Help w/EMG Interpretation

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rtr909

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Hi all. I really waited to post here as a last resort out of respect to the community, but I’m struggling. I hope some of you may have insight into this.

I’ll start by saying a couple weeks ago I noticed my fingers on my left hand felt a little weak, grip has not been as strong, typing slower and sloppier. Typing and grip still an issue, noticed more difficult to hold my PS5 controller yesterday, harder to hold remote control etc.

So I went to neurologist who did exam, said exam was normal, ordered EMG probably to alleviate any concerns I had that it could be something serious. (I understand that exam would be normal, my grip is not terrible and it’s my outer, weaker fingers).

Had the NCS/EMG yesterday in left leg and arm, doctor who did it said results were “completely normal” in both areas. She only spent about 10-15 minutes of EMG portion on the leg and probably another 10 minutes of EMG portion on arm, I feel like it was quick because she did not expect anything. NCS was normal. I do not have actual results to share at this time.

Anyways, she only stuck needles in probably 4/5 points in my arm during actual EMG to test strength (forearm, upper arm, one in thumb muscle).

My concern is that I don’t think she tested the muscles my forearm that control my pinky/ring finger - this is the specific area that is feeling weak. I feel like she was focused on thumb and forefinger part of grip/hand/forearm.

So my question is, would the EMG show abnormalities in other parts of the arm/hand if there were abnormalities with pinky/ring finger that have not been felt elsewhere?

I understand I cannot get medical advice here, just looking for some opinions or input from people with me who may be more familiar with the EMG.

Thanks in advance

*edit: I should mention I saw a physical therapist who said that left hand/arm had slight weakness, though he would attribute it more to it being non-dominant arm. Hoffman sign negative, not sure if it matters which fingers are affected (mine are outer fingers not thumb/forefinger).

I should add, I understand I’m not giving a lot of symptoms that would lead to diagnosis. The weakness isn’t clinical, but it’s new, and I’m compensating for weakness w/pinky by using thumb and forefinger, so I can feel some pain in thumb due to compensation. My pinky can go side to side okay, just not up and down as easily, which is why I’m mentioning forearm muscles not hand muscles.

I want to clarify. I have read the “read before posting” a number of times over the last several weeks. Hence waiting so long to post.

I understand “clean EMG = no ALS”. My question is, what does clean EMG on inside parts of forearm/hand and other parts of arm mean for outside parts of forearm if they were not included on EMG? Anything?
 

KimT

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By the time you experience weakness in a limb, there w should be EMG evidence in many of the surrounding muscles and even in other limbs. For that reason, not all muscles are tested during an EMG.

My EMG showed ALS even before I had weakness.
 

rtr909

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Thank you for your feedback, KimT. I’ve been feeling pretty bummed that I was able to get an EMG pretty quickly but I feel like it was rushed/incomplete.

I’m wondering if it would make sense to get another one that may be more complete on this arm?

I’ve reached out to the doctors to ask their opinions as to the completeness of the first one and to ask if another would be indicated.
 

Bestfriends14

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Your EMG was more than enough considering you have no clinical weakness. Further, unless you are a neuromuscular specialist, you have no education to second guess how thorough the person was who conducted the EMG. Again, considering you do not have any of the hallmarks of ALS, the EMG you received was rather generous.

It sounds as if your anxiety is making it difficult to believe the competent professionals you have seen. I hope once you have a conversation with your docs about why you do not have ALS, you will believe them.

Best of luck to you.
 

rtr909

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Hi Bestfriends, I appreciate your honesty. I will admit that my anxiety is making this situation worse, and that I have been doing a lot of Dr. googling. Like I said, I just wish I’d been more communicative with the doctor about my actual symptoms.

The muscles that were included in the left arm EMG were:

Deltoid
Triceps
Bicep
First dorsal interosseous
Pronator Teres

Again, confirmed they were normal. But like I said my concern was that the whole forearm was not done because I did a crappy job explaining my symptoms.

I have already been working w/psychiatrist, therapist, etc around my anxiety for a while. This is just concerning because it literally feels like my strength and fine motor stills are going slowly in my left hand.

Either way, I have sent messages to doctor to follow up. It’s not that I don’t believe them, it’s that I did not do a great job of communicating symptoms.
 

Nikki J

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A few thoughts here. I think the other dorsal interossei are very difficult to emg ( maybe impossible). But anyway ALS is a disease of widespread denervation so surrounding muscles will show signs too. Ah but I am too early you say? I had an incredibly early emg because I had a pre existing research appointment. I wasn’t even sure my tiny weakness ( failure) was significant. But I didn’t have to do a complicated job of explaining. What can’t you do said the doctor. This I answered. She replied I think it is this muscle and placed the needle. Yes that is it. And there were changes in a number of surrounding muscles that were functioning fine. And it isn’t that I have fast progressing disease you can see that I have an ultra slow progression
 

rtr909

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Hi Nikki - thank you for your insight here. You seem very knowledgeable, obviously more so than I am. I also appreciate you relating your own experience. I guess that is my fear, that it is slow progression, only in these muscles right now, which are only slightly weak, not clinically weak, not failing, so wouldn’t be in surrounding muscles yet.

Are you pretty much saying that your opinion is that the EMG was likely sufficient?
 

lgelb

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The hallmark of ALS is specific abnormalities in multiple muscles that you do not think are a problem. If they only EMG'd the muscles that you think are a problem, they would not be doing their job. But that is not what happened. So I would say you can take that EMG to the bank and start considering if repetitive motion such as the game controller entails might be contributing to your issues. There are also lots of exercises to strengthen/balance your arm/hand musculature. You might go back to the PT you saw and ask them to craft a regimen for you.
 

rtr909

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Hi lgelb. Thanks for your insight, you make some good points. I understand that if there are abnormalities they will show up in other muscles early on.

What I’m wondering is if my weakness is so minor/early, that the abnormalities in these muscles are minor, so they may not yet be existent in other areas in the same limb. If that makes sense?
 

Nikki J

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As I already told you that was not my experience. And my neurologist who has been practicing in ALS for more than 25 years said they had never seen anyone so early. We have answered you. Believe us or not. Asking over and over here won’t yield different results. Please address any more concerns to your doctors. Good luck
 

lgelb

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No, that's not how ALS works. The process that causes the nerves that control the muscles to die isn't one muscle at a time, and by the time clinical weakness (as recorded by a doctor, and from your point of view, failing at a task, not feeling that you might) exists, if ALS is causing it, it will show up on EMG because there is nerve damage that is causing the weakness.

I agree that we're done here -- closing the thread. Please do not start another.
 
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