Localized hand twitching, mild weakness?

[WorriedMuch]

I haven't been able to get my hands on the graph unfortunately, only the description of my EMG. Sorry if it's clumsy language-wise, I had to translate it and I am not good at medical terms. I would be most grateful for your opinions. Is it absolutely clear I couldn't have been misdiagnosed with ulnar nerve irritation?

I also noticed on the clinical exam report they wrote I have brisk reflexes in the arm.

NCV showed slight slowing of the ulnar nerve at the elbow level

Myography: studied left upper limb corresponding to myotomes C5-C8 muscles, in particular m. inteosseus, ulnaris
dorsalis I, m. abductor digiti minimi, and m. flexor Carpi ulnaris. In addition, studied both lower limbs and right upper limb proximal and distal muscles, and muscles of the bulbar and thoracic region.

No abnormal spontaneous activity, and no fasciculations on needle insertion. Vas. upper limb ulnar muscles m. abductor digiti in moderate motor units diminished and high amplitude unit potentials, m. interosseus in dorsalis I a slight reduction in units, m. flexor in Carpi ulnaris just a hint of unit potential polyphase.

In other muscles left. upper limb, other limbs, body and bulbar area normal recruitment of motor units, unit potentials normal.

 

[affected]

You are good to go - please consult with your doctor if you have more questions. This is not ALS.

 

[WorriedMuch]

I hoped I'd never come here again but some new concerning symptoms appeared. After my EMG that led to the neurologist concluding I probably have an irritated nerve I followed his advice on avoiding to bend my arm at the elbow. As part of this I was only typing with my right hand for a few weeks. During this time I started having painful cramps in my left hand and arm. A week or so ago I decided to start using my left hand for typing and realized I can't stretch my thumb outwards from a neutral position. Unable to stretch it enough to do key combinations. Did a bunch of stretching exercises for the hand hoping it would take care of the problem, but it just won't move. I don't feel any pain or weakness.

The GP has forwarded me to a neurologist with +3 reflexes in the left arm and both legs (no weakness, but acknowledged the tumb doesn't move) and said that possibly the EMG was done to early and if I have ALS it's incurable anyway so it doesn't matter how long I have to wait because of covid lockdowns.

I am floored. Is my doctor incompetent regarding how EMG works or could they really have done it too early? I got the impression there's no such thing as too early from these posts but it's a doctor... Several muscles in my left arm were tested, not the thumb ones but several others.

 

[affected]

read this at least twice please - I apologise we didn't ensure you read it before you started all this months ago, but surely you had read it at least once.

Important - READ BEFORE POSTING! Answers to common concerns about possible symptoms

We will try to answer reasonable questions. We are not here to argue with you. If you announce that you ”know” you have ALS when the doctors say otherwise, or you have not bothered to see a doctor, your thread will be closed. It is not our place to try to convince you you are wrong. Neither...

www.alsforums.com

it clearly tells you this is garbage, keep coming back to read this when you get worried again.
This post is here so our actually paralysed members, many of who breathe with a machine, don't have to answer the same things over and over which is a huge thing to expect of anyone.

Please now refrain from posting new things, we can't help any further. I'm sorry you are in such a state.

 

[WorriedMuch]

Afflicted, I have. Unfortunately reading this makes me worried even more since


It really does happen that something stops working all of a sudden. It is generally one muscle so it will not be a whole limb, but the movement done by that muscle is suddenly gone. >>>

This is pretty much exactly what seems to be have happened with my thumb. I can hold narrow things and curl the thumb inwards, but grabbing anything thicker than a toilet paper roll is not working as I can't spread it outward enough to grab. This is the primary reason why I've posted again - something on the sticky seems to describe the issue

 

[Bestfriends14]

You are not describing ALS at all. As afflicted and others have said, it's best to move on and start looking at avenues that may be more in line with what you are experiencing. Having this unhealthy obsession with ALS is just that-unhealthy, as well as unfounded. Please, move on and stop posting unless you get a diagnosis of ALS (which you won't).

Take care and best of luck to you.

Goodbye.

 

[KarenNWendyn]

You had a recent EMG that was normal. In ALS, EMG changes tend to be widespread early in the course of the disease. If you had ALS, your EMG should have shown something. We don’t feel you have ALS. However I have a feeling no one here will be able to reassure you. I suggest you not post further until after you follow up with your doctor.

 

[lgelb]

The most plausible explanation is that you babied your L arm so much, you assumed an unnatural position and pinched a nerve, strained a tendon or what have you. You might try PT with a referral from your PCP, to test that hypothesis.

 

[WorriedMuch]

Thank you so much for all your replies. Lgelb, I definitely was babying the arm before starting to use it properly again. I will assume the scenario you described is what happened until I get to the doctor.

 

[WorriedMuch]

Could I please ask one more question regarding the ALS pattern on EMG?

Is it impossible to have chronic changes (reduced recruitment, incomplete interference pattern in the symptomatic muscle) show on the EMG first without any acute findings? I mean, can it happen that the first EMG finds only chronic changes and with progression the acute denervation appears or does it always happen simultaneously? Never in stages?

Also does a slowed NCS which is only detected with a motor nerve, while the sensory part is intact, rule out MND?

I am following up on my condition with the neurologists but right now they are having trouble correlating my clinical symptoms to my EMG and I am being observed to see what happens. I am very scared that a scenario I described could happen. Is it medically impossible?

Thank you so much in advance to you wonderful people if you chose to answer, and hope you are staying safe in these difficult times.

 

[Clearwater AL]

Worried, as you wrote....

"I am following up on my condition with the neurologists but right now they are having trouble
correlating my clinical symptoms to my EMG and I am being observed to see what happens."

They (Neurologists) know more about your symptoms/condition than anyone here. To badger
members here any further for possible answers that are, at this time... pointless.

After 11 posts,, two pages and replies from very ALS knowledgeable members who in their
opinions have tried to assure your are not describing ALS....

there really isn't any purpose of a 12th.

Work with your doctors. Come back after you finally get a diagnosis and let us know.

Key words: ..."after you finally get a diagnosis." Lock word: "After."