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Suggest Treatment For Thenar Muscle Pain While Having ALS
Question:
If you can read my prior questions it will help.
I am worried about pain in my thenar muscke that has been constant for 7 weeks. It is particularly concerning because i have had muscle twitches during the same time frame. I had a clean emg a few weeks before the thenar pain. What worries me is that there appears to be some thenar atrophy.
I am very concerned this could be a presenting symptom of ALS and i would really like your opinion. I can do sll the things i normally can do, but not without pain in the palm under the thumb. I do use a mouse all day at work and hope this is a coincidental timing of irritation to something?
I wonder if the emg was too early to pick up issues with this. I also wonder if my hand looked like this and i never noticed until the pain.
I thought weakness was the key before atrophy and normally ALS doesnt present with pain? Although overcompensating fine muscles may cause pain perhaps if this were a presenting symptom. I am very concerned and looking for some reassurance that perhaps it might point to something else.
Of course, i want a direct opinion about your experience regarding such a presentation and what it normally has been.
If there is atrophy, what would be a normal timeframe before it would show on an emg?
If you can read my prior questions it will help.
I am worried about pain in my thenar muscke that has been constant for 7 weeks. It is particularly concerning because i have had muscle twitches during the same time frame. I had a clean emg a few weeks before the thenar pain. What worries me is that there appears to be some thenar atrophy.
I am very concerned this could be a presenting symptom of ALS and i would really like your opinion. I can do sll the things i normally can do, but not without pain in the palm under the thumb. I do use a mouse all day at work and hope this is a coincidental timing of irritation to something?
I wonder if the emg was too early to pick up issues with this. I also wonder if my hand looked like this and i never noticed until the pain.
I thought weakness was the key before atrophy and normally ALS doesnt present with pain? Although overcompensating fine muscles may cause pain perhaps if this were a presenting symptom. I am very concerned and looking for some reassurance that perhaps it might point to something else.
Of course, i want a direct opinion about your experience regarding such a presentation and what it normally has been.
If there is atrophy, what would be a normal timeframe before it would show on an emg?
Brief Answer:
Subtle differences from one side to another.
Detailed Answer:
Good evening. I did read your questions previous to this one and believe I have an idea of your concerns. The fact that your EMG several weeks ago is normal is compelling evidence that the hand muscles or muscles of the thenar region are not likely suffering from any type of motor neuron disease (i.e. ALS). The other point to keep in mind (which was mentioned in Dr. Taka's responses to you on the other question) is that ALS is not known to significantly or exclusively affect one side of the body. It is typically a symmetric process and covers both sides equally. The other thing is that ALS is not known to affect "thenar muscles" and leave other muscles intact. That's almost surgical precision for a disease process which is well known to affect the body in a global or at least bilateral fashion. In fact, if anything the disease is typically noticed by symptoms in the lower extremities before upper. Another good reason NOT to consider ALS as likely in you as in other people is your gender.
If you were to say that someone in your family had pathologically confirmed ALS then, your gender would be of little consequence. You are correct that weakness also typically precedes atrophy of any part of the body and once atrophy begins to be noticed the presence of fasiculations is not uncommon. So far we've not heard much about any of these details. Also, ALS is not known to be a painful syndrome therefore, I think that for all these reasons the odds of a motor neuron problems such as ALS is quite low on the differential list.
If I've satisfactorily addressed your questions could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback on your opinion as to our transaction?
Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 40 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Subtle differences from one side to another.
Detailed Answer:
Good evening. I did read your questions previous to this one and believe I have an idea of your concerns. The fact that your EMG several weeks ago is normal is compelling evidence that the hand muscles or muscles of the thenar region are not likely suffering from any type of motor neuron disease (i.e. ALS). The other point to keep in mind (which was mentioned in Dr. Taka's responses to you on the other question) is that ALS is not known to significantly or exclusively affect one side of the body. It is typically a symmetric process and covers both sides equally. The other thing is that ALS is not known to affect "thenar muscles" and leave other muscles intact. That's almost surgical precision for a disease process which is well known to affect the body in a global or at least bilateral fashion. In fact, if anything the disease is typically noticed by symptoms in the lower extremities before upper. Another good reason NOT to consider ALS as likely in you as in other people is your gender.
If you were to say that someone in your family had pathologically confirmed ALS then, your gender would be of little consequence. You are correct that weakness also typically precedes atrophy of any part of the body and once atrophy begins to be noticed the presence of fasiculations is not uncommon. So far we've not heard much about any of these details. Also, ALS is not known to be a painful syndrome therefore, I think that for all these reasons the odds of a motor neuron problems such as ALS is quite low on the differential list.
If I've satisfactorily addressed your questions could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback on your opinion as to our transaction?
Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 40 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I deeply value your opinion, time and consideration.
I thought ALS presented on one side, so thankful fir your input.
I must ask... Do you think my muscle twitches may be due to stress (I have never had a health scare like this in my life)?
And... What might be the reason for the constant palm / thenar pain? All of my problems seem to be on the right side (cramping in lower leg) - thenar pain (forearm pain occasional) - and weak bicep right side (it gets sore easily after using it). I picked up my 40 lb child today and carried her about 200 feet only to find my bicep sore within hours.
I am wondering about any condition which might cause one sided symptomatic weakness, cramping or pain?
I deeply value your time and feedback.
I thought ALS presented on one side, so thankful fir your input.
I must ask... Do you think my muscle twitches may be due to stress (I have never had a health scare like this in my life)?
And... What might be the reason for the constant palm / thenar pain? All of my problems seem to be on the right side (cramping in lower leg) - thenar pain (forearm pain occasional) - and weak bicep right side (it gets sore easily after using it). I picked up my 40 lb child today and carried her about 200 feet only to find my bicep sore within hours.
I am wondering about any condition which might cause one sided symptomatic weakness, cramping or pain?
I deeply value your time and feedback.
Brief Answer:
Details of EMG
Detailed Answer:
Thank you for your return comments. You state that an EMG that was done within the past several weeks was clean. Therefore, I can only assume that the study was performed by an expert and included possible pathology at the level of the wrist, elbow, and neck. Had there been any problems at any of those points then, a report of an abnormality would've been filed. Therefore, the next question I must ask is whether or not there is actual thenar atrophy or is it simply a mild asymmetry between one side of the body and another. If there were actual atrophy then, it would be very difficult for an EMG done properly not to show something such as increased insertional activity or some form of reduced amplitude wave upon muscle stimulation compared to normal.
Therefore, it certainly is possible that nerves and anxiousness could be contributing to your symptoms, at least in part.
Definitely a neurological examination by a neurologist could determine whether or not there exists true muscle weakness of a peripheral nature in your biceps.
One other area to look at for unilateral weakness and loss of stamina and/or some sensation on one side of the body would be the neck. If you were my patient I would consider ordering an MRI of the c-spine with plain films as well and then, be sure that the EMG that was done was appropriate for finding pathology of compression across the wrist or possible at the level of the cervical spine or neck.
If I've satisfactorily addressed your questions could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback on your opinion as to our transaction?
Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 51 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Details of EMG
Detailed Answer:
Thank you for your return comments. You state that an EMG that was done within the past several weeks was clean. Therefore, I can only assume that the study was performed by an expert and included possible pathology at the level of the wrist, elbow, and neck. Had there been any problems at any of those points then, a report of an abnormality would've been filed. Therefore, the next question I must ask is whether or not there is actual thenar atrophy or is it simply a mild asymmetry between one side of the body and another. If there were actual atrophy then, it would be very difficult for an EMG done properly not to show something such as increased insertional activity or some form of reduced amplitude wave upon muscle stimulation compared to normal.
Therefore, it certainly is possible that nerves and anxiousness could be contributing to your symptoms, at least in part.
Definitely a neurological examination by a neurologist could determine whether or not there exists true muscle weakness of a peripheral nature in your biceps.
One other area to look at for unilateral weakness and loss of stamina and/or some sensation on one side of the body would be the neck. If you were my patient I would consider ordering an MRI of the c-spine with plain films as well and then, be sure that the EMG that was done was appropriate for finding pathology of compression across the wrist or possible at the level of the cervical spine or neck.
If I've satisfactorily addressed your questions could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback on your opinion as to our transaction?
Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 51 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I deeply appreciate the detailed reponse.
My last two questions - would it be possible for the cramping and pain in my hand and forearm to be presenting symptoms and not yet show on an EMG?
I had low amplitude on the ankle peroneal nerve on the EMG and I am having some pain and weakness in that ankle upon exertion. Should i be concerned that this was done too soon and might not have picked up damage? The amp on the ankle was 1.4, but did not show denervation signs
I think you have done a great job answering my questions.
I am wondering if osteoarthritis could be a factor.
Thank you again - i look forward to hearing from you.
My last two questions - would it be possible for the cramping and pain in my hand and forearm to be presenting symptoms and not yet show on an EMG?
I had low amplitude on the ankle peroneal nerve on the EMG and I am having some pain and weakness in that ankle upon exertion. Should i be concerned that this was done too soon and might not have picked up damage? The amp on the ankle was 1.4, but did not show denervation signs
I think you have done a great job answering my questions.
I am wondering if osteoarthritis could be a factor.
Thank you again - i look forward to hearing from you.
Brief Answer:
Highly unlikely to be ALS
Detailed Answer:
Good morning. Thank you once again for these last 2 questions which I am happy to answer.
It is highly unlikely that pain/cramping in the hand and forearm on one side of the body are due to motor neuron disease for the reasons I stated above. Your EMG was done at a very adequate time in the evolution of your symptoms such that any pathology related to something such as ALS or even any other possible disease process such as compression of the median or ulnar nerves would've been expected to show something. You state the presence of atrophy as well as your other symptoms of pain/cramping, however, this will need to be correlated with a neurological examination which I am unable to do on you therefore, I am in a disadavantaged position to make a firm diagnosis.
I recommend to you (and I believe this recommendation was also made by another doctor on this network) that you be examined by a neurologist where you are at so that a solid diagnosis can be made clinically. Then, testing results will make more sense to interpret.
As far as the low amplitude finding in the peroneal nerve at the ankle...once again, predictions about underlying processes are best done by a neurologist who has had the chance to examine you as a whole and to get other pertinent history. The fact that you are complaining now of what seems to be symptoms in both upper AND lower extremities on the same side of the body suggests something more than compression of nerves at one site are at work. Of course, you may also have things going on in multiple places such as the low back as well as the wrist but I again, we go back to the exam and more detailed history which you must seek out from a local specialist in your area.
Osteoarthritis can be an explanation for many things involving pain and cramping in the limbs and I'm sure any neurologist looking at this picture as you've presented it would keep that in the back of their minds as they worked you up.
I would appreciate knowing how things work out after seen your local neurologist so please feel free to drop me a line. Cheers!
If I've satisfactorily addressed your questions could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback on how you felt my answers may have helped?
Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 68 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Highly unlikely to be ALS
Detailed Answer:
Good morning. Thank you once again for these last 2 questions which I am happy to answer.
It is highly unlikely that pain/cramping in the hand and forearm on one side of the body are due to motor neuron disease for the reasons I stated above. Your EMG was done at a very adequate time in the evolution of your symptoms such that any pathology related to something such as ALS or even any other possible disease process such as compression of the median or ulnar nerves would've been expected to show something. You state the presence of atrophy as well as your other symptoms of pain/cramping, however, this will need to be correlated with a neurological examination which I am unable to do on you therefore, I am in a disadavantaged position to make a firm diagnosis.
I recommend to you (and I believe this recommendation was also made by another doctor on this network) that you be examined by a neurologist where you are at so that a solid diagnosis can be made clinically. Then, testing results will make more sense to interpret.
As far as the low amplitude finding in the peroneal nerve at the ankle...once again, predictions about underlying processes are best done by a neurologist who has had the chance to examine you as a whole and to get other pertinent history. The fact that you are complaining now of what seems to be symptoms in both upper AND lower extremities on the same side of the body suggests something more than compression of nerves at one site are at work. Of course, you may also have things going on in multiple places such as the low back as well as the wrist but I again, we go back to the exam and more detailed history which you must seek out from a local specialist in your area.
Osteoarthritis can be an explanation for many things involving pain and cramping in the limbs and I'm sure any neurologist looking at this picture as you've presented it would keep that in the back of their minds as they worked you up.
I would appreciate knowing how things work out after seen your local neurologist so please feel free to drop me a line. Cheers!
If I've satisfactorily addressed your questions could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback on how you felt my answers may have helped?
Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 68 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for everything! I have appreciated your thoughtful and detailed responses.
Brief Answer:
You are very welcome
Detailed Answer:
It has been a pleasure to help you. I hope the information was informative and serves you well.
I'd be very appreciative in return if you'd choose to close this query and provide just a few words of feedback on our interaction.
And please do look me up in the future at www.bit.ly/drdariushsaghafi for other questions or a status update on this problem.
Cheers!
You are very welcome
Detailed Answer:
It has been a pleasure to help you. I hope the information was informative and serves you well.
I'd be very appreciative in return if you'd choose to close this query and provide just a few words of feedback on our interaction.
And please do look me up in the future at www.bit.ly/drdariushsaghafi for other questions or a status update on this problem.
Cheers!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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