Need help based on symptoms and report - Thank you for reading this

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aerospace

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Hello,


Thank you to everyone that on this forum for providing input to people who are struggling. It is such kind work and I greatly appreciate everyone’s time. I've been struggling with symptoms that started on July 1st 2021. I read the post that fully explains that first symptoms of ALS, but I feel because of certain reasons (will explain below) I should seek input. I hope that you can kindly provide your perspective based on my history.

A little about me: 35, male, healthy and active prior to July 1st which is the date for the start of symptoms:
July 1st when hiking I perceived weakness (felt like knee buckling) for my right leg while going downhill (uphill seemed to be a bit easier) and it continued. This was painless Additionally I get this tingling/pins feeling on the top left of my right hand (fingers felt fine)

Since July 1st my right leg has felt like it has gotten progressively weaker which prompted me to see a neurologist. Currently the leg does not have any clinical weakness based on neuro examination, but it feels weaker than it did before July. The neurologist ordered blood tests, MRIs (brain, 3 segment of spinal cord, right leg/pelvis) and performed a clinical exam. Everything came back normal including my clinical exam with no clinical weakness.

Then I had an NCV/EMG for my right arm and right leg which came back normal. Please see report for my nerve study test that was performed on July 22nd. Along with the continued perceived weakness for my right leg, on July 27th I started to notice a weird sensation (I describe it as a minor deep dull ache that starts in my mid inner hamstring/adductor and travels up to the bottom of my glute and groin). When I looked at my emg I see that they did not test my hamstring, major glute muscles, and adductors, which I believe would have been tested if I would have had the test on or after July 27th when this sensation started. What I'm concerned about is if there is possibility the EMG may have missed something that was indicative of a MND because when I took it back on July 22nd, I could not locate the muscles that were feeling week, and because of this the doctor did not test these muscles as you can see from the EMG report (major glute muscles, hamstring, adductors are not specified). At that time and now, it just feels that my overall right lower proximal limb (and just below knee) is weaker. I'm just very concerned the EMG may not have picked up everything because of this.

Additionally, I've been experiencing more symptoms since the EMG on July 22nd which include constant rhythmic twitching in my right calf. The twitching also comes on in my right and left lat and left tricep. This twitching never occurred before and my right calf cramps sometimes. Additionally, the right-hand tingling/pins feeling that I mentioned earlier has gotten worse where it feels like it might be cramping (I get this tingling/numbing on the top of my right hand and into my forearm for 2 hrs straight in the evening, and this sensation goes into my thumb and index finger and they feel like get stiff and spasm intermittently during these 2 hrs). Hard to tell is this is cramping in my hand, or something else, but it seems to be every day now. The neuromuscular specialist that I’ve been seeing has not detected any clinical weakness in both my right hand and leg yet (last time I saw them was August 4th). They also performed the EMG I had on July 22nd.

Everything started July 1st. I know the EMG that I had on July 22nd is helpful, but I feel that it was done too early and would have been better for detecting MND if the symptomatic muscles in my leg were tested. Can someone please provide their perspective on if they think this sounds like a MND? Should I repeat the EMG?

Thank you so much for reading this and greatly appreciate your time.

Michael

Just to clarify my leg weakness, even though the neuromuscular specialist has not detected clinical weakness in my leg and said it appeared normal, I've noticed a weakness through my own strength testing based on a comparison between my right and left leg. My right leg has decreased in strength compared to my right since July 1st.
 

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Bestfriends14

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So, despite your clean clinical exam, your clean EMG, you having read the sticky that explains, in detail, why your exact symptoms are not ALS, you needed a bit further explanation? As for you doing your own strength testing, where did you get your neuromuscular fellowship to make this clinical conclusion? Doctors don't even diagnose themselves, so your conclusions fall under the "subjective " category.

Nothing you've posted says ALS. Knees buckling while going down a steep decline says weak knees, not ALS. You improve this by strengthening your quads through weight training (guided by a personal trainer).

You are good to go. Take care and best of luck to you.
 
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