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LOU6683

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Hi,
I asked a single question lat month and was satisfied with the response as I felt it was helpful and very much appreciated. I just have two quick questions maybe someone can answer for me. Are hyper reflexes usually an early presentation or after weakness? secondly is cramping a late stage issue or is that early part of the disease. I get what feels like cramping in both feet when walking mainly in the soles of My feet.. My neurologist is sending me for an EMG next week. My reflexes are normal as is My arm strength. Even though I have noted
clinical atrophy in My deltoid and bicep.. Thanks for the response in advance.
 

GregK

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LOU6683

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Hi Greg,
Thanks for your response, I was diagnosed by two Dr.'s with atrophy, or I would not think about coming to an ALS message board. I am well aware that alot of things can cause atrophy, but its the muscle twitching and cramps in My feet that have me a bit concerned.
 

lgelb

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Hyperreflexia can occur early or late, or not at all as it relates to upper motor neurons. "Cramping" is one of those terms that means different things to different people, but again there is no standard order of presentation.

Let us know what the EMG shows.

Best,
Laurie
 

LOU6683

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EMG normal / MRI denervation

Hi,

I posted a while back about the atrophy in My bicep. On Jan 7 I
went for My EMG. Dr, who is a DO Board certified in Neurophysiology and Electrodiagnostics Medicine did the test 7 spots both arms and a few in My neck. She stated all clear. I went for an MRI on the arm last weak and that shows diffuse denervation of My brachialias muscle with patchy spots of edema... Neurologist said He will call the Dr. that did EMG because something is not right.. Anyone have anything like this. Could ALS be confined to a single spot where it was missed? The EMG needle portion has all 0's
 

ShiftKicker

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Mod note- rolling new post into already open thread. Please keep posting here so folk can see all your posts in one place.
 

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If the “EMG needle portion has all 0’s”, then that rules out ALS. There is some other localized process in the brachialis muscle showing up on the MRI.

The radiologist, neurologist, and electro diagnostics doctor need to confer to determine what that process is. But you don’t have ALS. ALS doesn’t present that way and would not cause muscle edema.
 

LOU6683

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Ok, I appreciate the response. I am waiting for the Dr to call back because He stated that denervation on a MRI without it showing on an EMG is very, very odd. I do have atrophy but its isolated to the brachialis muscle. I do have very little weakness that the Dr tested me today, He was a pain Dr. He gave my arms some good pulls and said very slight difference in the arms. How do I know that the Dr who did My EMG did not miss anything? Supposedly EMG is all she does for the Practice. But I suspect they don't see many MND..I noticed the atrophy in Oct and it has been pretty stable. I do have twitches in My legs and other areas. I don't like that these Dr don't have any answers to what is going on.. Thanks in advance
 

LOU6683

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Dr called back about my emg

My Dr. called me back and said that He spoke with Neurologist who did EMG. He stated that she does not understand why the denervation seen on the MRI was not observed during the test. The Dr who called is also a Neurologist said that I should see a Neuromuscular specialist. He said that the edema scene on MRI is what happens to the muscle early on in the denervation process before atrophy. He said it is very atypical for a single muscle in My case the brachilias to go through a denervation process. I said could this be ALS and He said well "if it is very early and atypical anything is possible" Not very comforting. I meant to ask him if the Dr doing the EMG would have to be looking for ALS on the EMG or is it a cant miss once the test is done. Very confused, I have aches in my forearm along with both My hands and feet and am living on gabapentin. He also said I had 4+ muscle strength is the effected arm
 
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KarenNWendyn

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Your overall presentation does not suggest ALS.

The aching really points away from it, among other things.

Appropriate diagnosis requires that the doctor look at the big picture, history, physical exam, and all test results.

I’m glad you’re planning to see a neuromuscular disease specialist, not because I think ALS is likely, but because they are skilled at putting everything together and can hopefully give you answers.
 

LOU6683

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Thank u for your response, just spoke with My family Dr who I know 35 years He said " ALS does not present this way and it does not effect a single muscle. He also thinks the EMG was ok and this is a local process. Maybe Parsonage turner syndrome. I will post after I see Neuromuscular Dr. Once again thanks
 

LOU6683

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Quick question while I wait to see NM Doc

Hi,
I am waiting to see a Neuro muscular Dr in March, I saw a orthopedic Dr today who was recommended by My family Dr because He thought this may be a localized process. The Ortho told me what the 4 other Dr's said. Has no idea what is going on with My arm. I actual had 3 Dr's pull and press on Me today. Dr said it is Neurological and I should see another Dr or do nothing and wait 6 months. My question to the board is the Neurologist who did My emg was also electrodiagnostic Dr as it says it in Her credentials. What are the chances she missed ALS on the testing? she stuck Me 16 times both arms and My neck. If I have symptoms like atrophy, would it be blatant on the EMG. I do have some weakness in the arm, but My biceps are very strong compensating for the brachial muscle My strength is 4+ according to Dr today. Can it be missed if you are symptomatic?? thank u
 

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ALS is just one of a huge range of neurological issues, and is one of the rarest. Being told to see a neurologist does not mean ALS. Your appt with a neuro is coming up pretty soon now, write down all your questions and concerns, but don't ask do I have ALS - be open to a highly trained doctor knowing what they are looking for and doing about it.

Let us know after that and all the best :)
 

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Re: Quick question while I wait to see NM Doc

The chance she missed ALS that someone else would have found on the EMG: slim to none.

Atrophy per se does not show up on an EMG.

Parsonage Turner can be tricky to see on EMG if it's not being specifically looked for.

I would select from among the neuromuscular centers [Columbia/NYP, HSS, Mt. Sinai, Beth Israel], you've been to (and if you're not going to one, I would change that) and follow the diagnostic process through. But if you are already doing PT, so harm in asking that a new order be written from a standpoint of a provisional PTS diagnosis, to help guide future therapy, which can be updated if/as needed.

Best,
Laurie
 

LOU6683

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U are very right about Parsonage Turner the Ist Neuro said "If we suspect PTS we usually would not do an EMG". They did it on Me because I did not have the tell tale weakness that comes with the diagnosis. My muscles get very fatigued after brief use in My arms on both sides as well they feel twitchy and achy. I believe I am seeing a Dr. Lange HSS in NYC, I am trying to get in sooner so I have to call back on Monday. If not I may see another Dr in his office.
 
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