciate the comments here. Thanks.
 

Clearwater AL

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Boko, this is stunning, some of what you have written, also referring going back 15 years.

*“constant muscle pain in both my forearms, especially after using them or putting pressure on them, some associated nerve pain at times; body-wide muscle fatigue, especially for the left hand, with muscles shaking when I use them; hoarseness of voice and discomfort after singing; increased phlegm, so that I have to keep clearing my throat, which seems to be part of the hoarseness problem; tiredness; insomnia; palpitation.”

*(“constant muscle pain in both my forearms, especially after using them or putting pressure on them,”)

*(“plus it hurts and it's stressful, and I don't handle either very well.)

You don’t seem to be handling your symptoms too well either.

*“plus it hurts”

A million people before you have had EMGs and tests more painful that an EMG through the neurological diagnosis processes.

If you’re worried you may have an MND… “you gotta do what you gotta do” or just live with the second paragraph above.

I hope you find the fortitude to get that EMG… to answer the questions you ask.
 

affected

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TBH if that is your reasoning for not wanting an EMG, I don't see why you are here and what there is to discuss really.
Your doctors don't believe you have ALS or an MND, and we certainly don't.

All our members here have had at least one EMG, it might be time to discuss this elsewhere, we can't truly help.
 

KimT

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I've had more than 20 EMGs as part of a teaching project. In other words, I was a lab rat at Mayo Clinic for residents to practice on. I've never had any complications. The needles are like acupuncture needles. I had very muscular arms and legs. The needles rarely hurt. Nowhere near as much as a dentist needle. I was relaxed. If your doctors want you to get an EMG, get one. EMGs can reveal so much more than ALS. Most of them do. They do it in conjunction with a nerve conduction study and the two of them together will help the doctors figure out what's going on.
 

boko9223

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Thank you for your advice. I saw a very good neurologist today at an ALS clinic. I had been scheduled for an EMG first, then consult, but I was still apprehensive about getting an EMG, particularly about the risk of getting a false positive, which can sometimes happen with Lyme, which I have. She did a full examination, spending a lot of time with me. The only thing remarkable was no reflex in my biceps, and a small reflex in my triceps. But she was not concerned about that seeing that everything else was normal.

So, she didn't think an EMG was necessary if the nerve conduction test went well. She said it came back awesome! That was a relief. The test really wasn't that bad. She did order MRI's for head and neck, so I'll be getting those sometime soon. I'll report again after that. So, I'm not too worried. It is certainly not ALS and very unlikely PMA since nothing other than the absent reflexes showed up. She said if I had bulbar (since I have swallowing issues), even EMG has a hard time detecting that. And if I had carpal tunnel, my pain is not serious enough to get an operation for it anyways.
 

affected

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Terrific news - I hope you return to full health soon.
 
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