Hello! What you're describing sounds exactly like a pinched nerve in the shoulder, neck, wrist or back (very common, and als is VERY uncommon, affecting 1-2 people out of 100,000). The speech issue is anxiety; in other words, if youre terrified of speech issues, you'll be hyper aware of everything you say-- this is bound to cause a missed word. More importantly, bulbar als patients don't present that way...it's a VERY pronounced hoarseness or slurring that makes you sound drunk and that other people notice, nothing like what you describe. There are also symptoms (which I will not tell you bc youll start to imagine them) that would appear. Do you work on a computer? Many folks who spend much time on the computer at work have your same issue with hand. If anything, see your doctor about carpal tunnel syndrome. Finally, I don't know your age but als is practically unheard of in those under 40 with VERY rare exceptions. I'd wager u have mild carpal tunnel, and your speech is fine. God Bless!