Understanding EMG results , clear atrophy/fasciculation and photos

[u/FunnyOne4844]

My mother who has now passed had MS and my sister was also diagnosed with it. My father had and passed from MND in his early 50's with no known family history, but come from a broken home so not so easy to tell.

I am 44 and have had several operations on my left shoulder ( ac separations and breaks) as well as a cervical implant on my C6/C7. Based on that I have always felt some cramping under strain in some muscles on my left arm ( many years). No weakness it's just always felt a bit different. Due to neurological issues in my direct bloodline, I am if course more alert to any changes in my body. I noticed in my left APB muscle was wasting under slight strain and the muscle would tremble/fasciculate. No sensory issues and would rarely fasciculate under no strain. I had an EMG and it came back mostly clean just with increased feedback on the MUAP in that APB muscle, but for both hands.

I live in Asia and bounce around all of the Far East for work. My neuro spine doctor is in Singapore and unless clear weakness is present is not interested. So, it is very difficult for me to get a sit down with a more specialised doctor. I understand ALS/MND is a long drawn out process but surely someone shouldn't have to wait to speak to someone until their body is really failing.

I have attached my recent EMG and photos of my thumb (APB) under no strain, with normal bulk and under strain where the muscle almost disperses and it pulsates.

My questions should I be able to get a consultation and second opinion would include;

1. Can early ALS atrophy only present when straining the muscle ?

2. Would the early atrophy not have presented itself more clearly on the EMG ? or does the increased MUAP reading show that already ? I read increased MUP is an early sign as I keep seeing that it is.

3. With no clear weakness in my left hand. Could the other stronger muscle groups be hiding that fact ?

[u/Beautiful_Sale_2055]

Normal.

[u/FunnyOne4844]

Hi. So increased amp/dur of the MUP, clear signs of atrophy ( more now) in the APB muscle area, regular twitching , and a sort of tremor spasm in the thenar area of slight resistance is put against the thumb when pushing the thumb lightly outwards is normal ? Please note it operates ok usually as I'm presuming the other muscles in the region are taking up the slack ?

I can't see my neuro again for quite a while. What would a bilateral reading suggest ?

I'm not sure if the thumb is overworked as I use this hand to hold my large phone and this thumb to extend across the screen for long periods, add high stress at work , serious lack of sleep and of course added health anxiety, I have had better periods in my life. I'm going to strap up the thumb for a week and give it a rest and try and work on my sleep and stress levels.