Localized hand twitching, mild weakness?

WorriedMuch

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Hey everyone! I’ve been following this forum for some time and finally decided to ask for your opinions.

I am a 35-year old female, and my symptoms started with a slight tremor in my left hand 4 months ago. The tremor gets worse after using my hand for a prolonged period of time.

About a month ago my thenar muscle and the muscle on the top of my palm between the thumb and index finger began to twitch and quiver. It hardly happens at rest but if I move my fingers or flex my hand it triggers the twitching. Soon the twitching spread to the muscle going from the pinkie to the wrist, my thumb and to my palm. It's not happening anywhere else in my body but in this one hand.

When I visited a neurologist the twitching wasn't so persistent and I didn't know I could provoke it with a hand flex so it went unnoticed, but neuro said that I have mildly reduced strength in my left hand, not due to a pinched nerve or neuropathy; and the tremor is neither parkinsonian or essential in nature. I myself haven't noticed any weakness or loss of function in my hand.

A week ago I saw my GP again because the twitching spread to a muscle under my wrist and I started having cramping in my palm every time I flex my hand. He gave me a quick strength test and said he didn't find anything abnormal (no weakness this time) and said he thinks all my symptoms are due to anxiety.

I didn't have any tests scheduled beyond bloodwork for thyroid, etc. which came back fine. EMG wasn't even discussed.

Should I still be concerned about ALS and see another neurologist? Could I have localized twitching/cramping in my hand without significant weakness because of ALS? The neuro's comment about 'mildly reduced strength' still bothers me but he didn't seem concerned too much about it.

I'd greatly appreciate your advice.
 

lgelb

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Asked and answered -- you have a localized hand issue. You might see a hand therapist or orthopedist. But you're in the wrong place here.

Best,
Laurie
 

WorriedMuch

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Thank you so much for your reply, Laurie.

What worries me is the neurologist I went to specialized in peritheral neuropathies, pinched nerves, limb issues etc. He assured me I have no nerve or muscle damage of any kind based on clinical. Just mildly reduced strength.

I was wondering, is reduced strength even the same thing as clinical weakness or is it a medical term referring to something else?
 

KarenNWendyn

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All neurologists are qualified to determine if you have nerve or muscle damage or clinical weakness. If he felt you had clinical weakness due to a neuromuscular problem, he would have told you.

As Laurie says, you have localized issue. Most likely there is tendon or ligament strain. This can cause twitching and cramping as well as reduced function in your hand. A hand therapist or orthopedist would be a good next step. Also consider an ergonomic assessment of your workplace.
 

WorriedMuch

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Thank you very much for your swift reply, Karen. I will ask my PCP to refer me to an orthopedist. It's also sure a great relief to hear there are other options for what could cause twitching and weakness, so thank you for mentioning those.
 

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Hi everyone,
I have made a post here before but there's been some new developments and I would greatly value your opinions.

My issues started in May 2019 when I had burning, cold, vibration and stabbing sensations in both of my feet. In August 2019 the sensations went away but got replaced by twitching in the inner sides of my feet and calves. After a few weeks those resolved o their own and I haven't had any issues with my legs or feet since.

About 2-3 months ago I started having twitches in my left hand - the top part of the thenar muscle, the hypothenar, the muscle on the upper side of my hand between the thumb and index finger, the muscles in my palm. Most of the twitching happens when I flex my hand or wrist. In the last two weeks the muscle on the inner side of my arm connected to the hand started twitching, as well as my eye, the corner of my mouth and my chin.

I had some mild weakess in my hand on the first clinical exam, on the second one performed by a different neurologist they said I didn't have any weakness. No numbness, tingling or any unusual sensations in my hand and both neurologists were sure I don't have any pinched nerve issues. I was told my MRI is normal but I have read the report and it says I have mild stenosis in my lumbar spine and I do occasionally get lower back pain.

I have just returned from my EMG (I will not get the graph according to the neurologist who performed it and the written report will be given in a couple weeks) so I can only write what the neurologist performing it said. There are abnormal readings on my ulnar nerve and on both of my legs. I was given an ''ALS protocol'' EMG on all four limbs and the left side of my torso and neck. The doctor said he sees nothing to suggest ALS. In the end he thinks I have some abnormally presenting pinch or irritation in my ulnar nerve (I have no pain, numbness or tingling and the clinical didn't show anything to suggest I have it) and mild nerve compression in the lower back is responsible for abnormal leg results. The chin, eye and mouth corner twitches 'are nothing'. I showed him the twitching in my hand and he said they are fasciculations but when I asked about BFS he said I don't have it either cos he didn't pick up a single fasciculation on my exam.

I was wondering, is there any chance the EMG findings in any kind of nerve pinching/irritation can be mistaken for those seen in ALS? Would you know if anyone on these forums was ever misdiagnosed with any kind of a nerve pinch before ALS? I am really bothered I don't have any other symptoms besides twitching and cramps in my arm or hand that would suggest nerve damage, and with the doctor saying I don't have BFS the face twitching is disturbing. My thenar also twitches and I thought the ulnar nerve is the other side of the hand?

Thank you very much for your time and unfortunately I can't post my EMG report yet.
 

Nikki J

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please stay on one thread. Your post was merged.

without seeing your report we can only speak generally but no , a nerve irritation or pinch would not be confused with ALS

when you get your report if you want to post it you may However you have no weakness and your doctor said no ALS
 

lgelb

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Ulnar neuropathy is very common, with or without symptoms.

The twitches in your face and hand don't have to be neurological. Paying attention to your diet, hydration, sleep, stress, exercise and stretching can often make them better. The connection with flexing certain muscles completely points away not only from ALS but lots of other serious stuff.

Now that significant neurological disease has been ruled out, I would go back to your PCP and talk about general wellness and the possibility that you are still getting over something like a virus, from what you described as your presentation. That in turn suggests looking at therapeutic massage, bodywork that elongates muscles like tai chi, maybe hot tubbing, a course of NSAIDs, etc. In short, it sounds like you have some irritated muscles that are referring their irritation to other muscles. This is a pattern that can be changed.

The good news persists -- you're in the wrong place.
 

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I'm so glad for your great news - terrific EMG result.
 

Dee Dee 0617

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Madame, your moniker says it all. You are in fact worried much. I am just not sure why. The people, we here, have trusted the neurologist who diagnosed us with a terminal disease. How we wish it were a mistake. The neurologist said you do not have a terminal disease. Yet, you persist in wanting something "this " devastating to be wrong with you. If you think this type of disease will garner attention, it won't. If you think he'll come back to you he won't. If you need friends, well plan on getting a new bunch every 2-5 years cause I don't know how to be much plainer. Please Go Live Your Life. God bless you
 

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Thank you so much for taking the time to answer. I will post my EMG results when I get them, and would be really grateful if you could take a look.

Dee Dee0617, I am very sorry if I offended you. Nobody would want attention at such a cost. I received a diagnosis with key symptoms that I don't have, without any explanation for my twitching so far and according to the stiky's on this forum partial EMG findings for this diagnosis might overlap with a dangerous disease.
I simply wanted a second opinion. The way I understood it some people here are medically trained, have seen plenty of abnormal EMGs (possibly more so than my neuro) and I trust their opinions enough to not pursue this further if they say there's nothing to be concerned about.
 

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worried, people with a lot of experience have already told you that your EMG is NOT indicative of ALS. There is no explanation for twitching because twitching means nothing, it is not a sign of anything sinister.
You have been told you may post your EMG, but please realise that terminally ill people are not going to say anything much more than - this is not ALS. This is a site for ALS support. There are heaps of sites where you can go for medical help from strangers. This is not setup for that. You have already been cleared of ALS, we won't say anything different. The stickies here in no way indicate you have 'a dangerous disease'.
You can pursue many other avenues for help however.
 

WorriedMuch

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Lgelb, a special thank you for your comment. None of my doctors mentioned neuropathies can even be asymptomatic. I have in fact been assured I don't have one many times before the EMG because I don't present symptoms - which is why I got so worried about a possible misdiagnosis.

Afflicted, I am sorry I was wrong about the sticky. I found a comment that ALS, peripheral neuropathies and Guillian-Barre
can have some similar presentation on EMG in another thread and I admit I really freaked out at this. I may have also misunderstood what this information means.

Could I please ask one more question regarding how EMG works? I have had the worst symptoms in thenar and hypothenar muscles. They checked the hypothenar only. If the findings in hypothenar were not indicative of ALS as well as some other muscles in my arm, is it possible they stick a needle in the thenar and it ends up with positive results just in that muscle?

It seems my EMG report is ready but I can't have access to it until I meet the neurologist which will still be a while from now.
 

KarenNWendyn

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I found a comment that ALS, peripheral neuropathies and Guillian-Barre
can have some similar presentation on EMG in another thread and I admit I really freaked out at this. I may have also misunderstood what this information means.
Not true. Peripheral neuropathies and Guillain-Barre have abnormal nerve conduction. Nerve conduction tends to be normal in ALS. The EMG (needles in the muscles) shows a characteristic pattern in ALS.


Could I please ask one more question regarding how EMG works? I have had the worst symptoms in thenar and hypothenar muscles. They checked the hypothenar only. If the findings in hypothenar were not indicative of ALS as well as some other muscles in my arm, is it possible they stick a needle in the thenar and it ends up with positive results just in that muscle?
You say both your hypothenar and thenar regions are symptomatic. If you had ALS, testing either of these regions would be sufficient. It’s not necessary to test both. In ALS, the abnormalities tend to be widespread, often before symptoms develop. That’s why only a select group of muscles is often tested.
 

lgelb

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The answer to your question is no. ALS shows up in the EMG in multiple muscles, not just the ones you think have weakness.
 
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