Hand twitch and weakness slowly traveling from finger up arm

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Hey all,

I am a 27-year old male in California that has been going through some weird symptoms lately and wanted to seek some advice. I have already scheduled an appointment with my GP, hoping to see if there's anything that will come of it (good or bad).

I have been experiencing what I consider BFS twitching for the past couple years. Widespread, no associated weakness, etc. After having my fair share of health anxiety. I took steps to combat it (seeing a psych, taking SSRIs, meditating and generally trying to live a healthier lifestyle).

I will try to be as to the point and succinct with these symptoms as possible: Lately I have been seeing my twitches more focal to my left hand, basically completely on the muscles that control my index finger and thumb and that surround them. Normally I would have thought that these were more BFS twitches, but they seem to have become a hot spot. I have had a bit more trouble doing things with this hand than normal like opening bottles and turning keys in doorknobs. There is no pain associated with this weakness, but my hand has steadily become stiffer over the past few weeks and I have been experiencing some pain from that. I am aware that ALS is about failing and not feeling, but I'm unsure as to what degree the failure is supposed to start.

What compelled me to make this account and post is that I have also noticed that the twitches have been traveling from this spot up my arm. So far it has traveled from the finger, up to the spot between my index and thumb, and now it is also my palm that is experiencing the twitching. To my knowledge the weakness hasn't spread, but the twitching has. Does this sound like ALS (non-benign) twitching?

 

[lgelb]

No, this doesn't sound like ALS, but it merits consideration of how you hold your phone/gaming console, grip a steering wheel, and do keyboarding. Even when your R hand is dominant, your L hand is doing something.

When you see your PCP, s/he may want you to have a study of the nerves in that hand.

Best,
Laurie

 

[KarenNWendyn]

I have had a bit more trouble doing things with this hand than normal like opening bottles and turning keys in doorknobs. There is no pain associated with this weakness, but my hand has steadily become stiffer over the past few weeks and I have been experiencing some pain from that.

The twitching itself is not worrisome. The pain, stiffness and difficulty doing things most likely represents a musculoskeletal problem such as repetitive strain, tendinitis, or arthritis. There could also be a localized nerve issue. ALS would be at the very bottom of a long list of possibilities.

Starting with your primary care physician is a great idea. If s/he has any concerns, I’m sure you’ll be referred to the appropriate specialist.

I definitely wouldn’t lose sleep worrying about ALS.

 

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Thanks, both of you. I'm definitely not going to lose any sleep over this, but it's hard to not be anxious waiting for an appointment. As you say, it's still on the list, despite being at the bottom. If it's okay I'd like to keep the thread open until I at least get answers from doctors.

 

[lgelb]

My point was not to keep ALS on the list, but to note that your doc may want to check that you don't have another type of nerve problem. ALS is about the rarest of these.

The thread will close automatically at a certain point. If you have something to report before then, please add it here. If not, you can start a new thread.

 

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Hi, quick update:

I saw an orthopedist who pretty quickly diagnosed me with carpal tunnel but ordered an NCS/EMG on my left hand to be sure. I've done this song and dance before, and had a clean EMG a year and a half ago (All four limbs were tested and resulted in a clean EMG). I have read cases where clean EMGs with no typical symptoms eventually resulted in an ALS diagnosis, so the possibility still being there doesn't do me any favors.

Today I began experiencing another worrying symptom, in that my left foot started walking inherently differently on my left side than right. No tripping, but there's a definite change in my gait that I have noticed. Not sure if that is anxiety related, but I don't know how to approach getting that worked up and/or looked at as well.

 

[KarenNWendyn]

I have read cases where clean EMGs with no typical symptoms eventually resulted in an ALS diagnosis,

That would be rarer than hens’ teeth. I’ve never heard of it.

Regarding walking differently on your left side with a change in your gait — most likely this results from a mechanical problem involving your feet/ knees/ hips/ spine. A physical therapist could help you a lot with that.

 

[collapsed]

Just for reference, below are the studies I found that back up my statement from the previous post:

The onset of amyotrophic lateral sclerosis

 

[KarenNWendyn]

The paper you reference presents two case reports of patients evaluated for other musculoskeletal issues and happened to have normal EMGs during those evaluations. The first patient developed muscle function failure 18 months later and the second patient developed failure 20 months later. They were each evaluated for these new symptoms and had abnormal EMGs consistent with ALS.

You have to realize that the initial problems they had were not ALS related and they did not have ALS when they were evaluated for those initial problems. Their ALS presented with muscle function failure, not with their previous problems.

So if you’re making the point that a person with “a clean EMG and no typical symptoms” has the start of ALS — no, that’s not what these case reports are saying. They are saying that ALS started abruptly in these two people, months after the evaluation for their other problems.

People with ALS aren’t born with it. They develop it at some point in their life. Nobody knows exactly when ALS starts because there is no light that goes off when that first motor neuron is lost.

So your quote that there are “cases where clean EMGs with no typical symptoms eventually resulted in an ALS diagnosis” was out of context.

 

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Hi everyone, just a quick update since I had an NCV done on my arm today. I was under the impression that I was going to be getting an EMG, but the neurologist I saw did not say one was ordered. I was highly confused and a little upset because I was told that an EMG was ordered by the ortho that I saw.

The NCV was normal, which didn't really assuage my fears of this disease since I'm aware that the NCV is typically normal in ALS. I know that I should be happy about this and be relieved that it is just carpal tunnel, but my mind won't let me keep playing the 'what if' game.

On a different note: for the past couple of weeks I have encountered difficulty pronouncing certain sounds in everyday speech. Sounds like the 's' in 'less', or the g/j sound in 'edge' have started to come off differently than I'm used to, and I can't seem to get myself to pronounce them correctly by going back and/or slowing down. On top of that, I have been finding myself biting my cheeks and tongue more often. I came down with a cold a couple weeks ago, around the time these symptoms started showing, but I talked to my GP and he said there would be no reason for a cold to cause these kinds of symptoms. Bulbar onset is something that I'm definitely worried about here, but it seems like it would be too fast to go from a hand issue to bulbar involvement in a matter of a month.

In the meantime, I've tried seeing if this could be allergy related as I think a lot of people are getting affected at this time of the year. Problem is, I've never really been affected by allergies this way. I've started drinking more water, taking allergy meds, etc. but I don't know how long I should wait before taking anymore steps.