Need help interpreting...

CJV

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I started 4 months ago with weakness in my left hand, particularly my "pinch grip." I now have muscle atrophy in the thenar muscle and on the pinky side of my hand. I also have twitching on the left and right arms, some minor twitching in other parts of the body including the face and tongue. I am having trouble getting a neurologist appointment, the soonest is 4 months from now. I'll need psychiatric care well before then.

EMG.......
All nerve conduction studies within normal limits
Needle eval of left deltoid showed increased insertional activity and increased spontaneous activity. The left 1syDortInt muscle showed moderately increased spontaneous activity. The left Abd Poll Brev muscle showed moderately increased spontaneous activity. All remaining muscles showed no evidence of electrical instability.

Impression:
Abnormal study:
1) There is evidence of a left median neuropathy with a reduction of amplitude with proximal stimulation, which may be reloated to technical factors. The finding does NOT correlate with the clinical diagnosis of carpal tunnel syndrome.
2) Left ulnar sensorimotor testing is normal.
3) Upon needle examination portion of the exam, denervation potentials were observed in the left deltoid, abductor pollicis and the 1st dorsal interosseous muscles. Cervical paraspinal muscles did not reveal any abnormal activity. These denervation potentials may be related to cervical spine radiculopathy, but the diagnosis is not confirmed here.
 

Nikki J

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Have you had a cervical mri? It would also help to post the chart from the emg ( deidentified). The narrative does not seem to show an als pattern but the chart would make it clearer
 

lgelb

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Agree with C-spine MRI and that EMG evidently is not related to ALS at all. Also, remember there are many causes of/contributors to atrophy, including the spine problem(s) the EMG suggests may be the case.

Best,
Laurie
 

CJV

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Thank you. All I have is the narrative. Cervical MRI shows some bulging at C5-6 and slight at 6-7
 

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CJV

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There has been some preliminary talk of Parsonage Turner Syndrome. I had COVID vaccine Feb, Mar, then Shingrix twice in May. Saw symptoms May, muscle wasting right around then.

Two more MRIs Friday, back surgeon consult next week. The twitching is maddening.
 

lgelb

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Some injections can be slightly misplaced and accidentally cause nerve damage around the deltoid. It usually goes away.
 

CJV

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Interesting. It is the arm I chose, although the deltoid is the last symptom I had. Weakness, atrophy, fasiculations. The deltoid has been no problem until about a month ago.
 

ShiftKicker

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CJV, please repost your results with all identifying information blacked out. If you could also include the EMG summary, that would be helpful.
 

lgelb

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Just a note to suggest a second opinion before considering any back surgery, as with any procedure of that magnitude. Especially with your history, it's not something I would jump into.
 
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CJV

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UPDATE:
The spine surgeon said this is not coming from my back. Suggested the neuro appointment, which I have on Wednesday. I admit I'm consumed and frightened.
 
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