Shoulder Muscles And PLS

[Zaphoon]

I've been perplexed regarding the frozen shoulders I have and have wondered if they are frozen as a result of having PLS or if it is indeed just an extraordinary case of bilateral frozen shoulder syndrome (17% of cases have been known to be such).

I found a book entitled, "Clinical Management of Sensorimotor Speech Disorders" authored by Malcolm Ray McNeil. In this book, chapter 50 is dedicated to PLS and is authored by Shannon N. Austermann Hula and Nayan P. Desai.

Regarding PLS, they write:

"Motor examination is notable for spasticity and weakness, mainly of the shoulder abductors, hip flexors, ankle dorsiflexors and elbow, wrist, finger and knee extensors."

The V.A. neuro thinks the PLS has been contributory in my case of frozen shoulders and I think he's probably got it right.

Kim

 

[Geo]

Kim you just could be right ,but in my case and problably in others i have arthritis in my neck hips and some in my shoulder . My hand froze the other day and contracted inward in a grasping manner. Its all controlled by the Brain . You could have something.
Geo

 

[Moonmark]

Hi,

I have a question for people with PLS. do you have a normal EMG with PLS? I have some of these symptoms that PZ mentioned-- shoulder and arm weakness (not frozen, but my arm muscles on my dominant side have become smaller than my left arm and the hand/arm/shoulder is weaker.) I was diagnosed with tendonitis of the R shoulder, elbow, and wrist. It is affecting my right ankle now, which frequently "bends" and gives out. I have a lot of muscle tightness in my legs and hips and finger weakness with fine motor things. I had a normal EMG in June and two neuros say a neuro condition is possible, and one said not "ALS at this time," while the other said "unlikely." I have had some twitching here and there, in various places. and urinary urgency. off and on excess saliva. and brisk reflexes of 3-plus, but no Hoffman's or Babinski.

no diagnosis and this has been going on for about 8 months or so. another neuro visit next month.

is PLS a possibility?

just wondering--

Sandra

 

[Zaphoon]

The thing that bothers me about a diagnosis of PLS is its rarity. Some figures quote 1 in 10 million.

I'm no medical professional so take this with a grain of salt. In PLS, you usually see some neurological signs manifested like the Babinksi and/or Hoffman. The EMG is usually normal but minor, nonprogressive EMG abnormalities (fibrillation potentials in distal muscles) may be noted in PLS. You won't have the kind of EMG results found in ALS. If that happens, the diagnosed is changed from PLS to ALS. This is my understanding.

PLS, as you probably know by now, is a diagnosis that is arrived at by ruling out all other possibilities. Neurologist do not like to bring up motor neuron diseases in their conversations while still in the early stages of diagnosis. Most of them realize you are already stressed enough as is. Telling somebody they may possibley have MND often has a tendency to induce further stress.

Odds are against you having ALS and more against you having PLS.

Kim

 

[Erica]

Sandra, From what I understand the PLS is predominantly UMN disease, where as ALS a combination of UMN and LMN. Erica
Kim: Since my initial presentation was pain and weakness in R shoulder and before my ALS diagnosis, I was given exercises for "frozen shoulder". If you interested, I can scan and email them to you.Erica

 

[Zaphoon]

Erica, Thank you! I'll send you my email address in a pm.

Kim

 

[Judith]

Since doing Range of Motion exercises daily, they have helped my stiffness a great deal. I have been diagnosed with PLS.

Judith

 

[Zaphoon]

Thanks, Judith! It's nice to know that doing range of motion exercises can help with the stiffness.

Kim

 

[lydia]

I wish that we could find, in laymen's terms, how spasticity and weakness, mainly of the shoulder abductors, hip flexors, ankle dorsiflexors and elbow, wrist, finger and knee extensors actually plays out in real life. I know that I am stiff and sore, always. I know that my balance is off; for example even leaning slightly over while wiping a table clean requires herculean effort to not tip forward. Getting up from a chair always requires launching by arms and some rocking. I frequently walk like a troll or penguin for the first few steps of motion. Driving a car for more than an hour straight means my right leg is nearly impossible to bend or stretch for a good day or so after.

Is any of this spasticity? weakness? what? I was observed by neuro to have mild clinical weakness on left side, but no mention of spasticity. I have read about exams that determine/measure spasticity and know that I have never been examined in that way. So I wonder about the real life manifestations of it. Every now and then I just have to crawl out of the woodwork and wonder aloud about spasticity. I apologize Zaphoon for whining on your thread. But I believe the issue that I have that impacts my life the most negatively is in fact spasticity.

I think we need a Jeff Foxworthy version of "you might be a redneck ..." for spasticity. Like, "if your foot bends in an impossible position and stays that way, you might be a spaz" (no disrespect intended) My foot bent that way last week and I yelled for my son. I wanted a witness. He actually was afraid my foot would break. Now I know that is not normal.

Lydia

 

[Zaphoon]

Lydia,

No need to apologize! They way you described yourself you could have been painting a picture of me. It takes a lot of effort to rise from a seated position, especially if the seat is low (like a well worn sofa). The walking like a penguin thing... me again!

In my opinion, it takes a bit of guts for a neuro to give a diagnosed of PLS just because of its rarity.

Zaphoon

 

[halfin]

I've been having quite a bit of what I think is spasticity lately. The way it plays out for me is that my movements have become jerky and uncoordinated. For example, if I make a fist and then suddenly straighten my fingers, they move in a jerky pattern. They don't just extend, there is a kind of hesitation partway along. I am finding this with other movements as well, extending my legs for example. Sometimes too I get tremors, particularly if trying to move my arm or leg against resistance, the limb starts vibrating back and forth an inch or so. Fortunately I do not have significant cramps. Occasionally I get a little sore cramp springing up but I can stretch it and it goes away. Last night I was having some trouble with my neck muscles tightening as I was moving during the night, but they weren't cramps and weren't painful. It was just that I had a hard time relaxing the muscles. That's how it seems lately, my muscles just don't relax and let go properly.

 

[paleshia]

yep, hypertonic is the term the pt used. my hand started that way...just a little jerky in my thumb and index finger. now i can barely open that hand, no more jerkiness there, it just doesn't work. the spasticity has moved on the the other arm, my left leg, i feel ridiculous sometimes and i probably look it too. that hesitation is exactly what happens to me, and i know what happens next...bummer.

take care hal and don't overwork those muscles too much

 

[halfin]

Thank you, Jen, I appreciate the good wishes, and I hope you too have things calm down and stop changing. Best we can hope for these days.

 

[piperl4]

What has me even more baffled is if PLS is so rare like 1 in 10 million there are 20 times more than those odds just on this site. Look under the Veterans section and there are even a ton more. the VA says is is not anything to do with ALS and everyother Doctor says it is. Guess they just do not want to pay up. So I just cannot figure out the real odds on PLS. I know when it first started in me they said it was PLS then changed their minds when I could not breath or speak, and a raft of other things. Johns Hopkins scored me 43/49 on the scale and my other neuroligist came up with 29/49 and I never answered one question differantly. I have lost faith in Johns Hopkins now and just stay with my local doctors for my supportive care.
Seems like everything is always a hassle even dying. They just cannot even leave you to do that in peace. If you have PLS then in 5 min with the right neuroligist it can change to ALS or turn out not to even be PLS. I have seen both ends of the scale and I am disapointed the VA has taken such a dim view on UMN-Dominant ALS. It would seem the odds are many times over that it is ALS in reality if diagnosed properly. That is if the stats of 1 in 10 million are true.
Dave

 

[halfin]

I wanted to mention something on shoulder pain. I've been having shoulder pain the last month or so. In my case it seems to be because I sleep on my sides. I can't sleep on my back, my tongue falls back and I can't breathe. But sleeping on my side, my weight is on my shoulder and it rotates forwards. After a few hours it gets really sore and I switch sides, but by the time I wake up both are sore.

My wife is a PT and helped me set up a pillow arrangement that really helps. I put one pillow under my rib cage, then a gap, and two pillows under my head. My shoulder goes in the gap. This takes some of the weight off my shoulder and I am waking up without pain. Maybe this can help other people who are having shoulder problems.