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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I am a 28 year old female. Over the past month, I had

Customer Question

Hello! I am a 28 year old female. Over the past month, I had soreness/achiness in my left shoulder blade. It started with tension in my arm and my left thumb shaking when bent (at times) not all the time. I still get thumb shaking from time to time but my shoulder issues seem to have resolved. However, I am very worried because about a weekish ago, my left leg started feeling odd when I walk. The muscles do not feel relaxed and at times it seems a little harder to walk than my right leg feels. Sometimes I have achiness in my thigh muscle as well but mostly, it feels a little odd when walking and stiff/the muscles aren't relaxed. I am worried. This morning I attempted to go on my exercise bike and when I got off, only my left leg was VERY stiff up by my thigh and even now it still feels weird to walk on and I'm having intermittent aching in my thigh. My calf usually feels strange to walk with. Sometimes, my ankle feels strange when walking, sometimes it's a slight discomfort. Anyway, it just takes more effort. I know it's rare, but I am worried I am developing ALS since all of this is one sided. I have a history of worrying about health stuff, but these are real symptoms. Thanks!
Submitted: 11 months ago.
Category: Neurology
Expert:  Dr. Frank replied 11 months ago.

Hello. welcome to JA Your symptoms are not compatible with the diagnosis of ALS. You could, however, have problems of muscle tone and cramp/fasciculations resultant to that problem. The most common reasons are changes in electrolyte balance as can be from endocrine disorders (thyroid dysfunction), side effects of certain medications, or stress causing diffuse fasciculation syndrome (BFS, CFS). If you are concerned, you should see your doctor for an evaluation and appropriate blood tests. ALS is a disease of old men with an incidence in the US of 150k:1. In people your age without a family history it is more like 500K:1. It does happen, but rarely. You do not have diffuse symptoms, the initial problem is focal and atrophy with fasciculations are seen. So do not worry. Please get back to me to discuss this further if I can help dr Frank

Customer: replied 11 months ago.
Ok thanks for your input! I am worried because it is one sided. My one leg does get aches or maybe cramps, not sure how to tell the difference in the calf area especially when sitting down and it is harder to walk with my left leg. I understand the opinion of electrolyte imbalance, etc. but wouldn't that be affecting both sides? I have had no issues with my right side which is what leads me to ALS or something like that. I do have muscle twitching in my legs, bottom, etc at times, especially at night. In terms of the thyroid, I had a thyroid nodule that was biopsied in the summer and was found to benign. Recently, due to an enlarged node I had a cut scan of my whole neck including thyroid with contrast and everything was normal...so Idk if that rules that out. I don't have a history of ALS in the family but worry because this is all on one side.
Expert:  Dr. Frank replied 11 months ago.

I understand, and if it is all one sided,then you need to get an answer to this problem. I assume it does not involve your face, correct? Then, although there could be a lesion in the white matter pathways as they come down from the brain (internal capsule, basis pontis) involving only arm and leg fibers, with the atrophy you note, again if real, you would place the lesion in the spinal cord, at C4 or 5 level, within the cord so it effects UMN (upper motor neuron) fibers within the cord to the left leg. With that, you might, or might not have bladder complaints, again because it is not bilateral. Symptoms of urinary urgency or hesitancy. Bladder symptoms are seen in unilateral lesions of the cord. If you have such a lesion, then you might have a L'hermittes sign (lay flat on your back, look up to see your feet. Or have someone raise your head to see your feet. Flexion of the neck causes pain down your back into your traps and lower back area) And you might have spasticity in the left leg. (try hopping, is it smooth and symmetric?). You are correct that any metabolic issue should present with bilateral symptoms. Please get back to me to discuss further if I can help. If your thyroid blood studies are normal, and the imaging you describe is negative, it is unlikely to be related. Dr Frank

Customer: replied 11 months ago.
Hi dr Frank! I recently also had a car scan of my head which was normal as well as x rays of my thoracic and cervical spine and all was normal, no lesions...as well as my shoulder blade. I'm not having any bladder issues.
Customer: replied 11 months ago.
I'm just worried about ALS because the left leg feels weird to walk with. My tension in the muscles of my left arm has gotten better and I only get that intermittently. I still do get shakes in my left thumb when it is bent which then leads to the tension/soreness in my arm but this isn't consistent. My leg seems to have started acting up right after the issues with my left shoulder blade resolved itself (after over a month). I'm just worried about a neurological disorder or something really bad.
Customer: replied 11 months ago.
No involvement of my face.
Customer: replied 11 months ago.
I also should mention that I worry a lot about health stuff unecessarily sometimes but this is pretty real.
Expert:  Dr. Frank replied 11 months ago.

Well that all sounds good. By xrays of the cervical and thoracic spine, I assume you mean plain Xray images. that is good for bone issues, but is not going to give you information about lesions within the spinal cord. You need an MRI of the Cervical spine for that with T2 FLAIR images. If you have atrophy within the muscles of the shoulder, I would recommend you see a neurologist who can evaluate you for spinal cord problems. My suspicion is that you are anxious, but there is no way to say that from here, and in Neurology we always put anxiety symptoms on the back of the list as you don't want to miss something that is purely neurological. Dr frank

Customer: replied 11 months ago.
I don't have atrophy that I can see of at all. so you are saying that it's possible I might have spinal tumors or cancer in my spinal cord?? That's pretty worrying!!! My only other medical problems have been an enlarged node in my neck that never went away and a new one I've had under my left arm. They did an ultrasound of the one under my arm and all is well and a cat scan with contrast of my neck and all was normal.
Customer: replied 11 months ago.
The tension in my arm comes and goes but I am not noticing any atrophy of muscles in either my arm or leg. I have my husband look everyday and everything is symmetrical and the same size.
Customer: replied 11 months ago.
It's just that I get shaking in my thumb which then translated to soreness and a feeling of fatigue in my hand/arm and then now this feeling of having to use more effort/stiffness in my left leg.
Customer: replied 11 months ago.
sometimes aching in the leg. What are your thoughts?
Expert:  Dr. Frank replied 11 months ago.

The CAT scan of the cervical spine with contrast is a good study, and excludes you having a tumor or demyelinating disease like MS/ALS demyelination within the spinal cord, so do not worry. If you have muscle disease, an inflammatory muscle condition like polymyalgia rheumatic or sometimes fibromyalgia, you might have elevations in CK, a muscle enzyme A rheumatologist would help you to diagnose an intrinsic muscle disease. I cannot explain the lymphadenopathy from here, have you been screened for Epstein barr virus (EBV) and disorders like chronic fatigue syndrome/fibromyalgia? That can give you diffuse muscular weakness, even stiffness in joints and muscles. I hope that helps Dr frank

Customer: replied 11 months ago.
Well, I am worried because I never had a cut scan of my spine with contrast...only of my neck, I don't know if that makes a difference. They were looking at my lymphnodes then. I only had an x Ray of my thoracic and cervical spine and shoulder blade. I had cat scan of neck and head/brain. Now I'm worried I might have a tumor or something really serious.
Expert:  Dr. Frank replied 11 months ago.

You don't need an entire spine scan. There is a lot of radiation in a total spine CT so you need to evaluate the risk/benefit. You need to realize that this service is an information service, I cannot tell you what is wrong with you., and with your anxiety this is not beneficial to you. Dr Frank

Customer: replied 11 months ago.
Thanks I appreciate it. So what you are saying is, they may have seen abnormalities in my cervical spine when they did my neck scan?
Expert:  Dr. Frank replied 11 months ago.

I certainly did not say they saw abnormalities in your cervical spine. I hope I was able to answer your questions. Please remember to rate my service if satisfied as that is how I am compensated for my work. Just click on the rating stars. thanks *****

Customer: replied 11 months ago.
Sorry that is not what I meant. I meant when they did a cat scan on my neck, were they also able to see my cervical spine?
Expert:  Dr. Frank replied 11 months ago.

Yes, I meant that using a CT scanner with IV contrast allows you to see the spinal cord anatomy pretty well, like an MRI scanner, so if you had a problem within the cervical spinal cord, it would have been detected. Dr Frank

Customer: replied 11 months ago.
Well I had a ct scan of the neck with contrast, would they still be able to see my cervical spine. I know they were able to see my lymphnodes and thyroid gland.
Expert:  Dr. Frank replied 11 months ago.

Yes. they would see your cervical spine including the spinal cord. Dr frank

Customer: replied 11 months ago.
Thanks. That would most likely rule out cancer or ALS? I thought they did a nerve test for that? So what's your best bet on what's causing this? My arm was fine for awhile until last night when j us my arm up for be on one and my thumb started shaking. Today it hurts
Customer: replied 11 months ago.
I don't know if it matters but the head scan was done without contrast, just he neck scan was contrast
Expert:  Dr. Frank replied 11 months ago.

That would rule out cancer in your spinal cord area of your neck the brain scan doesn't have to be with contrast unless they were looking for cancer that needs contrast enhancement, they are rare actually, as most brain cancers cause swelling and/or mass effect and are seen. ALS is confirmed by EMG/ a nerve test, to exclude it from other conditions. You don't need an EMG to diagnose ALS, as it is fairly obvious on examination. Have you had a neurologist look at that thumb tremor? It could be as simple as carpal tunnel. Dr Frank

Customer: replied 11 months ago.
I haven't been to a neurologist for if. I have been to a rheumatologist and showed them. It doesn't happen all the time, it's here and there. Usually when I'm holding something such as my phone and my thumb is bent. Afterwards my arm hurts up to my elbow/upper arm area. When it was really bad even under my arm was hurting on the very outside/bone area. They also did an ultrasound of that. I got this to go away after awhile until my thumb started doing that last night.
Customer: replied 11 months ago.
I've been given baclofen and neurontin.
Expert:  Dr. Frank replied 11 months ago.

look up cramp fasciculation syndrome and tell me if it fits. This is mostly in men, but let me know Dr Frank

Customer: replied 11 months ago.
it sounds like it to a point. I do have anxiety about health stuff but I can exercise. My arm cramps up after awhile if I am typing or leaning on if...to be honest I haven't figured out what sets it off, and then my thumb will start. It only does it maybe once a week recently IF THAT but it isn't a spasm, more of a tremor, you can see my thumb shake. My muscles get fatigued and weird afterward in my arm. In terms of my leg, it's just a feeling of slight stiffness but I can bend and everything. I just feel like I have to exert more effort to move it, like I'm more conscious of it than the other leg. Sometimes I have a discomfort in my ankle, as if I'm about to roll my ankle...it's hard to explain. Hopefully, it's not something horrible like ALS. Today, I did 45 min on the exercise bike (stationary) and 15 min of kettlebells (mostly squats) I haven't done that in awhile so both legs were shaking like leaves. But anyway, I'm hoping this is nothing bad as I can feel the feeling that went away in my arm is back again.
Customer: replied 11 months ago.
If bent, my arm starts feeling like it's not relaxed and starts feeling like it gets achey.
Customer: replied 11 months ago.
I would say crampy as if it's uncomfortable and I have to move it. So yea...as you can see I'm just worried about ALS or cancer or something really bad
Expert:  Dr. Frank replied 11 months ago.

I would not worry about having cancer or ALS, that does not make sense, it does not follow the progression of your symptoms as you describe it. So I would suggest you continue to work out and focus on positive aspects of your work out. Dr Frank

Customer: replied 11 months ago.
Hi dr Frank! Just wanted to touch base with you. I worked out with a kettlebell weight yesterday and yesterday my shoulder/arm was bothering me from my thumb shaking the night before. I am sore all over from the weights but my left shoulder is particularly sore to touch and a little tense. Even when I drive, the pain/tension extends down into my arm. I'm Hoping this is nothing horrible, I don't know I guess that one particular shoulder/shoulder muscle in my back is just a touchy area.
Customer: replied 11 months ago.
I should also mention that my right shoulder is fine.
Customer: replied 11 months ago.
Not sure if this matters or not but last night I was getting nauseous for no reason at times and this morning I woke up with a head ache and have been feeling a little off. I'm worried because of my enlarged lymphnodes but they also examined them in a cat scan with contrast so I guess I'm just worrying.
Expert:  Dr. Frank replied 11 months ago.

I can talk to you by phone if you wish. I will put out the phone option, if interested, put in your number and a time to call. Dr Frank

Customer: replied 11 months ago.
Hi there! I would rather not do a phone call. Thanks!
Customer: replied 11 months ago.
Hi dr Frank! Just wanted to know what you think of my one shoulder being super sore after weight lifting. Thanks! 😀