Weak wrist and atrophy get me scared

Hello

I would be glad to get some response from people with experience of EMG:s ( for example Wright and others)
My symptoms make me scared. After having fascikulations mainly in calves for some months, I started develop atrophy inside hands . EMG 1 month ago showed no denervation or reinervation, only some chronic neurogen changes in right leg. However EMG showed some low IP from trapezius, back and vastus lateralis. No Fibs or PSW.

Now atrophy starts to work its way up the right forearm, and wrist starts to get weak. I dont know if its clinical weakness, but I get problems when I use arm, turning in awkward positions, for example washing my back, take out credit card from wallet, carry heavy things etc. Forearm is cold all the time, and joints in hands and forearm are cracking. However EMG in arm was normal, though I don´t think they put more than 2 needles there. ( biceps and near thumb)

I have widespread fascikulations in many parts of body , besides in calves they seem to continue every time ca 15 seconds, and then show up in another place.
Also there is atrophy in other parts, calf and butt.

I cannot get explanation for my problems , I will try to get a second opinion from specialist in neuromuscular diseases, but they have long waiting list.

I would appreciate any response and expereiences you might have on the issue of atropy and EMG.

To Al and all Moderators

Why don´t my threads show up under New posts?
it´s rather frustrating, people dont see what I write--

Hello Victor

Given that you recently had an EMG in your affected areas and it was clean . . . that points away from ALS. You say that shortly after your EMG you started to notice atrophy and some weakness in your arm but again, if it was EMG'd just a month ago, that atrophy and weakness is not due to ALS. ALS simply does not move that quickly.

You could certainly have some type of peripheral neuropathy. The denervation from a peripheral neuropathy typically takes a few weeks to show-up in an EMG after it has started (it takes time for PSW's and fibs to develop after denervation). This of course would not be the case with ALS, because if symptoms are noticed, ALS has been developing for some time and the EMG would assuredly be dirty by that time.

Having said all of the above, your atrophy might not be muscle atrophy (muscles aren't the only things in the body that can go through atrophy) and your weakness (or feelings of weakness) could very well be due to anxiety, given you seem like you're in a bit of a panic. My advice would be to go to a neuromuscular specialist so he/she can determine what is happening to you. In the meantime, relax, because your story isn't the story of someone with ALS and quite frankly, doesn't sound life-threatening.

I wish you the best.

Thank´s a lot Wright for your help. I have some more questions.

I have had problems with right leg for 6 months too, and also developed calf atrophy ( looks like a cave under tibia). And my right butt is visibly smaller than the left one.

However amplitude in muscle gastroc caput and vastus lateralis was marked with a + . So EMG was´nt clean in leg , and I just wonder how they can be so sure this come from old problem that not connects with MND? And also IP was marked with low fg in 4 places--
When I asked doctor that performed EMG she wasn´t so sure. She said in her report that "for the time being no points towards MND."
Then Neurolog that looked at the report said it was ok--

But the + in amplitude and low IP sounds a bit worrying too mee, What do you think?

And also I wonder-- If it was perifer neuropathy, wouldn´t that show in the other test? Neurografi, sorry I don´t know the english name. There was some minor changes in foot, but nothing in hands.
She said it was not polyneuropathi.

victor11 said:

To Al and all Moderators

Why don´t my threads show up under New posts?
it´s rather frustrating, people dont see what I write--

Click to expand...

Because, for you, they are not new posts. When you click the Submit button, unless your post is flagged for moderation, the board immediately takes you to the new thread you have created and that new thread is marked as "read" for you. Thus, it will not show up on the New Posts page for you. It does show up on the New Posts page for the rest of us, however, which is where I found it and read it before writing this response.

Sounds like somebody needs to take either a deep breath or a stiff drink, whichever provides the best relief from anxiety. All that turmoil can't be helping your situation. If you need answers quicker than you've been getting them here, your best bet is your local MND association or, preferably, the doctors you have already been seeing.

Hope this helps and good luck to you.

Thank´s
Sorry about that technical thing, now I understand.
I am very greatful for all help and good advice, unfortunately there are long waiting lists for doctors here.

Victor

Your EMG did not have any active denervation (i.e. PSW's or fibs). That is reason it points away from ALS. Again, by the time you have symptoms (if they were due to ALS), ALS is well on its way and the EMG will undoubtedly be dirty. Even if you had active denervation, it doesn't mean you have ALS. An EMG can be dirty for a gazillion reasons. It's the entire story (patient history, EMG and clinical exam) that will determine a diagnosis.

The increase in motor unit amplitude simply means that you have had a previous problem with a nerve that subsequently healed and reinnervated the muscle. That leads to fiber-type grouping and subsequently the motor unit potentials are larger and/or longer in duration. It could have happened 6 months ago or 6 years ago or whenever. It doesn't matter. Most adults would have the same EMG that you have.

In regards to the possibility of you having a peripheral neuropathy: I explained that to you in my previous post.

It's my guess that the atrophy you speak of has either always been there or is not true muscle atrophy. As I said, RELAX and let your physicians determine what is happening to you, if there is anything happening to you.

Victor,

Please listen to Wright, what he says is so true..if it were ALS it would have shown up in your EMG. I have a type of neuropathy and my EMG did not show denervation for 2 months after my first symptom. However with ALS it will show immediately. Again I do not have ALS and I have a very dirty EMG..but hey I'm a dirty girl lol. I also have brisk reflexes with this neuropathy however brisk is consider normal for me. About the atrophy...lol..I thought I had atrophy before this thing really got bad now I know that what I had before was not really atrophy bc what I have now is true atrophy and you can tell the diff believe me. If you think you have atrophy, try taking a creatine based muscle builder with NO2. It has really helped me stay looking pretty dang beefy

Ok thanks a lot to both of you.
I feel a bit more releaved
Actually I take some creatin powder along with Q 10 and E-vitamine

Victor

To Wright

I´m sorry to bother you again, Wright. But you seem well initiated, and there is one thing about my EMG I don´t understand.
For areas trapezius, paravert T6 and paravert S1, dr say in report I have uneven ( or maybe irregular) contraction level.(And also low IP.) This problem with contraction level makes her judging limited in those areas, she says. But not pathology for sure, she says.
I remember when I had muscle relaxed, she said I did´n´t relax enough, there was still activity in muscle.
Maybe that´s a bad sign that I had activity in relaxed muscle? What´s your experience about this matter?

Regards from Victor

Victor, it's difficult for anyone to relax the paraspinals during an EMG, so it means nothing that you couldn't relax them.