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PostPosted: November 25th, 2013, 6:23 pm
by angelormr
Hello, I'm new here and I apologize because I have no command of the English language, then use google translator. Since June come with fasciculations. After I emerged an area of ​​atrophy in the left forearm, and now observe that the dorsal region of my hand is getting grooves. Electromyography did two that were normal. But I feel pain in atrophied region, shoulder, scapula and hand. There are times when it seems that everything is cooling, at other times the withered region warms. I went to a neuro in September and he liked the physical examination was normal. But I've been realizing this slowly progressive muscle wasting. My question is: what comes first, atrophy or weakness? You may already have atrophy and ALS and have clean electromyography?
I read that before 6 months electromyography can give normal in ALS. Is it true? Excuse me questions, but I'm kind of desperate.

Hugs to all


PostPosted: November 25th, 2013, 11:38 pm
by Yuliasir
Hi Angelo,

first, if you speak French, therer is a Francophone forum here where conversation might be easier for you.

second, did the doctor also think you have atrophy? Perceived atrophy is very frequent among our fellows - dents, physiological difference in the limb size are overpercepted and taken for atrophy. Dorsal part of hand virtually has no muscles moving fingers (they all are on the forearm), only tendons, and mostly if you really have hands wasting, it is casued by loss of subcutaneous tissue. It also happens with our fellows.

third, muscle pain is very common for BFS. You also describe things called paresthesia (cold or warm feeling) which also very comon for BFS and not for ALS.

Weakness ALWAYS comes first. Atrophy is a result of muscles not working due to denervation or forced inactivity (like in cast). Non-working muscles make your limb clinically weak. Should you have any real fresh atrophy, you would not have clean EMG and clean clinical exam. In some cases, when atrophy is not progressing becasue it is due to local nerve trauma happened once, the whole limb may be working still, but usually in that case renervation occurs and no bad signs occur on EMG.

ALS involves paresis due to death of anterior horns (weak paralysis) and spastic activity due to death of central motoneurones. Therefore, in ALS are three main criteria of diagnostocs: clinical weakness (complete inability to use muscle, ususally without any painful effects, shown as inability to do simplest things like open the door or keep foot parallel to the ground), change in reflexes sturcture for the affected side (mixed hyperreflexia and loss of reflexes, pathological reflexes etc.), very specific changes in muscle response and conduction shown on EMG.

Therefore, if you have clean exam, clean EMG (two) and no clinical weakness in neither part of the body, then it is not ALS.