Confused about EMGs- weakness, atrophy but normal emg

[BENNY07]

Hello, I am a 31 year old female, and I have seen multiple neurologists since having onset of symptoms- about 3 months ago- started with a weak feeling in the knee, that leg and both hands/arms going numb and waking me from sleep, then the numbness feeling creeped up to my neck and face and tip of tongue, which mildly slurs my speech when tired.. Anyhow one week after my leg felt weak and both hips,I woke up and the tips of all my fingers were "floppy and thumbs both weak, and bent funny at the base when picking things up..
  The neuros agree there is clinical weakness on distal tips of all fingers and thumbs, with mild wasting/atrophy of my right (dominant) hand.. I have had 3 clean emgs . I have had fasiculations x 3 years- now more diffuse though.
    My last emg was today by an ALS clinic.. They put the needle into the muscles that I have clinical weakness and multiple others and everything was normal.. How is it that I can have weakness, atrophy but a normal EMG.. it seems like something would show up.. I had no fasics, sharp waves or fibs, and no signs of dennervation.
  
  I was confused as they seemed to be... everyone initally thought maybe I had cidp, but reflexes are normal and ncv normal too.. Is it possible to miss ALS on an emg when they test the correct/symptomatic muscles??

  I have a skin/nerve biopsy scheduled as a next step. Thanks so much for your time

[Texashere2023]

How are you doing? Did you ever get a diagnosis?

[colls22]

Hi Benny,  I wanted to respond to your post as, quite frankly, I was a little unimpressed by the doctor response you received. It was vague and basically a re iteration of a paragraph from a textbook, with all due respect.

Here is what I know, after extensive neurological consultations and three meg tests in the last three months. I am not a doctor, nor do I profess to be, but hopefully my information can be of some help. When it is stated that you can still have a "normal" emg while having actual disease presence and/or symptoms, that needs to be taken with a certain grain of salt.

Emg results run the spectrum from clean to abnormal, and all ranges in between. It is possible to have what might be classified as "normal" results, while still having something show up on said results. Normal is very different than totally clean. Clean results are just that, clean, no evidence of disease. Normal can include results that while they do show something, would not necessarily be classified as abnormal. It is these times that often require follow ups.

If you have had clean Meg's performed by qualified professionals, you do not have als. That really cannot be disputed. That's not to say you don't have something else going on, as weakness and atrophy would seem to indicate that you do, just not that.

Again with due respect to all of the wonderful doctors on this site, I just don't find it helpful at all to get the kind of answer you did.

Hopemive helped.

[BENNY07]

Thank you so very much for your time, I really appreciate it!
  
So if a muscle is directly tested with the emg needle, that is affected (weak and atrophy) by a MND, can that be missed, or not picked up by the emg?  (i have had three emgs in the past 4 months- my weakness started almost 5 months ago).
    I have an extensive history of preceeding events- birth of baby, procedure (iud perforation) gone bad resulting in blood transfusions and a GI issue that made me loose a lot of weight and i'm thin in the first place.. then the neuro sx started, I did now get an elevated ANA of 1:640- could that be relavant to all of this?  
   Still waiting on Musk MG, and LEMS results..
Thanks again so much for your time!

[Dr. Kokil Mathur]

Hi!
One can have normal EMG and yet there can be muscle wasting as seen in ALS, multiple sclerosis, metabolic disorders such as diabetes, and thyroid disorders. Focal inflammation of the muscle or muscle myositis can also be a cause. Involvement of a single nerve or mononeuropathy due to diabetes, vasculitis, infection (leprosy), trauma, or entrapment can also be a cause.
Since I cannot examine you and know other related conditions you may be having, nor is a detailed history possible on net, I have listed the various possibilities that should be looked into. Please consult your PCP/neurologist/treating doctor to run tests and examination to clinch a diagnosis.
Take care!