leg pain, twitching, size difference

[MApril]

Good evening,

I am 27, very young, but concerned about a noticeable size difference in my right leg along with muscle fatigue and tightness. I had been experience muscle cramps and fatigue in my leg and after about 6 weeks passed, I started doing a closer inspection at what could be the problem. When flexing my calves, it is easy to see my left muscle but when I flex the right, it's just not there. I whipped out the measuring tape and the right leg is indeed smaller than the left and there are noticeable thinner spots. This is for my entire right leg, not just my calf. I understand that we are not all symmetrical but this compared with obvious muscle cramps and tightness that is unrelenting has me concerned. Driving has been particularly fatiguing as it takes a lot of effort for me to operate the gas and break pedals with my foot - just something about holding my foot in that position as well as pressing down. After I get out of the car, I feel like my leg has been in a marathon.
In addition to this, I started to experience twitching in my right leg. I didn't initially link this with the pain. I was searching things like what causes jumping muscles, because they felt more like a jump than a twitch. I wouldn't have thought to call it a 'twitch'. It started in my thigh, and has moved down to my foot. My foot feels like a constant twitch, as if it's a pot of boiling water. My calf twitch feels deep like the entire calf muscle is trying to detach from my bone and escape through my skin. My thigh likes to do quick successive 'jumps'.
My doctor has ordered an EEG to rule out any possible seizure activity, I've had a brain MRI, blood work that measured various vitamins and inflammatory markers, urinalysis for dehydration, a knee MRI...all good. I've taken magnesium and calcium supplements for supposed sleep benefits for some time now so I don't think symptoms would be due to a deficiency in those areas. I honestly didn't think about ALS at all until I just watched a very touching youtube channel documenting a man's journey with the disease and he spoke of how his symptoms started as a constant muscle ache and then twitching.
I go to the neurologist next week. I want to let them do their job and I'm sorry for the intrusion on this forum, but it's really the apparent size difference in legs has me so concerned. It's startling for me to see. Is this something totally non-concerning as a muscle strain? Is any of this even close to resembling nerve problems/damage, much less ALS?

 

[skipper66]

I don't know what in the world makes you think you might have ALS. It doesn't appear that you took the time to read the stickies. Please don't continue to post and until you do so. We aren't qualified to diagnosis anything else. This is strictly a ALS forum. Please follow up with your neurologist for further answers. Good luck to you. Sorry, you are having any health issues at all. Kim

 

[MApril]

I thought Do I have ALS/Is This ALS? was the appropriate place to post a question regarding if whether or not my symptoms appeared to be ALS. Sorry for the intrusion.

 

[skipper66]

You wrote in the write part of the forum. But, you don't have ALS symptoms. We have a stickie that we post that covers alot of questions concerning ALS. You aren't an intrusion. But, your problems aren't ALS one's . It's not that we don't want to help. But, it would be unsafe for us to try to give you a diagnosis since we aren't Dr's or even try to guess what is actually going on with you. Please for you own good stay off of Dr. Google and take your questions directly to a qualified neurologist or your doctor. The internet can be misleading and cause unnecessary anxiety which you don't need . I'm sorry if I came off rude in my post. It wasn't my intention.

 

[lgelb]

You mention a brain MRI but not a spine study. If you haven't had it, that's what I'd do next. But I agree you are in the wrong place, which is great news.

Best of luck.

 

[MApril]

Thank you for your input. I went to the neurologist and had an NCS/EMG. The neuro noted the calf differences, and said you could lose up to 90% of your calf muscle without presenting with weakness because it is such a powerful muscle. He said the EMG can detect about 20% loss and on, mostly.

The nerve conduction study showed I had ‘beautiful’ nerves. He found the fasciculations in my foot. I didn’t ask all the right questions, like if he saw denervation, because I was half thinking about my discomfort from the EMG. I did ask if we could rule out degenerative causes and he said no. I asked if it was ALS and he said not likely, that ALS is typically painless presentation and I had pain in my leg. I asked what we do from here and he said it’s a waiting game as far as symptom appearance/disappearance and process of elimination. I can't find much on findings of fasiculations because mostly what I come across are fasiculations that don't show on EMGs. He is sending me for an MRI of lumbar spine, though I have no back pain.

After thinking about it, I am worried that he saw denervation because of his answers, but will ask him more in depth questions when I see him for the MRI results. I also don’t think he is going to write up a report since he did the EMG himself and can interpret the results from looking at the readings. I’m including a picture of the 'dents' in the problem calf.

 

[Nikki J]

I would be amazed if there is not an EMG report. It would be documentation both for your medical record and for insurance company. If he did it he charged for it and there needs to be a report. Just like there are notes on you office consult and exam.
I do not see any reason to worry about the dents.

Even if and it is a big if there was denervation on the EMG there are many other reasons. It sounds like he suspects a spinal cause

 

[MApril]

Thanks, Nikki. That makes sense regarding the report, I'll ask to get it.