Radiculopathy or als?

Bergwijn

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I'm a 43 year old male. Happily married, two amazing kids. I had a herniated disc two years ago that caused great pain and numbness in my left arm and the fingers of my left hand.

I've had fasciculations in my left upper arm/tricep for about 6 months now that finally bothered me enough to see my PCP about. He thought it might be related to the radiculopathy from the disc. He ordered a EMG but I couldn't even get an appointment until about 3 weeks from now. I know the result from that is very important but I'm going a little crazy with worry in the meantime.

As I worry and wait I feel additional symptoms. Today it seemed my left leg was weakening. It feels weak suddenly but how to be sure? And suddenly the fasciculations are all over. And I could be wrong but they seem to be progressing down the arm now. They have kept me awake at night.

Logic tells me that the sudden onset of these symptoms after visiting the doctor means they are just perceived. I know the weak leg is not concern until I can't walk normally perhaps but I'm terrified every time I walk now. I'm doing little extra "tests" on it too too just check if it's weakening, and I'm afraid those are causing a week feeling. Since my disc issue was cervical I'm afraid any leg issues will mean it is definitely something more serious.

Looking for your input both in my als concerns and how to mentally endure and evaluate all these things my body is telling me. Thanks for reading.
 

lgelb

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You have mostly answered your own questions. You have had cervical spine issues, so it would not be a shock to find that you now have lumbar spine problems. Widespread fascics argue against ALS, and a limb that "seems weak" is a long way from one that can't hold you up. Anxiety can fragment your sleep as well as anything else.

I expect that the appointment and EMG will be reassuring.

Best,
Laurie
 

Bergwijn

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Wow Laurie thank you for the quick reply. You have made me feel much better. I guess I will try to see it as a spine issue until I know differently. I'll update you when I get my results.
 

Bergwijn

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I am now getting more concerned. I still don't perceive any weakness but that left tricep is now a focus of the fastics, like a drum beat. It's keeping me awake. They do show up elsewhere but not as much. I'm comforted by the fact I've had them for a long time, probably actually more like a year, with no apparent weakness. That's good right? I'm just not convinced they are from my radiculopathy and they don't seem typical bfs.
 

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There doesn't have to be a cause for fascics, and often people default to "benign fasciculation syndrome" [BFS] because there is no more sinister reason. No, they don't have to be from radiculopathy.

If they keep you awake, you might start a food/drink/exercise/sleep diary and try to figure out what may reduce them. Presuming you get a clean bill of health from the neuro from that perspective, you might consider therapeutic massage, also. Sometimes muscles need a reset.
 

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Thanks for the reply! I will focus on the fascics and trying to make them go away. They really fill me with dread also, which only heightens the anxiety, and I go into that spiral. I will try to focus on happy thoughts!
 

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twitching means nothing. please go back to your doctor if you are really concerned and work through it medically. Laurie gives great advice, but also remember, this is a forum for terminally ill people. We are happy to answer your questions, but we can't hold your hand every time you get yourself scared again.

I truly wish you the best, but your doctor is the one to work with, as we will reassure you, then you will just scare yourself again and come back. That's not appropriate here.
 

Bergwijn

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I apologize, and I do appreciate your help and advice. Thank you for your contribution to the forum.
 

Bergwijn

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Just wanted to update you guys. Had my EMG today and the results were good. The technician said it was constituent with my neck injury and not als. Thanks for all your support. You were right.
 

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I have a follow-up question regarding a new symptom. I also had another EMG on my lower limbs, which showed no evidence of ALS. I passed my neuro clinical exam two weeks ago and he had no concerns.

However, this week I noticed some obvious atrophy at the bottom of the left tricep where the twitching began. It makes my elbow stick out much more than the other one. My wife also noticed it without my telling her. It is not a large area, but it is really obvious.

Do you think this atrophy is likely a result of the same radiculopathy that caused the twitching? What do you think is going on there?

Thank you for your time.
 

lgelb

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It could be. You can send a photo to your neuro if it wasn't noted at the time. The point to remember is that if this atrophy were an ALS sign, we would expect both functional impairment and an abnormal EMG. So from that standpoint, I wouldn't worry.

Best,
Laurie
 

Bergwijn

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Thanks Laurie,

The EMG did mention the tricep had "reduced recruitment," but I think he thought of that as a support to his conclusion that it was due to radiculopathy. If it had reduced recruitment then atrophy might be likely I suppose? It was all in one nerve branch I believe. No functional impairment or weakness yet.

Thanks again for your time, you have been great.
 

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You truly can only keep this discussion going with your doctor.
They examine you, as well as order and read your tests. I truly get that you are worried, but how many times do we have to reassure you? I am not saying nothing is wrong, just that it's beyond the scope of this forum now. You have been answered now and I truly wish you the best working with your qualified doctors.
 

lgelb

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Yes, reduced recruitment signifies that some neurons are not up to their task. If there were widespread abnormalities of that and other kinds, that your EMG didn't show, we might be concerned. With a single muscle involved and a substantively normal EMG, we are not, but I would ask about physical therapy, which is usually the first line treatment for radiculopathy and is often very helpful.

All the best.
 
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