Potential of ALS? Should I get an emg

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Grussman

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Hi all. First off, thank you for everything you lovely people so here. I’ve lurked for a while (family friend passed a couple years ago from ALS) and now I’m here to ask the usual question- does this sound like ALS? I am a 30 year old male.

12 weeks ago-
Shoulder pain and rib pain. I understand pain is not an early symptom. However, I dislocated this shoulder 2 years ago (and have since rehabbed it to be better than my good shoulder). Never had any pain post rehab. This is due to the stringent scapular stability exercises I have done and continue to do targeting post. deltoid, serratus ant, and rotator cuff muscles. I can no longer do these exercises- my shoulder feels like it is subluxating, due to perceived (not examined clinically) weakness in post. Deltoid, biceps, and teres major in L shoulder.

4 weeks ago, I went to the emergency room with a sudden onset of profound (perceived) weakness in both lower limbs and L arm. After being admitted to the neuro ward, I had a weird set of interactions regarding reflexes. First doc found hypotonia and very brisk reflexes in Left limbs. Second doc found brisk reflexes and sustained, incredible clonus (leg and body shaking) bilaterally. 3rd and 4th doc found brisk reflexes bilaterally. Had a brain, cervical, and thoracic mri- all clean. Happy me was discharged, as neuro found no evidence of MS (due to familial concerns, this is what I was worried about).

About 3 days after discharge, my hypotonia changed to rigidity/spasticity and fasciculations. Suddenly my wet noodle legs, especially left, were stiff and tense, with fasciculations. Left arm and shoulder would wake me up from sleep as posterior deltoid spasmed. Girlfriend noted I now snore for the first time ever. Around this time, I started having diaphragm pain and shortness of breath. As well, my left intercostal muscles seem to be atrophied compared to the right.

Noticed when grocery shopping that my left arm Could not really carry the basket, despite my right arm holding it without even noticing weight. Tried to do some yoga and shoulder exercises- cue 4 nights of no sleep due to unbearable pain. It was fine as long as I didn’t move, at which point muscle spasms would occur in my shoulder. At this point, fasciculations are occurring everywhere, but 90% in left leg and arm. Also was woken up thinking there was an earthquake but really was my intercostals vibrating like crazy. Also, I play guitar and am finding my left fingers don’t do what I want them to anymore. As far as atrophy goes, I haven’t looked- I figure if I do I’ll find it, whether or not it’s really there.

Debating trying for an emg- unfortunately I am currently pursuing my masters in Physiotherapy in a foreign country, so I have no gp, and my last hospital visit set me back 8 grand. I mention my degree because I am fully aware that generally, the people who present with “ALS” symptoms are health care students who know just enough about MND to self diagnose every symptom (me). I’ve refrained from performing any of the upper motor neuron disorder tests that I know on myself, as that sounds like a bad idea. However, I’d love some insight into whether I should pursue further diagnostics- as much as it sucked to pay 8000 last time I went to the hospital, I don’t mind spending money if it’s necessary.

Thank you so much for your time.
 

lgelb

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I would see an internist given the scope of what you report, to help focus any further investigations and avoid spinning your wheels. But I don't see any reason in what you've said to worry about ALS.

Best,
Laurie
 

Grussman

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Thank you Laurie, I appreciate the response. All the best to you.
 
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