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tokyobridge

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Dear ALS Community,

I've been having trouble with my index finger and thumb for about six months so I recently went to see a hand doctor. To my extreme surprise, she said my issues are likely related to the central nervous system and that I need to see a neurologist. Of course I was shocked as I had no idea hands were even controlled by nerves. I've since done a lot more research, educated myself and have made an appointment with a neuro.

My question: About 10 years ago I lost the ability to "click the mouse" with the tip of my index finger. It stopped working. I can move the finger tip but not accurately. Over the last 5-7 years or so I've lost the ability to type with that finger. (I used to be able to type very quickly, now I type without that finger. I keep it pressed against my index finger and use my index finger instead.) I retain ability to use the finger in other situations (button shirt, tie shoes) but pressing on an iPAD for example takes a lot of concentration and feels like I'm not in control of the finger's movement. Finger tip has commenced tremor when in certain positions.

For about two months now the lower third of the finger has felt very week along with the base of the thumb, which has also started to have a tremor (and hence suffers from some lack of dexterity and is no longer fully compliant when typing.) No problem with daily tasks other than typing. I don't suffer from tingling or pain.

Hand doc did not find hand or finger weakness as would present in carpal tunnel. (My finger "OK" sign was strong.)

I had also thought finger problems due to overuse or RSI, stressed ligaments or tendors. Hand doc says 'no'. Need to go to neuro.

I've had a hyperactive central nervous system for a long time. Two years ago new PCP was shocked at my hyper reflexes in my knees. I can start shaking extremely easily when startled or nervous (although mentally I'm stable).

Am I risk of a motor neuron disease?
 
Your neurologist will answer your final question, but I'll start with a little education that might help.

There are several nervous systems tied into your brain. One for feeling stuff, one for controlling automatic functions like breathing, and one for controlling the muscles we call voluntary. In ALS, only the voluntary nerves are affected. ALS is a brain disease. ALS destroys the nerves in your brain and brain stem that should send the "go" signal to your muscles, making them contract, so that muscle won't go anymore; it lays limp, useless, paralyzed. Then the ALS moves to destroy the next nerve, one by one in serial fashion. So a person with ALS will first lose use of a foot, then a leg, then the other leg, then a hand, that arm, and the other arm, etc., until the lungs and head are finally affected and the person dies (usually within 2-5 years).

Note that since ALS is a disease of the motor neurons, there is no feeling weak, no feeling fatigued, no feeling anything associated with losing the use of the muscles. They just don't go anymore, ever again.

Is your finger the first sign of ALS? I doubt it. Especially if it started years ago. More likely a single nerve has become pinched in your backbone or hand.

You said you have clinical weakness. Are you sure? Your hand doc said he didn't see weakness.
 
I should add that hyper-reflexes are not unusual, some people are just that way. Nervous shakes have nothing to do with ALS. Finally, your story didn't make me worry about ALS. Sounds like your finger is probably a simpler problem.
 
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