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Are Painful Twitching In Forearm And Shoulders Signs Of ALS?
Question: Hi Dr. Taka,
You and I spoke several months ago about my neurological symptoms and my fears of ALS. After our discussion, my symptoms seemed to subside. I still had twitches, but no apparent weakness or paralysis. Now, nearly seven months later, I noticed some somewhat painful twitching in my forearm, and my shoulders/arms have felt sore/tired despite no physical exertion. Another physician on this site stated that ALS conditions would probably worsen five or six months after primary symptoms began. Do you think I could be experiencing a progression of ALS symptoms?
You and I spoke several months ago about my neurological symptoms and my fears of ALS. After our discussion, my symptoms seemed to subside. I still had twitches, but no apparent weakness or paralysis. Now, nearly seven months later, I noticed some somewhat painful twitching in my forearm, and my shoulders/arms have felt sore/tired despite no physical exertion. Another physician on this site stated that ALS conditions would probably worsen five or six months after primary symptoms began. Do you think I could be experiencing a progression of ALS symptoms?
Brief Answer:
Still unlikely
Detailed Answer:
Hello again! While I am happy to see the trust you still put in me and this site I am also sorry you still have some health issues.
I completely agree with my colleague that ALS symptoms can progress slowly over several months, as a matter of fact that was the argument I offered last time around, that it didn't develop that quickly with fasciculations in different areas of the body so fast, that the widespread diffusion of your fasciculations went against that diagnosis.
However I still do not think it to be your case. First there is always the age factor. Again while it is not impossible, it is very rare for ALS to develop at your age, I've never had a patient your age, so that alone makes it unlikely.
Second there is now the prior history of fasciculations which improved which doesn't fit. ALS does not improve spontaneously transitorily, it progresses without a respite, new symptoms adding to the previous ones. So since it would be hard to believe that you developed two conditions in less than 6 months, first benign fasciculations and then ALS (at your atypical age for als) I continue to maintain that you do not have ALS.
I hope to have eased your worry somewhat.
Still unlikely
Detailed Answer:
Hello again! While I am happy to see the trust you still put in me and this site I am also sorry you still have some health issues.
I completely agree with my colleague that ALS symptoms can progress slowly over several months, as a matter of fact that was the argument I offered last time around, that it didn't develop that quickly with fasciculations in different areas of the body so fast, that the widespread diffusion of your fasciculations went against that diagnosis.
However I still do not think it to be your case. First there is always the age factor. Again while it is not impossible, it is very rare for ALS to develop at your age, I've never had a patient your age, so that alone makes it unlikely.
Second there is now the prior history of fasciculations which improved which doesn't fit. ALS does not improve spontaneously transitorily, it progresses without a respite, new symptoms adding to the previous ones. So since it would be hard to believe that you developed two conditions in less than 6 months, first benign fasciculations and then ALS (at your atypical age for als) I continue to maintain that you do not have ALS.
I hope to have eased your worry somewhat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the response, Dr. Taka. What concerns me most is that my arms feel stiff and mildly sore even though I've done nothing strenuous. Stretching my arms seems to cause a bout of twitching for a few moments, too. Does this have any bearing on your assessment?
Brief Answer:
Read below.
Detailed Answer:
Whether there are cases of ALS which can present with shoulder/arm muscle weakness.... well yes there are (as there actually are a ton of other neuromuscular conditions for that matter). But it is the whole which doesn't convince me, your prior anxiety regarding MS, the subsequent diffuse fasciculations, the age. It would fit much better with anxiety with increased tension in your neck and shoulder muscles.
However if those symptoms persist I am not saying that they shouldn't be evaluated, I am not that cocky to claim to be able to make or exclude a diagnosis without a physical exam or tests such as EMG, imaging and blood tests. But I wouldn't put ALS at the top of the list of possible causes, if anything would consider other conditions at your age such as polymyositis, myasthenia, thyroid dysfunction, muscular dystrophies etc.
Read below.
Detailed Answer:
Whether there are cases of ALS which can present with shoulder/arm muscle weakness.... well yes there are (as there actually are a ton of other neuromuscular conditions for that matter). But it is the whole which doesn't convince me, your prior anxiety regarding MS, the subsequent diffuse fasciculations, the age. It would fit much better with anxiety with increased tension in your neck and shoulder muscles.
However if those symptoms persist I am not saying that they shouldn't be evaluated, I am not that cocky to claim to be able to make or exclude a diagnosis without a physical exam or tests such as EMG, imaging and blood tests. But I wouldn't put ALS at the top of the list of possible causes, if anything would consider other conditions at your age such as polymyositis, myasthenia, thyroid dysfunction, muscular dystrophies etc.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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