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sea2021

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I have debated posting bc I am scared of the response I might get. I have convinced myself I have als.
Background: For years (since 2015ish) I have had a tremor and occasional trigger finger/thumb, in right hand. In 2019 I went to a neurologist & he did a nerve test and emg, it had an abnormal result and thought it might be a pinched nerve. Did an mri - during mri they found a nodule on thyroid and that took priority. Everything worked out with nodule and I just sort of let the nerve stuff go. He wanted to do another mri of a different area back then still looking for a pinched nerve.
Fast forward to now & ive decided it’s time to figure out what’s going on, recently there was some “wasting” in the thenar area, none on top, some “perceived” weakness but I can still button, opening things lift fingers, workout (kettle bell swings lift weights) etc. I haven’t had any changes anywhere else, and still slight tremor in left hand also(which I’ve had). I went down the Google rabbit hole and now I’m here. All that being said looking at summary of report do you think it could be ALS? I am going to see a new neurologist but can’t get in until December and my anxiety has started to make my mind/body play tricks on me. I would have expected it to progress much more rapidly if it were als, I’ve talked to a few doctor friends and all have said it’s unlikely that it’s als. I’m a just turned 37 female. Any insight is appreciated
 

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I don't think you need be scared of the response - there really isn't anything at all suggesting ALS in this report, just as you have been assured already.
December isn't really too far away, so since this has been going on for years, without stopping you doing anything, it may be best to concentrate on your overall health in the meantime.

Let us know how the December tests go.
 

sea2021

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Thank you for your response! The weakness is in my grip but only really noticed when lifting weights - and my middle finger twitches a little which I forgot to add. Your replay was reassuring, thanks!
 

Nikki J

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It is infinitely more likely to be a local process and everything you report could be accounted for by that. It has been a long time without loss of function. Try to stay away from Mr Google and concentrate on other things while you wait for your appointment.
 

sea2021

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Thank you for your response. I do have some follow up questions… when you say loss of function, do you mean total loss or just more difficult? Also, in all the googling (I know, I’m staying off now) it talked about p waves being bad and I noticed that in my report what does that mean? And last thing to be ALS would that kind of thing have to be found in more than just mostly my right hand? Thanks again for responding!
 

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Loss of function means inability to do something yes. My sister had hand onset and started with classic could not button. She could do everything else. But it progressed and within 6 months her hand was an atrophied paralyzed claw

yes p waves are seen in ALS but many other things too Including localized nerve damageThere is a specific pattern to ALS and yes it shows widespread involvement in multiple nerve areas
 

sea2021

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thank you both - your responses have relieved some of my anxieties.
 

sea2021

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I’m sorry I’m back with another question - my index/pointer finger in curving inward starting at middle joint towards the rest of the fingers, the middle finger seems to be slightly doing the same… should I be concerned that this is a sign of early hand clawing or another ALS sign?
 

Nikki J

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Can you move your fingers? Straighten them? Consider I mention my sister’s clawing and now less than 24 hours later you decide you have it?
 

sea2021

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Yes I can move them and straight them but the index is curved at the joint. The middle finger twitches around a bit and has no real strength and I guess that’s what I’m finding concerning due to that new “muscle wasting” in the thenar region. I am trying to find comfort in the previous reassuring statements and knowing that after almost 3 years from that test I still have function, but the thought does creep in. I also assume my anxiety about the situation has caused my body to have more twitches etc than normal as well.
 

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You need to stop now sea - go see a doctor. You are not going to believe us anyway.
I truly wish you the best, every time you feel anxious about something happening, get straight to your doctor as they can examine your finger and actually tell you if there is anything changing and any loss in strength.
We have done all we can now, please don't push this.
 

sea2021

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Question for clarification: I’ve read that abnormalities of Nerve conduction (so that would be the low amplitude etc in the first part of the summary?) point away from ALS even if there was that abnormality found on the emg?
 

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ALS returns a normal NCS result, so any abnormality in there indicates something else. The EMG portion will show very distinct abnormalities.
No more questions please - if you have questions, make an appointment and see your doctor.
 

lgelb

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Just a quick note for posterity that some people have coexisting nerve conduction deficits like ulnar neuropathy or diabetic neuropathy in the lower extremities. So an abnormal NCS does not rule out ALS, but ALS itself does not compromise the NCS part of the exam.

The key in your case is nearly three years in, your finger function is normal. Many of us have comparatively weak or crooked-appearing middle and pinky fingers. They don't get called on to do as much.
 

sea2021

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When you say that the key in my case is that 3 years in finger function is normal - (which idk if some twitching matters) is meaning because that points away from als as it would have progressed to no function or that if it is als it would be very slow?

Also - recently I have begun to experience twitching in the legs at night when trying to sleep and sore/cramp like feeling in the right calf. In yalls opinion, would those things be concerning or likely just my anxiety that has ticked up? I’ve also posted the table from the emg from 3 years ago in addition to the summary I posted earlier, thought that might give more insight to if als might be on the radar?
 

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