How would you explain muscle weakness?

Kryptyx

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I know there is a rule about having one thread in this forum. My previous thread from 2019 seems to be closed so I am writing a new one. Hopefully this is allowed in this case.

Continuing from my previous thread, I did follow-up with my doctors and had an EMG done that was deemed normal/unremarkable. After several more months of twitching they slowly went away, completely. Thinking back, this sort of just became out of sight out of mind but I do remember noticing that they had stopped.

Just recently, they have returned with additional symptoms. About 3months ago I noticed my left leg/ankle feel stiff compared to the right. It was sort of difficult to explain but rotating my left ankle felt different. I wouldn't say it was painful, just tight and seemed to cause a stretching sensation in any direction. My left foot also started to have mild discomfort when standing. Not enough that I needed to stop/sit but enough that I noticed it. My ankle and lower calf also appear swollen, likely edema. I could tell my thumb print would stay in my skin for example. Elevation seems to help reduce the swelling and sometimes the ankle felt "looser" as in to say, more normal. So I continued elevation and didn't think much of it.

Now just about 2-3 weeks ago I noticed the twitching return. It was in my calves, mostly left with a few "sparks" in my right. My left hand/fingers (index and middle mostly) have begun twitching. This is now spread to my right hand as well. The twitches in my fingers have been getting stronger, before they would be small/light movements now they are much more assertive and stronger. It's mostly noticeable at rest, but can happen at any time.

Today I saw my neurologist for the first time in several years. He performed several exercises with resistance and pushing all of which seemed to go well. He then had me flip my hands over, palms up, and I noticed after a while my left arm started feeling tired/stressed. It felt as if I was lifting something with my left hand and it wanted me to relax it. He did take notes of this and noted the finger twitching. He then had me walk, which he said seems normal but then asked me to walk heel-to-toe in a line and my legs got really shaky. Not even half way, he said I could stop. I never experienced this before but also never really walked like either. I didn't feel off balance, just shaking. I don't know how else to explain it.

He has a EMG schedule but not until mid-June. I also have some blood work to get done and then follow-up with him late-June. Of course in the meantime I'm quite worried as these symptoms are new and seem to be getting worse. At this point I'm 38 years old, which would still be relatively young to have ALS. I'm fairly logical and understand it could be a host of other things, including PD or MS or some non-serious condition like BFS.

I guess I'm mostly worried about the leg shaking and the muscle-strain sensation. Does any of this sound like muscle weakness? If not, how would you explain muscle weakness?

Thank you for your time!
 
Edema should be evaluated by a PCP.

No one can explain your feelings of weakness from afar. And shakiness is not necessarily anything at all.

This could be anything from a postviral condition to lack of sleep, a mattress that needs replacing, deconditioning, so many things. I wouldn't jump to anything as major as ALS, MS, or PD on the basis of what you've said.
 
Thank you for your update! Would it be fair to say that muscle twitching with ALS is more of a secondary effect after weakness is observed? As I said, during the examination I didn't have issues with weakness in my fingers. I would also suspect that in ALS it would be rare to have twitching on both hands at the same time as it usually works its way one section at a time?

In the early stages if a muscle fails, wouldn't you "feel" more tired/fatigued because other muscles are having to work harder to pick up the slack until they are eventually effected leading to inability?
 
Twitching is so common as to be meaningless without weakness which you did not have.

No I felt fine except for the pesky isolated weakness causing falls. And your doctor DID NOT detect any failure
 
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