Atrophy

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Atrophy

Postby Brummer on October 29th, 2012, 12:42 am

Dear all, I need some advice from experienced people like you are. Please excuse my English. I´m from Germany.
I have a question regarding EMG and atrophy. I started twitching 3 years ago and my neuro made many test to rule out serious neurologic or muscular diseases. All test came out fine and he says no reason to worry about. But the possibility to progress into ALS is always on my mind and I control my body every few month to make sure that nothing changes.
Now there are changes in my ankle. It is so much smaller than the other one even though it is my dominant leg and the muscles on that side of my body are all a little bigger than on the left side. That really scares me because I now exactly that this is new. I went to see my neuro and he also noticed the difference between right and left ankle. He put the EMG needles in three different areas of my foot and calve and said that he can see absolutely nothing. He worked in a neurological hospital for years and said he is very experienced in doing this. He said it could not be atrophy because there is no way that the EMG would not detect it but he has no explanation for the way my ankle changes.
I heard about people who had initially clean EMGs and later progressed into ALS and I know that I have no chance to check such statements written in the internet. So I´m not able to say if they are true. But I really need to know if I can be 100% sure that my ankle has no atrophy. Is there any possibility that the EMG couldn´t find it or that is has been done too early. I´m really aware of the disease. Could it be possible that I notice things much earlier than people who do not know the disease when feeling something is wrong and that it is too early to detect something?
Thanks for your help!
Cindy
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Re: Atrophy

Postby Yuliasir on October 29th, 2012, 1:23 am

Hi Cindy,
does your smaller anlke work the same as usually? if yes, then it is obviously not an atrophy, at least not due to neural damage.

Usually people who have clean EMG and then progressed to ALS still must have more or less usual route of the diseae, e.g., first paralysis, then atrophy, because paralysis (loss of neural conductivity) is the reason for atrophy, not vice versa.

your doctor is right that should that be atrophy, it would be seen on EMG because should it be atrophy due to died nerves, it would be noted as loss of electrical conductivity. But at that case you also would note loss of foot mobilty etc. If the muscle is really atrophied, it is not 'too early' to see that on EMG. So your muscle bulk loss must be not because of your nerves had died.

I am not a doctor, so I can suggest only this one: sometimes, when people have gait problems (pain in the leg, for example), they could change the gait in order to spare the leg, and that can cause some muscle waisting without significant loss of conductivity... but I do not know if you have that troubles.

Then, are you sure it is muscular change and not the unilateral edema? Sometimes we can have asymmetrical ankle edema due to sitting work (I had it, it is long lasting and not always looks like swollen skin etc. - just the ankle diameter is more for one leg than for another). In that case of course no neural changes would be on either side...
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Re: Atrophy

Postby Brummer on October 29th, 2012, 2:31 am

Thanks for your reply. I don´t make any kind of sports, so I think I would notice weakness very late. But right now I can use my foot the same way than before. I do not had any kind of injury or edema. And I need an explanation for the "atrophy" because my ALS fears are very very bad. My neuro said that I have to observe that ankle and now I´m really scared of a progression and I´m watching it every hour. That´s making me mad but I can´t get over my fears.
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Re: Atrophy

Postby jerry2 on October 29th, 2012, 3:08 am

EMG would show even old denervation (nerve loss) and atrophy. If it shows nothing, it is not atrophy. And if your EMG is clean and no atrophy you can not have ALS. Put the rest aside for your sake. Doctor has told you the most important thing.
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Re: Atrophy

Postby Brummer on October 29th, 2012, 8:12 am

Dear Yuliasir, I just had a look at my ankles. Could an edema only effekt the ankle area and not the upper side of my foot. Is it flabby and looks like normal foot only a little bit swollen. Does is hurt or is it discoloured? Thanks for your help!
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Re: Atrophy

Postby Yuliasir on October 29th, 2012, 8:16 am

that kind of weakness whih is related to ALS is really VERY noticeable because people just drop the foot (can not hold it under normal angle and it just folds out) or can not hold the ankle joint... As soon as you can walk and do not limp because the foot is out of the control and can stand on the toes and hills (please do not do it every hour, you would damage the achilles tendon!) - you are ok.
as for the ankle edema - the leg which is swallen (if the edema is due to bad circulation) - it is usually FIRST limited to ankles, but if not attended, it may spread to the feet as well. Swallen feet really looks flabby at the top and you might have certain feeling of pressure trying to put it into the shoe. Nope it does not hurt and usually no discoloration occurs. this edema does not affect walking ability and usually it gets worse when sitting.
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Re: Atrophy

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