Left shoulder/arm issues

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Scared83

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38yo male here. Started experiencing pain/tightness in trapezius, shoulder and shoulder blade, and arm on left non-dominant side. The left shoulder and arm feel weak as well and a little unbalanced, although I can lift overhead etc. It feels like the left arm has less strength than the right, but it is also my non-dominant arm. I do have some pain just below the clavicle when I press there, so I’m hoping it’s a nerve compression.

1. What do you think about ALS?

2. I read about flail arm variant, which really scares me. Can ALS start in the shoulder/shoulder blade? Are most flail arm cases bilateral?

3. I know I also have pain, but I found a few posts on this forum where PALS complained about shoulder pain.

Thanks so much for your time and input.
 

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Hello-

We always start by recommending people read here first: Read Before Posting

Have you been to see a doctor? Any other type of practitioner like a massage therapist or physio? There is a difference between perceived weakness and actual clinical weakness. A doctor or physio would be able to assess that for you and go from there with regards to reasons for issues.
 

affected

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I'd be interested to know what your doctor said when you were examined. What is the diagnosis and treatment plan you are on?
 

Scared83

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Maybe it’s my anxious mind, but your responses make me think that you definitely consider ALS a possibility? I was hoping for some reassurance that it is unlikely.

I have an appt to see dr next Monday.
 

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I believe it is your anxious mind. I doubt either of your prior replies thought it sounded like ALS. They were pointing out ( rightly) that you need to go to a doctor and get an exam and a plan.

as with someone who returned today with a benign diagnosis after jumping to ALS you are far more likely to have a common issue ( in your case some musculoskeletal neck/ shoulder problem) than an ultrarare variant of a rare disease And your sensory complaints also point away from ALS and towards something orthopedic
 

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Absolutely your anxious mind! If you haven't even been to a doctor yet, how on earth would you think strangers on the internet could help you get diagnosed with something?
 

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Goodness you are anxious!
I asked because you tell all the reasons you think you have ALS but don't even mention seeing a doctor. I bet your doctor won't think ALS in the least unless you bring it up and insist on it.
 

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My husband had flail arm variant. It began as nothing that you describe. And as with other forms of ALS, he didn't feel weak -- he was simply unable to move normally.

I am sure your visit will be reassuring as regards ALS. Until then, there is no point in reading up on something there is no reason to think you have. Live your life.

Best,
Laurie
 

Scared83

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Hi all, wanted to circle back after my dr visits.

Saw my GP who did strength testing and noted that I had 5/5 strength throughout. He thought potentially cervical radiculopathy and sent me for PT and a neck MRI.

Neck MRI did not show anything significant.

At my PT evaluation, the PT strongly suspects thoracic outlet syndrome (compression of the brachial plexus around the collarbone), which he believes explains my neck and shoulder ache and arm/hand numbness with paresthesias. I have poor posture with drooping shoulders, sedentary job with long hours at computer, high stress etc.

On the PT exam, he found normal strength except for left triceps that were 4/5 with no reflex at the triceps. All other reflexes were a bit brisk, but bilaterally the same. Hoffman negative. The PT believes the triceps weakness and lack of reflex is due to the nerve compression.

From my understanding, ALS in initial stages causes hyperreflexia and that a reduced/absent reflex points away from ALS? Is that correct? The slight weakness in the triceps worries me, but the PT’s explanation makes sense.

In your collective wisdom, is it time for me to move on from my ALS fears?
 

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Um, yes, we already said as much, but with the new clinical info you have gathered, all the more so; your fears of ALS are groundless. TOS generally responds to PT and changes in your posture, work habits, and stress management. All the best.
 

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That is such great news! You have been able to confirm, by examination, what we have said here and have some logical explanations and strategies to address these.

I'm so happy to hear this. Well done! Move on most definitely and don't let yourself come back to such fears.
 

Scared83

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Hi all, sorry to be back, but quick question regarding EMG for peace of mind.

I’m tentatively diagnosed with thoracic outlet syndrome. I saw my general neuro who performed a clinical exam, which she said looked pretty good. Only slightly abnormal findings was left triceps weakness 4/5 and slight weakness in intrinsic left hand muscles. She also detected a slight tremor in my left hand, but said that it was not the type they are concerned about.

I also saw a TOS specialist who tentatively diagnosed TOS and sent me for a NCS/EMG to rule out more distal compressions (carpal tunnel, cubical tunnel, etc.). The neurologist who performed the EMG stuck needles in the muscle between my thumb and index finger, a couple of other places on the left arm, and one up near my neck/shoulder. He had me contract certain muscles. After the test, he told me both the NCS/EMG were normal.

My left arm and hand feel weak/dull, even at rest to the point that I feel I need to move or shake them to make that feeling go away. I also get lots of twitching in the left arm and hand. From browsing the TOS forums, it seems like many people have similar complaints, which they attribute to nerve compression up at the brachial plexus.

With that background my questions are hopefully simple:

1. Am I correct that a normal EMG in my symptomatic limb effectively rules out ALS? In other words, if my slight clinical weakness, twitches, and tremor were related to ALS, it would have shown up on the EMG?

2. Although I wasn’t sent for an EMG to rule out ALS, is it safe to assume that a board certified neurologist would have been able to detect ALS-type findings if they existed in the symptomatic limb?

Thank you for your time in responding to my questions.
 

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When you first came here Shiftkicker directed you to the extensive information post we created to answer all these kinds of questions. (scroll back to post #2 in this thread and click the link again)
You truly need to discuss your fears with your doctor because we are not going to be able to reassure you.
1. yes
2. yes
Please, for your own sake, let this go and work with your doctors with an open mind, and believe them.
 

Scared83

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Tillie, thank you very much, I appreciated your patience and answering my questions. Laurie or Nikki, if you disagree or have anything to add about the EMG, I really trust your opinions too.

Im trying my best to move on from it. I know twitches mean nothing, but it’s the slight weakness that gets to me. That said, I know rationally that weakness can be caused my many more things than ALS, including TOS and other types of nerve compression. I just need to let my rational brain prevail and listen to my doctors like you say Tillie.
 

Scared83

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Nikki and Laurie, I know you are very busy, but you seem to be the EMG experts here. If you have a chance, could you please take a look at my two questions above. I appreciate your time and energy.

Thank you so much.
 
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