Split Hand, Progressive Hand Weakness, Thenar Cramps/Paim - 21 Year Old


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May 1, 2024
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I am reaching out to you all today in regard to my current situation. I am a 22-year-old male who has been experiencing some symptoms for over a year now.

Past Symptoms

- Body Wide Fasciculations/Muscle Twitching, Leg stiffness, Ankle stiffness and difficulty walking/going up stairs
These started last June and were body-wide. Of course, as many of us who have these symptoms, we search doctor google and look for answers, and of course I stumbled upon ALS. I was somewhat deterred and of course seeked out medical treatment and assessment for the issues. I had a full body EMG, which came back clean. (Which I have attached in the google docs link below) I then as some people don't, accepted that I wasn't dying and then went on finishing out my semester at school, where I got a girlfriend and finished out with very high marks in my classes!

- Voice Stamina and swallowing issues - was scared for a couple weeks of these symptoms then realized it was just GERD and got on medication, and these symptoms subsided.

Current Symptoms -

Split Hand // FDI and Thenar Atrophy and Progressive Weakness
Thumb Tremor//Attatched in Docs
Slight Wrist pain//Forearm Cramps
Palm Pain/Cramps
Back of hand Cramps
Thenar and FDI Twitching
Very Slight non-continuing intermittent tingling in thumb

- My Palm issues started about 4 weeks ago when driving home from school, with some weakness to turn my steering wheel using just my thumb and pointer. I had just finished exams and writing and typing a lot so I thought it was nothing too severe. Fast forward to this week at work, and I have had significant progressive weakness since that first incidence over 4 weeks ago. I have had trouble typing, writing, and using my hand to grip door handles, my shoelaces, and especially while driving. I have also had some wrist and forearm cramps and pain that have come along with it, as well as pain in my thumb and my thenar. I know what you're thinking, pain doesn't come with initial ALS symptoms, but this is pain from my thenar and palm cramping, as messaging the area seems to temporarily relive the issues. My FDI muscle on my right hand has also additionally shrunk, which I feel as though has directly impacted and induced the back of hand cramps and sensations that I have been experiencing. Thenar and FDI also are induced in heavy twitching when in use, and during rest. I am not a normally anxious guy, and my last three months have been pretty amazing, with me getting my dream job, finishing school, and finding someone I'd like to spend a long time with.

I have a Bilateral EMG/NCS this Wednesday but I am being drowned by fear due to these recent symptoms and physical muscle changes. I am only 22, and I know many of you will say that it's rare to have ALS at such a young age, and I agree with you! But I also was diagnosed with Ocular Toxoplasmosis at 17, causing neurological amnesia and eyesight impairment, and was the youngest to ever have it in over 15 years in my large area! (CDC and others came and looked at me like I was a guinea pig)

I would just like to get some opinions from PALS on this issue, as my thenar and FDI seem to get smaller over every couple days continually. I am scared and don't know how else to handle this fear without considering alternative views.
Attached below is my google drive, In it is photos of my thenar and FDI in my Right Dominant hand, as well as a video of my thumb "tremor" as I know it is not a traditional essential tremor.

Pictures videos not allowed

in addition to excessive yawning
Sounds like a localized hand issue, possibly an overuse injury secondary to writing/gaming/texting/sports, and not at all like ALS.

Presuming the EMG is reassuring as regards any neuromuscular disorder, I'd see a hand therapist for an evaluation. Often, they can work with you to determine what you could do/avoid to feel better.
Clean EMG of Left and Right limbs. Does L AND R Cervical Paraspinal EMG testing clear me of bulbar?
I don’t know why you even ask since you reported limb symptoms and admitted your voice issues had another diagnosis but yes
Barium Swallow and GI endoscopy recently showed no inflammation in my esophagus or throat, so its very strange that I am having these troubles.
Squeakiness from allergies/GERD/dryness won't necessarily be seen on endo/barium, since those look for ongoing disease processes.

As Nikki says, you are in the clear in re ALS and I repeat my recommendation that you discuss PT with your doc.