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Suggest Treatment For Muscle Twitching And Atrophy In Right Shoulder
Question: I have been having twitching muscles over the last 4 weeks, started in my right tricep and now i am having them on my feet and other parts of my body. I also have atrophy in my right shoulder (however ive had an injured shoulder for the last 6 months, so this may explain that ....) I have visited my doctor who assures me there is nothing to worry about. I am concerned it could be MND. I would like your opinion please?
Brief Answer:
Electromyography/observation
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
On the basis of clinical history you have provided,it is early and difficult to say whether it is motor neuron disease(MND) or not.
Fasciculations can be a part of benign fasciculations syndrome(BFS).Atrophy of the shoulder, as you mentioned,can be explained by the injury.However,longitudinal observation is needed to see if atrophy and weakness develops in other regions also.If it does,it will go in favour of MND.
Presently,I suggest you to undergo Nerve conduction studies and Electromyography(NCS-EMG) to see for evidence of motor neuron disease.
Baseline EMG at present will also be helpful as it can be compared with future EMG,to see for any electrophysiological worsening,if any.
Hope that I have answered your query.If you have some further questions,I shall be glad to answer.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Electromyography/observation
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
On the basis of clinical history you have provided,it is early and difficult to say whether it is motor neuron disease(MND) or not.
Fasciculations can be a part of benign fasciculations syndrome(BFS).Atrophy of the shoulder, as you mentioned,can be explained by the injury.However,longitudinal observation is needed to see if atrophy and weakness develops in other regions also.If it does,it will go in favour of MND.
Presently,I suggest you to undergo Nerve conduction studies and Electromyography(NCS-EMG) to see for evidence of motor neuron disease.
Baseline EMG at present will also be helpful as it can be compared with future EMG,to see for any electrophysiological worsening,if any.
Hope that I have answered your query.If you have some further questions,I shall be glad to answer.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Regarding my shoulder there is definitely no weakness and has improved over the last 4 weeks, which I assume is positive?
My twitches can be felt but my dr mentioned that muscle twitches in MND are normally only visible and you can't feel them?
I have suffered health anxiety issues over the last 10yrs so she has put this down to another episode of HA.
She did a physical examination checking reflexes etc so surely if she had concerns she would of referred me to a neurologist for more tests?
My twitches can be felt but my dr mentioned that muscle twitches in MND are normally only visible and you can't feel them?
I have suffered health anxiety issues over the last 10yrs so she has put this down to another episode of HA.
She did a physical examination checking reflexes etc so surely if she had concerns she would of referred me to a neurologist for more tests?
Brief Answer:
Observation
Detailed Answer:
Hi,
Thanks for being in follow-up.
Of course,if the shoulder has improved,it is not a part of MND.
I don't confirm to this feature of muscle twitches-'muscle twitches in MND are normally only visible and you can't feel them'.They can be felt even in MND.However,more often than not,diffuse fasciculations are a part of 'benign fasciculations syndrome',especially in absence of atrophy and weakness.
Even I am saying that,these fasciculations are likely to be benign.Anxiety precipitates fasciculations.
If she is sure that it is not MND,You can just be under observation and go for NCS-EMG if any worsening or new symptoms occur.
Hope that I have answered your query.If you have some further questions,I shall be glad to answer else please close the thread,rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Observation
Detailed Answer:
Hi,
Thanks for being in follow-up.
Of course,if the shoulder has improved,it is not a part of MND.
I don't confirm to this feature of muscle twitches-'muscle twitches in MND are normally only visible and you can't feel them'.They can be felt even in MND.However,more often than not,diffuse fasciculations are a part of 'benign fasciculations syndrome',especially in absence of atrophy and weakness.
Even I am saying that,these fasciculations are likely to be benign.Anxiety precipitates fasciculations.
If she is sure that it is not MND,You can just be under observation and go for NCS-EMG if any worsening or new symptoms occur.
Hope that I have answered your query.If you have some further questions,I shall be glad to answer else please close the thread,rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your response.
When you say signs of weakness can signal MND, would this weakness be very noticeable and could you give me examples? I am currently using the gym and have not noticed anything has got weeker apart from the shoulder during its rehab stage ( now it's back to lifting the same weights I used to)
When you say signs of weakness can signal MND, would this weakness be very noticeable and could you give me examples? I am currently using the gym and have not noticed anything has got weeker apart from the shoulder during its rehab stage ( now it's back to lifting the same weights I used to)
Brief Answer:
As follows:
Detailed Answer:
Hi,
Thanks for being in follow-up.
Of course,the weakness will be very noticeable like-
Distal upper limbs weakness-
examples like difficulty in buttoning and unbuttoning the shirt,difficulty in holding the spoon and breaking the bread crumb,difficulty in taking food towards mouth.
Proximal upper limbs weakness-
example,like inability to lift hands above the shoulders
Distal lower limbs weakness-
examples like difficulty in inserting feet into the slippers and holding the slippers between toe fingers while walking,foot drop
Proximal lower limbs weakness-
example like difficulty in standing from squatting position.
However,in classical MND,distal muscles are affected more and early as compared to proximal muscles.
Hope that I have answered your query.If you have some further questions,I shall be glad to answer else please close the thread,rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
As follows:
Detailed Answer:
Hi,
Thanks for being in follow-up.
Of course,the weakness will be very noticeable like-
Distal upper limbs weakness-
examples like difficulty in buttoning and unbuttoning the shirt,difficulty in holding the spoon and breaking the bread crumb,difficulty in taking food towards mouth.
Proximal upper limbs weakness-
example,like inability to lift hands above the shoulders
Distal lower limbs weakness-
examples like difficulty in inserting feet into the slippers and holding the slippers between toe fingers while walking,foot drop
Proximal lower limbs weakness-
example like difficulty in standing from squatting position.
However,in classical MND,distal muscles are affected more and early as compared to proximal muscles.
Hope that I have answered your query.If you have some further questions,I shall be glad to answer else please close the thread,rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sorry to ask more questions.
In MND is the twitching more localised and not jump from one part of the body to another in the space of minutes?
Plus would atrophy happen all over or again is it normally in one location?
In MND is the twitching more localised and not jump from one part of the body to another in the space of minutes?
Plus would atrophy happen all over or again is it normally in one location?
Brief Answer:
It tends to be localised.
Detailed Answer:
Hi,
Thanks for being in follow-up.
Yes,in MND,twitching is more localised and not diffuse as in Benign fasciculations,unless it is advanced disease.
It does not jump from one part to another as you said.
Atrophy is also localised to segments.
Hope that I have answered your query.If you have some further questions,I shall be glad to answer else please close the thread,rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
It tends to be localised.
Detailed Answer:
Hi,
Thanks for being in follow-up.
Yes,in MND,twitching is more localised and not diffuse as in Benign fasciculations,unless it is advanced disease.
It does not jump from one part to another as you said.
Atrophy is also localised to segments.
Hope that I have answered your query.If you have some further questions,I shall be glad to answer else please close the thread,rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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