Patient's Query
Hello doctor,
I had a scary symptom. I had EMG done and it was normal. But twitching still occurs. Recently had a reoccurring twitch in my hand. The twitch has left a slight indentation. Is this ALS? Please help.
Hi,
Welcome to icliniq.com.
I understand your concern.
There are a number of reasons for intermittent muscle twitching, with a majority of them being benign conditions. As long as you do not have any muscle weakness associated with it, you need not worry. Things will get better gradually in a week or two. If not, then get yourself examined by a neurologist.
I hope this helps.
Patient's Query
Hi doctor,
Thanks for your reply. But the twitching has been going on for four months. After two months, I had a neurological exam, and it came back normal. I have been diagnosed with BFS. My concern is not the twitching. It is the indentation in the side of the hand. I get a common twitch there, which pulsates in that one area. But there is like a small indentation there now. My concern is that this could be atrophy. I do not have weakness. Please help.
Hi,
Welcome back to icliniq.com.
I understand your concern.
Symptoms of BFS (benign fasciculation syndrome) may persist longer. It has been shown in a number of different studies that patients with BFS do not develop ALS (amyotrophic lateral sclerosis). The indentation you are noticing is hard to comment on without examining you. If there is no weakness, I would not worry about it too much. If you still want to pursue this further, you can get a local muscle ultrasound to see if there is any atrophy. Even if we find out some atrophy, the treatment plan might not change other than longer and frequent follow-ups.
I hope this helps.
Patient's Query
Hi doctor,
Thanks for your reply. How could there be atrophy without ALS?
Hi,
Welcome back to icliniq.com.
I understand your concern.
We do not know if it is atrophy. If there is no weakness, then the muscle is most probably intact. Even if there is atrophy, there are a number of different causes for it beyond ALS. ALS needs EMG (electromyography) for diagnosis. If it is normal, it is unlikely to be ALS.
Patient's Query
Hi doctor,
Thanks for your reply. I provided the photo of the indent here. There is no weakness. I shoveled snow for three hours yesterday and lifted weights. No strength differences. But the part that bothers me is not that there is an indent or that I twitch. The indent is occurring in a place where I get a constant twitch.
Hi,
Welcome back to icliniq.com.
I understand your concern.
I understand it can be concerning. Shoveling snow requires mostly core strength and proximal limbs muscles. I would check the strength in the little finger by moving it outwards. If it is not weak, then I would worry.
Recurrent focal twitching can cause focal muscle injury leading to this, but this would not mean it is ALS. It requires EMG. I would recommend you get a focal ultrasound and EMG, including the area that you feel is atrophied.
Hope this helps.
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Answered byDr. Nene Devavrat Harihar
Medically reviewed byiCliniq medical review team
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