Confused by Symptoms

[Res11]

Hi Everyone,

I've recently had a confusing set of symptoms and am trying to plot the best course forward. I appreciate all of your time and will do my best to stay within the rules of this forum (and apologizes for any mistakes on my part).

I am a male in my late thirties. After a two month period of intense computer usage (14+ hours a day), I recently began to experience a painless side to side twitch in my right middle finger some 30-40 times a day. Since I had no other symptoms of note, I was generally not concerned and thought it was a classic overuse injury. I gave myself several days of complete rest and severely limited screen time, etc. I saw no improvement in the twitch (which again, didn't concern me). I resolved that if I didn't see improvement in a month or so I would follow-up. After several days of rest and before returning to normal activity, I began to have severe cramping along the sides of my wrist and into the base of my thumb joint. This produced noticeable pain in my wrist and hand, but not in the area of the twitch.

The twitching and cramping has now spread to my feet, particularly at night to the point where it wakes me from sleep, which produces pain and an occasional pins and needles sensation. The twitching can be relatively intense. I am concerned by such unexpected and diffuse involvement. I am reassured by the fact that I have not detected any noticeable changes to my strength or any ill effects on my activity in daily life. I understand such observations have their limitations. I will also mention that the twitching in both hands and feet seems only to occur at rest (also comforting).

I have read in various places that some people present with twitching/cramping as their initial symptoms and the sudden involvement of my feet in what I assumed to be a minor overuse/orthopedic injury is concerning. I was wondering if any of the members here had a similar presentation or had heard of one? And if their initial cramping produced significant pain?

I have limited options for follow-up as I have recently moved to a new state and I was advised by the health system, which my insurance uses that the wait for a PCP would be 6-8 months and possibly equally as long for a neurology follow-up (a PCP referral required). I must decide if a neurology follow-up is better than an orthopedic, etc.

I have a complex neurological history with two important items of note, I was born with a neurological injury, which resulted in a chronic, lifelong muscle imbalance, which has been noted since childhood. This has produced modest deficits between my left and right side since birth as well as a different appearance to my muscle tone. My neurology exams have been generally unremarkable and a neuro has never felt the need for an EMG. I have not noticed any differences between my baseline strength and dexterity in either side (pre or post twitch). I also have a history of cervical disc herniation with all discs between C3 and C7 herniated with the most pronounced changes at C3-C4 and C6-C7. The cervical disc injury has never produced twitching/cramping of any kind previously.

I also wanted to ask members if a complex neurological history had ever complicated an EMG or seeking help from a new practitioner?

Thank you again for your generosity to myself and this community.

 

[Nikki J]

Hi
first the pattern you describe symptoms in one hand followed closely by both feet does not sound typical of ALS. Second cramps are twitches are non specific to the extreme.

yes cramps can hurt a lot but when they are done the discomfort fades pretty fast. It doesn’t cause constant pain.

I sympathize with the pcp issue. There is a real shortage of primary care providers everywhere in the US I think. I trust you have an appointment made even if it is months out? You might ask to be on a cancel list especially if you can be available on short notice

i would hope the pcp would help you decide what type of follow up you would need.

your c spine issues will very likely show on an emg. Your birth injury may as well. However ALS has a specific pattern and should be distinguishable from any old injuries

 

[Res11]

Thanks so much, Nikki!

The last time I contacted them on an unrelated issue, I was told they would contact me in 6-8 months to schedule. I will contact them again today. If I want faster results I may have to get creative (cash, another state, etc., but these really aren't good options for me).

I didn't mean to imply I was in constant pain. But the cramps are long lasting and not a typical cramp I might get from stretching, overextending, etc. It is more a dull, long lasting cramp rather than a clamp pressing and releasing.

I try not the let the situation bother me and I remind myself that I have no noticeable loss in functional strength, daily activities, which basically leaves me with twitching alone (hardly indicative of anything). Even then twitches only at rest and in the rare event the twitches last long enough for me to counteract them with movement, they do go away when I move the finger. Nonetheless, the symptoms certainly feel scary as I experience them.

May I ask how my C-Spine or previous injury might show on an EMG as opposed to ALS?

 

[Nikki J]

I do not have the energy to teach you about emgs. Nor would it help you but als is ongoing acute and chronic denervation in widespread areas. There are sites on the web meant for neurologists in training that will teach you if you choose

did you try any other pcps? I don’t know your area but a six month wait to be seen is common in mine but not even getting an appointment scheduled for 6-8 months seems extreme

 

[lgelb]

In most every state, you can Google virtual appointment [whatever specialty you are looking for, including primary care such as an internist in your case] and there are third party options (groups of physicians who moonlight or work virtually full time). Licenses to practice telehealth vary by state and you did not provide yours, so I cannot offer suggestions.