Please help!

[carole2015]

First and foremost, thank you for reading my post. I am in need of some help.
About 6 months ago, I started feeling some weakness on my thumb, index, and middle fingers. They were also cramping up. I went to a neurologist and he did an emg. This were the results:
"This is an abnormal EMG and nerve conduction study. The electromyogram reveals evidence of chronic reinnervation of the muscles suggesting a previous axonal injury of the left ulnar nerve above the wrist. There was also some chronic reinnervation of the left median nerve muscles above the wrist as well. However, this was less robust. The nerve conduction reveals slight entrapment of the median nerve at the wrist, which is compatible with a median neuropathy. However, the actual nerve conduction was normal. There was significant slowing of the left ulnar nerve motor conduction in the left forearm, but normal above suggesting a lesion distal to the elbow. The radial nerve was normal"
The neurologist I saw at the time didn't really explain what these results to me. When I asked about ALS, he said it wasn't but he couldn't rule it out.
Fast forward to now (6 months later). I started having twitches on my thumb that stopped after 6 days. Now, when I pinch something the muscle between the thumb and index finger fasciculate. I also see atrophy in that muscle (confirmed by doctor) im having extreme weakness in the same fingers (also confirmed by doctor) It is hard for me to pinch things and fold clothes. I went to see a different neurologist and he also doesn't think it's ALS but also won't rule it out. No new EMG done. He thinks it might be due to an elbow injury I had many years ago. The odd thing is that I never had issues like this. I would think that if it was due to the injury I would have had these symptoms much sooner.
I am stressing out thinking it's ALS. The fact that both neurologists said they can't rule ALS out is making me very worried.
Can someone explain to me why the neurologist doesn't think it's ALS from the EMG results? I see the word "abnormal" and "reinnervation" and panic. Is reinnervation what we see in ALS? Or is it denervation? Or both? If there was denervation would that have been in the report?
This is so frustrating and scary.
I look forward to reading your comments. I know there are many knowledgeable people here.

 

[Atsugi]

Hi, Carole. I understand your fear but I think you don't have to fear ALS.

Your EMG did not read like the reports I've seen about ALS. There was no mention of denervation. Apparently, your nervous system is healing itself, not being destroyed by ALS. I'm no expert, but that's what it says to me.

For one thing, the report suspected a lesion. That's not ALS. It also spoke of entrapment. That's not ALS. But these would explain your weakness.

The really good news is that your neurologists--the experts--are not concerned about ALS. Trust them.

My wife was a doctor and I've known a lot of doctors. They often refuse to speak in absolutes and rarely will put their license on the line in case a freak event occurs. They have to worry about lawyers, so they get used to saying "I can't rule it out completely" when in fact, they know it's not ALS.

If there was denervation, the report would have said so.

This might be something simple, so don't get too upset. I'm not a doctor so I can't diagnose you, but I know ALS fairly well and what you're describing doesn't sound like it.

Don't get too worried about this. Anxiety is useless, counterproductive, and can be downright debilitating. And from what you posted, you have nothing to be anxious about.

 

[lgelb]

Carole, I agree w/ Mike -- no denervation says nothing to worry about -- but if your sx are getting worse, and they are still localized to the L hand, I would see a hand surgeon for a 2nd opinion. It's very possible that PT and/or an injection could help you.

Best,
Laurie

 

[carole2015]

Thank you so much Atsugi and Laurie for your response. I really appreciate it. I feel much better now. As much as I try to stay positive the fear of ALS takes the best of me at times. Specially when I am not able to do things I was able to do before. I will make an appointment with the surgeon that took care of my injury a few years ago. Hopefully they can take care of it as Laurie mentioned.

 

[Dusty7]

Carole, very simply,
ALS is a disease of widespread, acute denervation and chronic reinnervation. Your EMG shows no acute denervation and the denervation/reinnervation you do have is not widespread. You do not have ALS. Good luck!