Seeking insights on mysterious muscle weakness

[Hydvfd]

Hi everyone, I'm hoping some perspectives on my ongoing medical situation.

Symptom Progression

- History of cubital tunnel syndrome, with ulnar nerve transposition in 2023 with no positive impact. Unable to use keyboard or write for significant length

-recent symptoms began last December ,with worsening weakness primarily in upper legs, then progressing to upper arms

- Weakness significantly increases with prolonged activity (unable to stand for more than a few minutes)

- No significant pain accompanying the symptoms

- Muscle twitching present in legs, feet last three weeks

- in all cases, was physically fit in muscle groups before they were affected

Medical Investigation So Far

- Neurological exam was largely normal (minor hyper reflexes of knee, but not clinically weakness )

- Spine MRIs (cervical, thoracic, lumbar) were unremarkable

- bloodwork was normal (including testing for MG antibodies)

- Rheumatologist does not believe symptoms are related to arthritis

-Pending EMG which is scheduled


I'm reaching out to see if anyone has any advice on potential paths forward or diagnostic approaches.

If this looks blatantly unlikely to be ALS, would be happy to hear that. This was downplayed by the neuromuscular physician, but I don’t have another condition which I am being indicated I might have other than a non-descriptive peripheral neuropathy.

 

[lgelb]

The speed going from upper legs to upper arms argues strongly against ALS. It sounds more post-viral than anything since lack of clinical weakness/atrophy argues against myopathy as well.

I'd discuss empiric physical rehab with your PCP if they have no more tests to suggest. You might also consider a long Covid clinic for screening.

 

[Hydvfd]

Thanks. I started doing physical therapy effective today actually.

Just for clarity, the legs to arms progression was separated by two weeks. I still take the point this would be quick if it were to be ALS

 

[lgelb]

Yes, unheard-of quick.