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Dr. Rogala
Dr. Rogala, Board Certified Emergency Physician
Category: Medical
Satisfied Customers: 220
Experience:  15 years experience, Workmen's Comp, Medical Review Officer
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Began with thumb unable to extend and turned into thenar atrophy.

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Began with thumb unable to extend and turned into thenar atrophy. Whole hand weak, all digits. Sent for MRI, severe disc degeneration at c5-6 and c8-T1, with osteophytes. EMG abnormal, indicating difficulties in 5/12 muscles tested. Slow, high amplitudes, with fibs. NCV reveals normal sensory, low amplitude in motor. Is this beginnings of ALS?

Thank you for your question.


You have an exact anwer for what is causing your problem in your hand. It is the Disc degneration at the level of C5-6 and C8-T1. This area of the spinal cord innervates the Brachial plexus which innervates the muscles in your hand. If there is a bulging disc present, this can be operated on. If it is just the degneration, they can do a balloon procedure which would be explained to you by a neurosurgeon or orthopedic surgeon. It will not help any permanent muscle damage, but will alleviate the current pressure on the nerve roots that ate at the spinal canal and prevent further damage.


No, it is not the beginning of ALS. That is an ascending degenerative nerve disease that starts with problems in the lower extremities and extends upward. Absent reflexes in an ascending fashion are the hallmark. It never occurs in just one extremity.


Hope this helps. Please click accept if you are satisfied.

Edited by Dr. Rogala on 2/22/2010 at 8:51 PM EST
Customer: replied 6 years ago.
The emg doctor appeared very concerned as a result of the numbers obtained. He said there was both chronic and active denervation. They want to do another EMG of the other 3 limbs to see. Also, the neurosurgeon I saw today looked at the MRI and did not seem assured the degeneration was directly related to the symptoms - although he did say it was certainly possible. He said the ALS was a "remote chance". Whether it's my imagination now or not, I'm getting cramps and twitches and can't sleep anymore. Wish I could be more assured, by more answers like yours

It can possibly affect the other hand, because both sides of the body are affected at that level of the spinal cord.


When he said ALS was a remote chance, he was being polite. It is not ALS.


Cramps and twitches go along with compression of the nerves. ALS does not.





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