Arm and Ankle symptoms

[Zacksmom]

I am experiencing an ache in my shoulder along with mild arm pain that extends into my wrist w/ very mild numbness in my index finger.  I had an MRI that showed herniations at C5/C6 with "mild ventral cord" flattening.  I have a herniation in my L5/S1 with loss of signal.  My right ankle feels like I have a sock on too snuggly.  No pain, just weird.  I have been having muscle twitching in mainly my legs and rarely in my upper right arm.  I attribute the twitching to the fact that I have had NO dietary or supplemental calcium in my diet in 4 months.  I have a son who is nursing and has been diagnosed with a milk allergy so I can't have it either!  I have been supplementing with calcium/mag/vitamin D over the past 2 weeks and feel as though the twitching is lessening.  When my GP first evaluated my arm he also noted tedonitis in my elbow, but felt that the herniations were more pressing and sent me to a Neuro.  I ended up getting"worked in" with the nurse prac. who said the MRI was "nothing to worry about" and perhaps my desk at work was "too high".  I am frantic about ALS.  This a.m. I had my husband push down on my arms while I lifted up and he laughed and said I was stronger than him.  I can walk on my toes/heels easily and typing this message is not difficult.  But the sum of the symptoms, twitching, arm weakness and ankle "weirdness" is scaring me to death!  My secretary just lost her husband to ALS and she tells me his initial symptoms was twitching.  What advice can you give?  Thanks so very much for sharing your time and talent.

[sixers]

hi-  here are my symptoms.  For about a month I have had a feeling of heaviness and perceived weakness from my shoulders into my hands equally on both sides.  Sometimes I have twitches, but I get them all over.  I saw my doctor who says I am fine.  I saw my physical therapist who said my strenghth and range of motion is fine.  I googled my symptoms and ALS popped up.  It now consumes every second of my day.  Every professional I saw said not to worry, and that my anxiety makes it worse.  I am a 29 year old male.  My question is would ALS come on symetrical or not.  Both arms have the same exact feelings in them.  Please let me know.  Also, I forgot that I have a shooting pain in my back when I straighten myself up.  Let me know what you think.  

[etc...]

Mike,

I noticed several of your posts and you seem very knowledgeable. Can you tell me how you determined your problems were muscular?  I am at the end of my rope and looking for anything I can to try to get rid of my pain since a rear-end car accident November 7th and have had constant pain since. I have been seeing a Chiro 3x a week and have an epidural scheduled for next week. My MRI show problems (mild) at C5-6 and C6-7. My ortho wasn't concerned because the word mild was used. However, the pain is not mild! I have pain in the shoulder blade area that I can't get rid off and numbness in left index finger as well as pain in left wrist and elbow. When I look up and turn my head down both sides the pain shoots down to the area of the shoulder blade. Also the range of motion is not 100%, not sure it will ever be. My ortho said to try the shots and then I need to strengthen the muscles in my back. I feel like it is more than muscle pain, however, the only exercises he gave me were for neck, not back. I have tried rubbing my back and putting pressure on the area and was getting limited relief but the constant pain is back. One other thing I might add, when the accident happened, I was in the process of turning my head over my left shoulder which could be why all the pain on the left side. Any input would help.

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.      
   The symptoms and story that you present are consistent with a radiculopathy (pinched nerve) at C5/6 as well as L5/S1.  A radiculopathy is caused by compression of a nerve root as it exits the spinal column, which causes pain/numbness/tingling in the distribution of the nerve affected and eventually weakness/atrophy if long standing or severe.  The mostly sensory symptoms that you have in your arm is consitent with a C5/C6 lesion (the index finger is supplied by the radial nerve with nerve roots in the C5/C6 roots), and the purely sensory sensation in your foot is also consistent with L5/S1 radiculopathy.  ALS generally presents very differently.  ALS is a pure motor syndrome (numbness/tingling is not typical) with a usual presentation of weakness, atrophy and fasiculations (twitching).  The next test that you need is an EMG (this can show changes consistent with a radiculopathy, and can also evaluate for any changes that might be consistent with ALS (though unlikely)).  Your thought about calcium and the twitching you had is a good one, and I would have them check a calcium level and a ionized calcium level to make sure your supplementation is adequate.  If a radiculopathy is confirmed on EMG (as I suspect) then from your decription it sounds like physical therapy will be the best therapy for you.  However, depending on the severity of the disc disease and your response to physical therapy you may need to consider surgical correction in the future.
I hope this has been helpful.

[AMO]

zacksmom,
here is what the docotr had ansered your privious questions.......11/15/06  AND  11/27/06 .......


Zacksmom
11/15/2006
. I began having a strange weakness in my right foot and right hand/arm a few weeks ago. No loss of strength, just weird feeling. A couple of days ago numbness began to come and go. I went to the ER at the advice of my GP and when they did a CT scan of my head the radiologist noted what appeared to be degeneration and a bulging disk in my neck. I am scdeuled for an MRI tomorrow. My question... can a bulging disk cause weakness/numbness in arm AND leg? THey gave me an injection of Depo-Medrol and the numbness/weakness is some better, but I am having vision changes. Next question... could ALS be a possibility? I am very fearful of that disease! Thanks so very much!

CCF-Neuro-M.D.-SH
12/1/2006
Zacksmom First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
A bulging disc in the neck usually causes symptoms in the upper extremity only by compressing the nerve roots as the exit the spinal column. However, if the disc is compressing the spinal cord itself then, it can cause arm and leg symptoms. Spinal cord compression is generally associated with increased reflexes and spasticity, while nerve root compression is associated with decreased reflexes and low/absent muscle tone. A disc cannot be responsible for visual changes. I would suggest that you have an MRI of your brain as well as your cervical spine to investigate for multiple sclerosis, or small stroke, etc due to the visual changes. This is very unlikely to be ALS. ALS is a pure motor disease, with weakness, atrophy, fasiculations and rapid progressive course. Your symptoms sound mostly sensory and somewhat intermittent.
I hope this has been helpful


Zacksmom
11/27/2006
. My MRI report states the following:
Broad based central disc protrusion at C5-6 with mild ventral cord flattening.
Right paracentral smaller disc protrusion at C4-5
Minimal disc bulge at C6-7
Loss of normal signal within L5-S1 disc.
There is broad based central disc protrusion and annular tear at L5-S1
I have been having weakness and numbness in my right shoulder and arm, with numbness in my pinkie and ring finger. My right leg from the knee down has similar symptoms. I was terrified of ALS when the symptoms started, but now feel that the MRI suggests other causes. Can what is going on in my back cause these symptoms? Also, can rehab/therapy remedy this or is surgery a "have to"? Thanks so very much!
CCF-Neuro-M.D.-SH
12/17/2006
Zacksmom First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms you describe are non-specific and may or may not be caused by the MRI findings that you describe. I agree that your symptoms do not sound like ALS. "Mild ventral cord flattening" could be a cause of your right shoulder/arm/hand symptoms, but many people with this finding have no symptoms at all. The same applies for the disc protrusion/annular tear at L5/S1. You need further testing to evaluate the specific cause of your symptoms (although the MRI was a good start). Your next test should be an EMG (nerve-muscle test) to determine if you have nerve root compression causing your symptoms as your MRI would suggest. I would also recommend that you get a SSEP (somatosensory evoked potential) to assess whether the "mild" cord compression reported on your MRI has any functional consequences. I would also recomend that you see a neurologist and get a full exam to assess whether any other testing may be needed. It is to early at this point to predict the best treatment for you, but many people are helped with physical therapy and time, while others need surgery (annular tears tend to get more surgery).
I hope this has been helpful.

[mike1105]

obviously this forum is not helping-- you posted the same question again. If I were you I'd consider going to the Clevland clinic or The Mayo where hopefully you'll get answers that satisfy you. If your problem turns out to be muscoloskeletal you'll need to fix it yourself under the direction of a good physical therapist-- but at one of these clinics your medical qustions should be answered. You were told by the forum doc it does not sound like ALS. they'll say the same thing again, most likely.