Neuro told me it’s either carpal tunnel or ALS.. pls help me

[Diana79]

Hi everyone, I have been fearing ALS for some time but didn’t want to post here as didn’t want to take away precious time from any of you, but now my fears are eating me and would love to get your thoughts and expertise. My symptoms are: twitching in my thumb (thenar) since weeks, a lot... not constant but multiple times every day. And until it was just that I was controlling my fears following what you all said here about just twitches and no weakness etc, but now there is more.. symptom 2) thumb weakness confirmed by neurologist (even though I didn’t notice it meaning it still functions completely) and 3) Thenar atrophy confirmed by the neuro as well... when I asked about what it could be he said carpal tunnel maybe even though it’s my left hand... and when I asked about ALS he said it could be too... so I walked out with a carpal tunnel or ALS guess... next step is EMG but I am scared and terrified as never before..

So here few questions that I am asking for your expertise..
a. Is there anything else that could cause thumb atrophy and weakness and twitches? (All localized to the thumb)
b. Can the EMG differentiate carpal tunnel and ALS? I’ve read around here about dirty or clean EMG, would the EMG be dirty also with carpal tunnel or how does that work... (maybe it’s a different type of results.)

Thank you SO much in advance for your time... and I am sorry that I ended up asking you this

 

[KarenNWendyn]

Carpal tunnel syndrome is orders of magnitude more common than ALS. Carpal tunnel syndrome refers to compression of the median nerve in the wrist. There is usually pain or numbness associated with it, but not always. EMG can show denervation in carpal tunnel syndrome but the nerve conduction will be slowed across the wrist.

In ALS, EMG will be abnormal in multiple areas but nerve conduction should be normal. Pain and numbness point away from ALS.

There are other nerve compression syndromes that can cause similar abnormalities. Certain forms of arthritis and wrist injuries can also cause thumb weakness.

 

[Diana79]

Thank you Karen, this is helpful. I forgot to mention that I also feel weakness and loss of movement in my ring finger. does that point to the split hand “syndrome”? I have seen in some places that the ring finger is the one impacted (together with the thenar eminence) in the split hand syndrome, is this correct?

 

[KarenNWendyn]

You’re getting ahead of yourself. Let your neurologist finish assessing you.

 

[Diana79]

Yes I probably am you are right... but still long to wait for the next visit and I am feeling terrible... I am in shock I didn’t expect that as I thought it was just asymmetry left vs. right hand as I had read in this forum and in the BFS one, but neuro said atrophy..

May I ask just another question please.. would atrophying muscles still function and get hard when I use them with strength? My thenar and also the first dorsal interosseous are smaller on my left (twitching) hand (which freaks me out as that is what hand split means I believe) but if I use them with strength they do get hard.. I feel this is strange.. anyone could share thoughts about this?

 

[affected]

Truly, try and stay calm and let the doctors do their job.
The key to panic here always seems to be that the person decides to ask the doctor could this possibly be ALS, and the doctor hedges their bets and says, well maybe it could. Then it's panic stations.
Had you not asked I'll bet anything the doctor would NOT have mentioned ALS.
So you brought it into the conversation, and now you will hold onto it.

You have a doctor who can examine you, test your strength and do the tests. That's all we can do - your symptoms are really minor, we can't do anything more and examining and testing yourself is useless.

To be honest, I see so many other things rather than ALS. Please now work with your doctor, then come back and give us the results. Our members can't go through each tiny strange feeling and address them one by one. Your doctor however will be able to answer them all. Some of our members are using their eyes to operate their computers, while being assisted to breathe with machinery.

 

[Diana79]

You are right, my apologies. Thank you all for your responses, I will post an update when I know more (after the tests). Thanks again !

 

[Diana79]

Hi everyone, I had my EMG yesterday and it came out clean. I am sincerely relieved and grateful. The doctor who had said I have thenar atrophy said that finally its not, its just asymmetry because of my left hand.. (wonder how he could have been so sure before but anyway, I guess I have just a very weak left hand which happens to fasciculate).

What I would like to ask you is.. could it be that the EMG has been done too early since I fasciculations only since 2 weeks? I have been reading that denervation shows up on am EMG only after 4 weeks. But what I am thinking is... if I really had thenar atrophy that would mean the denervation process would be going on since more than 2 weeks right? (And more than 4 I guess) Meaning the EMG would have definitely picked up abnormalities, correct? I promise this is my last question then I put my mind at ease..

Also wanted to ask where I could make a donation for the research to find a cure for this disease. Could you please recommend me a location to do that? Thank you.

 

[KarenNWendyn]

Congratulations on your clean EMG and being cleared of ALS.

No the EMG was not done too early, especially given that you have symptoms. Please reread this link:

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

Donations to the neuromuscular department at the facility that tested you would undoubtedly be welcome. Or to the Mayo Clinic or Massachusetts General Hospital neuromuscular department. Specify that you want it to go towards ALS research.

I feel your thread has run it’s course so I will close it. Please do not start another. Best of luck and congratulations once again.