Another 'what could it be' question

[ChrisE]

Background - 52y Male/ 6'5 215 lbs
Ive had various issues with my legs in the past. 18 months ago i had EMG, Arterial & Venous Doppler's, a MRI of the Neck (Lymph Nodes were removed).
Last year i started having weakness in the legs (again). In the past it would last about 2 months, then it would go away.
So far this has not happened. Both legs are tired. My knees ache all the time. Usually one leg (when aching) feels tight on the inside (the flabby area), the other on the outside.
The knees usually ache where the upper and lower bones meet, although any area that is 'attached' to this has ached/hurt (soreness/tightness). My fingers and toes ache - but they have ached before(arthritis).
Occasionally their will be a pulsation in my lower legs, with small twitches (that i can) on the surface of the skin.
I also feel/hear a cracking (like cracking knuckles) happening between my knees and ankles. When this starts, if i 'twist' my legs without moving my feet, it will happen at will. Sometimes this will be painful.
If I lay on my back (sometimes) my upper legs will feel like being 'sun burnt'.
If  I stretch out while on my back, the outside bone/muscles on both legs will feel tight along with my knees & ankles aching.
I find that everything is worst in the AM then the PM. Hot water helps my fingers and toes, but cold water seems to make my legs feel better (for a little while)
Im am scheduled for another EMG, but am starting to get paranoid and thinking about this more and more. Reading these, i see others are worried too.(the best wishes to them).

Thanks for any suggestions

[ChrisE]

They did the EMG, while not saying much (other then i need to come back for another), it was "hinted" that there was weak signals getting to the feet. (what does that mean?).

[ChrisE]

Thanks for your reply.

Most of the cracking sound (and feeling) is coming from between the knee and the ankle - while the knee sometimes cracks, its usually from below that point.

If i have my legs in a position for a while, they will begin to ache - sometimes tightness(back of leg/calf), sometime just a tired or heavy feeling.


Again thanks for your reply.

[ChrisE]

[footnote to my above post]

I;ve had general weakness in the past but it usually lasted only a month or two (mostly with the legs). Also I do not sleep well (4 hours at most a night).

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

Please keep in mind that I am unable to diagnose you since I am unable to examine you, this forum is for education purposes only. Much of the symptoms you describe may be related degenerative joint disease and arthritis.  The pain in the knees with popping, and grinding that is postion dependent can often be seen with joint disease, back disc disease and lumbar canal stenosis.  The twitches that you have noticed on your skin may be a symptom called fasiculations (small twitches in the skin that do not cause movement across a joint).  Many things can cause fasiculations including viral syndromes, metabolic disturbances, muscle diseases, and motor neuron disease (including ALS).  Concern for serious disease such as ALS comes when weakness is persistent and atrophy is also present.  Since your weakness is intermittent may suggest that some other process is going on. Given the story that you provided I would agree with another EMG, and also an MRI of the thoracic and lumbar spine.  I would also suggest labs that assess muscle function (CPK,aldolase) and metabolites (Na, K, Ca, Magnesium,etc) parathyroid function and a paraneoplastic panel (antibodies sometimes seen in occult cancer).  You have mentioned your repeat EMG, I would urge you to see a neuromuscular specialist since EMGs are very subjective and it takes considerable skill to interpret the results.  I hope this has been helpfull.