Should i do another EMG / Second opinion

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Janders

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I so appreciate the struggle with diagnosis and associated fears and concerns. Appreciate you reaching out for support. My husband had a total of 4 emgs in his diagnosis journey. The first two were negative and we were assured 'can find no major issue'. As weakness and tremors progressed without explanation, a third and fourth emg (two different doctors) confirmed ALS in Jan of 2021. It appeared to be the changes in EMGs as well as unexplained symptoms around weakness and function that assisted in diagnosis. This can be a most difficult and confusing process. I wish the best for you and your family
 

lastime20151

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Small follow up. Well actually not so small but I hope it helps to other worried people.

1. So I have just bought a digital grip dynamometer which confirmed (thank God) that my grip in my left hand is almost same as in my right hand. So I stopped worrying about my minor left hand atrophy. Can be from constant desktop work with PC, I dont know. But the technician tested this area on EMG as well (results on previous page).

2. Neurologist (not ALS specialist though) and some people (thank you) here confirmed that muscle relaxants should not interfere with EMG results. Had a coffee though just before EMG test, reason for high MUPs? Well, who knows. Probably better to ignore it since like I mentioned previously, the results have to be interpreted based complete data set and not just one single parameter including clinical examination.

3. My heavy arm, heavy shoulder, and weakness when holding let say phone, or when showering and holding the shower handle above my head are still present. But I hope it is caused by from bicep tendonitis/shoulder impingement from end of Decemeber. What got me worried is the fact that this was treated in January and symptoms went away however 5 sessions with physio was probably not enough and it came back (we know that nerve injuries can serve as be a trigger to ALS but I guess not in 3 weeks. Also dr google says that it can take from 6 weeks to 3 months to fully heal a muscle/tendon injury, shoulder impingement even more… this might explain the high MUP as past injury but would it be present in neck elbow and hand? Again, who knows). Worth noting is that yesterday a patch containing Diclofenac sodium reduced the soreness from workout with physio.

4. Some twitches here and there (right leg, right finger right hand which is opposite side of the body, lets say twice a day) but during last month only once in my left arm where I had pain/injury in December (see my first post). My understanding is that with ALS patients twitches are constant and does not help when you move (so you just might be sitting or laying in position where the nerve is being pressed). This points away from ALS.

5. For anxious people looking at this thread in the future what I have not mentioned is that in January friend of mine passed away from cancer, young, in his 30s. We were not close anymore but hey, the shrink said this might triggered the anxiety and might have elevated my symptoms to levels that are affecting my daily life (constant self-observing, checking for reassurance online, etc.).

6. There is no doubt that my left arm (dominant) is weaker than my arm. But hopefully the physio sessions and time will make it better. I work with numbers and hey statistics do matter (seen Moneyball?). Chances of a person who is 34 with almost clean EMG, diagnosed by neurologist with no major denervation/reinervation and experienced some mental trauma to be diagnosed with this unfortunate disease and proximal shoulder (since my grip is fine) onset are less than almost none (since my grip is fine I guess), maybe even never happened before.

7. Therefore I decided not to go to that als specialist. Yes, part of me is affraid but the other part of me wants to move on with my life. Time will show I guess, but now I am less worried and more optimistic.
 

lgelb

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Thank you for the update. Your analysis seems spot-on (except the part about injuries triggering ALS, though ALS signs can sometimes be incorrectly attributed to injuries) and will help others.

It is very true that shoulder injuries that were inadequately treated can be a source of significant inflammation and downstream symptoms.

I am sorry about your friend. You are right, even though you weren't close at the time, losses like that can have a strong impact.

Please continue to get the help you need to build on your optimism and reclaim the health that anyone here affected by ALS would give a great deal to have.

Best,
Laurie
 

affected

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I honestly could not read that huge swathe of text. I got to something about drinking coffee before the EMG and zoned out as it followed that you can now test yourself for weakness and have decided those are the results you will believe.
But I figure the gist of the post is to say, you don't have ALS, which we have said from the start so huge congrats.
Please, we are happy, but that's enough, it is great news, now adult up and move away from here as coming back here even one more time will the most unhealthy thing you can do for yourself.
All the very best, work with your doctors.
 

Clearwater AL

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As per your user name... "Lastime". No need to reply.

" I am less worried and more optimistic." That's one of the best self
diagnosis we've read. Go with it even more.

Work with your doctors to find the path to a healthy, happy, health
worry free life.
 

lastime20151

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Hello unfortunately I am back with some follow up questions since ortho now denied shoulder impingement and is now mentioning tendonitis. MRI will be done today. Health anxiety is questionable since clinical weakness was also observed by physiotherapist. Hence:

1. Can anyone explain what giant Mups can be caused from. (neuro didnt want to discuss)

2. Why Nikky mentioned my emg is normal regarding ruling out als diagnosis?

2. Can anyone explain if giant Mups represent chronic denervation or reninervation? Which one.

3. Follow up on question 3, neuro put 4 on all tested areas (max value), why in the hell then he described no major denervation/reinervation was observed. Did he mean acute?

4. Do I understand correctly that chronic denervation cant preceed acute one. So first symptom has to be acute and then chronic not otherway around? What are the findings in acute denervation?

Thank you
 

Nikki J

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Address any more questions to your doctor. I am closing thread as we are going in circles. Do not start another

large mups can be from well developed muscles. I am not even sure that you had them as you have zeroes in high amplitude. you have 4 + in normal mup ( a column we don’t usually see) which seems to mean you had lots of normal mups but you need to clarify that with your doctor

even if you had large mups they can be a normal variant Mup abnormalities are a chronic issue though.
the process in als is ongoing acute denervation followed by chronic with acute
 
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