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What Causes Dull Leg Pain And Tingling And Twitching On Tongue?
Question: Sir/Ma'am,
I am a 38 y/o male wondering about how much if any I should worry about early s/s of ALS. My symptoms started two weeks ago with tingling and what was perceived twitching of my tongue. Since then, I have had sharp and dull leg pain bilat (4-10), and what I feel are painless single muscle spasms (not noticeable to naked eye but can feel) in my upper and lower extremities, which seems to be occurring more frequently each day, and fasciculations (noticeable) in my face. The pain in my leg does not seem to be "cramping" as I am able to walk without difficulty, as a matter of fact, I ran 7 miles today, but did have pain in legs and feet while running, slightly relieved by motrin. I have had to also clear my throat more frequently, spitting more than normal, and noticed that my voice has has deepened a little. My wife asked today if she thought I had some allergies or getting a cold. I have not seemed to notice any changes in dexterity, no slurred speech, and there has been no noticeable atrophy of my muscles. I guess I am more concerned about the increasing number of spasms throughout my body. I am a second year med student and maybe a little consumed by my books, but not sure if I should truly be worried, thanks! SR
I am a 38 y/o male wondering about how much if any I should worry about early s/s of ALS. My symptoms started two weeks ago with tingling and what was perceived twitching of my tongue. Since then, I have had sharp and dull leg pain bilat (4-10), and what I feel are painless single muscle spasms (not noticeable to naked eye but can feel) in my upper and lower extremities, which seems to be occurring more frequently each day, and fasciculations (noticeable) in my face. The pain in my leg does not seem to be "cramping" as I am able to walk without difficulty, as a matter of fact, I ran 7 miles today, but did have pain in legs and feet while running, slightly relieved by motrin. I have had to also clear my throat more frequently, spitting more than normal, and noticed that my voice has has deepened a little. My wife asked today if she thought I had some allergies or getting a cold. I have not seemed to notice any changes in dexterity, no slurred speech, and there has been no noticeable atrophy of my muscles. I guess I am more concerned about the increasing number of spasms throughout my body. I am a second year med student and maybe a little consumed by my books, but not sure if I should truly be worried, thanks! SR
Brief Answer:
ALS unlikely
Detailed Answer:
I read your question carefully and I understand your concern.
Reading at that description I do not think ALS to be the case. One reason for that is the fact that according to the description you have developed in only two weeks symptoms which would belong to different divisions of the nervous system. That is unlikely for ALS. Its development as most neurodegenerative is much more insidious, affecting first one region and developing to other regions over the course of several months.
Another reason is because you seem to have sensory symptoms which are not typical for ALS. It's otherwise called motor neuron disease as it involves motor neurons sparing sensory ones.
So I wouldn't worry much about ALS. One explanation could be related to anxiety, it is by far the most common cause of those symptoms. However other causes must be considered as well first, so if symptoms persist a neurological exam for other possible objective signs as well as some routine blood tests for electrolytes, creatine kinase, thyroid function, vitamin B12 level, inflammation tests are advised to look for metabolic abnormalities which could explain those symptoms. If on exam some abnormality in muscle strength, reflexes, sensation etc is found more specific tests like imaging or nerve conduction studies may then be prescribed.
I hope to have been of help.
ALS unlikely
Detailed Answer:
I read your question carefully and I understand your concern.
Reading at that description I do not think ALS to be the case. One reason for that is the fact that according to the description you have developed in only two weeks symptoms which would belong to different divisions of the nervous system. That is unlikely for ALS. Its development as most neurodegenerative is much more insidious, affecting first one region and developing to other regions over the course of several months.
Another reason is because you seem to have sensory symptoms which are not typical for ALS. It's otherwise called motor neuron disease as it involves motor neurons sparing sensory ones.
So I wouldn't worry much about ALS. One explanation could be related to anxiety, it is by far the most common cause of those symptoms. However other causes must be considered as well first, so if symptoms persist a neurological exam for other possible objective signs as well as some routine blood tests for electrolytes, creatine kinase, thyroid function, vitamin B12 level, inflammation tests are advised to look for metabolic abnormalities which could explain those symptoms. If on exam some abnormality in muscle strength, reflexes, sensation etc is found more specific tests like imaging or nerve conduction studies may then be prescribed.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Taka,
Thanks for the reply. Couple of thoughts with common things being common:
Maybe the pain in lower extremities is possibly associated with a mild case of the do as I was outside working in some extreme heat a couple of days prior. The pain has subsided significantly, but do have some residual cramping in feet/toes. Would not be surprised if my ck was high. Thoughts?
when you mention sensory symptoms are referring to pain?
Lastly, so would you say (as a neurologist) the abnormality in muscle tone is the top symptom that would begin you to even consider als?
Thanks again!
Sr
Thanks for the reply. Couple of thoughts with common things being common:
Maybe the pain in lower extremities is possibly associated with a mild case of the do as I was outside working in some extreme heat a couple of days prior. The pain has subsided significantly, but do have some residual cramping in feet/toes. Would not be surprised if my ck was high. Thoughts?
when you mention sensory symptoms are referring to pain?
Lastly, so would you say (as a neurologist) the abnormality in muscle tone is the top symptom that would begin you to even consider als?
Thanks again!
Sr
Brief Answer:
Read below
Detailed Answer:
Thank you for your feedback.
Extreme physical exertion under heat can lead to muscle damage, so I wouldn't be surprised if the CK is high. If related to exertion should be transitory though and not responsible for other symptoms you mention.
By sensory symptoms I meant more the tingling feeling you describe at the beginning.
The top symptoms to consider ALS would be weakness. But more than individual symptoms it is the evolution which does make me exclude ALS in you. It does not have such widespread (limbs, throat, tongue, face) manifestations right away in a couple of weeks. As I said has an insidious onset spreading over many months.
I hope to have been of help.
Read below
Detailed Answer:
Thank you for your feedback.
Extreme physical exertion under heat can lead to muscle damage, so I wouldn't be surprised if the CK is high. If related to exertion should be transitory though and not responsible for other symptoms you mention.
By sensory symptoms I meant more the tingling feeling you describe at the beginning.
The top symptoms to consider ALS would be weakness. But more than individual symptoms it is the evolution which does make me exclude ALS in you. It does not have such widespread (limbs, throat, tongue, face) manifestations right away in a couple of weeks. As I said has an insidious onset spreading over many months.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir,
One last question from a learning standpoint:
In ALS, does the cramping and or fasciculations of muscles usually precede or following the muscle wasting?
Thanks again!
One last question from a learning standpoint:
In ALS, does the cramping and or fasciculations of muscles usually precede or following the muscle wasting?
Thanks again!
Brief Answer:
Fasciculations and cramping usually come first.
Detailed Answer:
Sure, I'll gladly answer your question. Usually it is the cramping and the fasciculations which precede the wasting. When a muscle fiber is initially left without any control from the nerve it can fire spontaneously which produces fasciculations. With the passing of the time receiving no more stimuli from the nerve (nerve stimuli have a trophic role as well), the atrophy (wasting) starts to develop.
Wishing you good health
Fasciculations and cramping usually come first.
Detailed Answer:
Sure, I'll gladly answer your question. Usually it is the cramping and the fasciculations which precede the wasting. When a muscle fiber is initially left without any control from the nerve it can fire spontaneously which produces fasciculations. With the passing of the time receiving no more stimuli from the nerve (nerve stimuli have a trophic role as well), the atrophy (wasting) starts to develop.
Wishing you good health
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Taka,
Good morning. I felt your answers were so great I wanted to follow up a couple of more time.
So since I last left off I ran the following labs that you noted in the first reply plus a calcium and magnesium level, all which were normal. I did have a glucose of 50, but I am sure that is nothing. Symptomatically, I continue to have intermittent cramping of my lower legs and now my back and jaw, as well as diffuse fasciculations, worse at night, and they do seem to be more noticeable in my left leg. I had my provider do a complete neuro exam on me and everything was normal to include normal reflexes.
My questions to you are:
Possible clinical impression?
Can ALS present with widespread fasciculations with no noticeable weakness?
Thanks for your time!
Spr
Good morning. I felt your answers were so great I wanted to follow up a couple of more time.
So since I last left off I ran the following labs that you noted in the first reply plus a calcium and magnesium level, all which were normal. I did have a glucose of 50, but I am sure that is nothing. Symptomatically, I continue to have intermittent cramping of my lower legs and now my back and jaw, as well as diffuse fasciculations, worse at night, and they do seem to be more noticeable in my left leg. I had my provider do a complete neuro exam on me and everything was normal to include normal reflexes.
My questions to you are:
Possible clinical impression?
Can ALS present with widespread fasciculations with no noticeable weakness?
Thanks for your time!
Spr
Brief Answer:
Read below.
Detailed Answer:
Hello again and thank you for your appreciative words.
Glucose of 50 is pretty low, perhaps it's just a lab hiccup, but it should be repeated just in case.
I wonder if the CK was included among those tests, was it normal.
If yes and that muscle rhabdomyolysis after the exertion you mentioned is excluded, then I do believe the symptoms are probably due to anxiety.
To answer your ALS question, no weakness is always there. Actually speaking from daily experience patients usually aren't even aware of the fasciculations when they come to me, their complaints are related to the weakness, it's only when I examine them and notice or ask specifically that they mention to have these twitchings.
Anyway, I repeat, even if you felt some weakness, I still wouldn't say ALS due to widespread of symptoms in only a couple of weeks.
Read below.
Detailed Answer:
Hello again and thank you for your appreciative words.
Glucose of 50 is pretty low, perhaps it's just a lab hiccup, but it should be repeated just in case.
I wonder if the CK was included among those tests, was it normal.
If yes and that muscle rhabdomyolysis after the exertion you mentioned is excluded, then I do believe the symptoms are probably due to anxiety.
To answer your ALS question, no weakness is always there. Actually speaking from daily experience patients usually aren't even aware of the fasciculations when they come to me, their complaints are related to the weakness, it's only when I examine them and notice or ask specifically that they mention to have these twitchings.
Anyway, I repeat, even if you felt some weakness, I still wouldn't say ALS due to widespread of symptoms in only a couple of weeks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Taka,
Your last post really put my mind at ease, thanks!
So the ck that you asked about was wnl. I wish i would have drawn an iron level and a cbc. The glucose was interesting as normally with any of my previous cmp labs they are consistently in the 90s.
I am still having the fasciculations and cramping which still has me a little perplexed and worried. But no weakness which keeps me optomistic. I am actually seeing neuro tomorrow, mostly to help rid my head of this concern. I would love for him to tell me i just have bfs and move on. If anything i learned alot about ALS and how sad its progression is for those who are afflicted.
I dont have any real questions, just wanted to say thanks for your clinical opinion. I am sure it is not easy to answer some questions based on fact you cannot perform a physical exam, but i appreciate your time!
Your last post really put my mind at ease, thanks!
So the ck that you asked about was wnl. I wish i would have drawn an iron level and a cbc. The glucose was interesting as normally with any of my previous cmp labs they are consistently in the 90s.
I am still having the fasciculations and cramping which still has me a little perplexed and worried. But no weakness which keeps me optomistic. I am actually seeing neuro tomorrow, mostly to help rid my head of this concern. I would love for him to tell me i just have bfs and move on. If anything i learned alot about ALS and how sad its progression is for those who are afflicted.
I dont have any real questions, just wanted to say thanks for your clinical opinion. I am sure it is not easy to answer some questions based on fact you cannot perform a physical exam, but i appreciate your time!
Brief Answer:
Thank you.
Detailed Answer:
I really appreciate you taking the time to write those kind words. Wishing you all the best.
Thank you.
Detailed Answer:
I really appreciate you taking the time to write those kind words. Wishing you all the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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