wrist drop: ALS or MS?

  I have been experiencing some weakness in my right wrist and have noticed that it tends to drop when I am picking up heavy items (unlike the left wrist).  The grip in both my hands is fine though.
  I should add that during the past few months I have had muscle twitches, muscle cramps, hyper reflexes, numbness and vertigo.  An initial EMG done one month ago was fine but the physician did note the hyper reflexia.  I am concerned about ALS or MS and was wondering whether you know if wrist drop is more prevalent in either disease.  I do have several people in my family with autoimmune disease.
  Thanks,
  Dana
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There is not enough data available to come to any conclusion. The total pattern of motor impairment must be assessed. Generally, if one has an isolated wrist drop, I think of a nerve injury (for example, radial nerve) rather than anything in the brain or spinal cord (as in MS or ALS).
Hyper-reflexia is often normal. The key for the doctor is to assess the symmetry and distribution of elevated reflexes. I have met many normal individuals (and I am one of them) who have reflexes which could be graded 3+ on the typical scale. Reflexes, like any clinical finding, must be interpreted cautiously.
Muscle twitches and muscle cramps are nonspecific. Twitches can be called fasciculations if they conform to a certain pattern. Yes, fasciculations can be seen in ALS, but what is often overlooked is that they can be normal or can be found in focal nerve injuries.
I can't tell you for sure that you don't have ALS or MS. However, in my view, the probability is unlikely. Both are worrisome diseases, and doctors are conditioned (trained) to think of the worst and raise the possibility but I'm not sure that is a particularly helpful practice.
If you desire second opinion, you are welcome to call 800 223-2273 and ask for neurology appointments. Your best bet is to see a general neurologist or perhaps one of the neuromuscular specialists (betting this is a peripheral nerve injury).
I hope this helps. As you know, this information cannot substitute for medical advice obtained directly from your doctor. CCF MD mdf.