Thenar atrophy but no way to check weakness

[NeuroMinded]

Hello, everyone. First of all, I would like to state that I have the utmost respect for everyone on these forums doing their best to help each other and those in need. I visited here a few years ago when I had a scare and I'm glad to see it's still going strong. Now, on to my story.

Three years ago, waiting for the bus home from college, I noticed a single twitch in my thumb, which I thought odd since I had never experienced such a thing. A few days later and I had twitches and cramping all over, including my tongue, which lead me to research on the internet which of course led me to ALS among other things. I had known about this disease since I was a child and had watched a documentary on Stephen Hawking, so I was predisposed to fearing it and assuming the worst. I eventually went to a neuro and had a full battery of tests performed: MRI, EMG, EEG, nerve conduction. Everything came out fine except for a tiny pineal cyst, and so my mind was set at ease and I've given no thought to all the twitches since.

In fact, the whole experience left me so impressed with my neurologist that I decided to change schools and study biology with the intention of becoming a neurologist myself. The work was grueling and I often spent days on end writing up labs and studying, but it all paid off, I aced the MCAT, and I have just filled out my primary AMCAS application for medical schools. I decided to celebrate by taking a vacation from everything and I bought Diablo 3, which came out 4 days after my last final exam. For three weeks I played nonstop until I noticed my right hand cramping severely in my thenar eminence. I figured I had clenched the mouse too hard and for too long, so I took a break for a few days, but the cramps subsided slowly and came back whenever I tried to play for more than a few minutes. This last weekend, I carefully examined my hands and I noticed asymmetry between the abductor pollicis brevis muscles. I can still perform all tasks and I've tried a few novel ones like lifting heavier and heavier weights between my thumb and index fingers, but I can't figure out how to test the particular muscle in question.

In any event, my entire hand is cramped and the particular feeling under the thumb is at times buzzing. I also notice fasciculations during contraction. Up until this point, I have given no thought to ALS or any MND, although I have noticed over the last few months that when I started lifting weights (for the first time ever, really!) I could not perform as many biceps curls with my right arm and afterwards it would remain fatigued for an entire day while the left arm felt fine. I should have mentioned this to my neurologist at my followup a few months ago wherein I had an MRI just to check the pineal cyst. The MRI was normal, but my insurance has since expired due to my age.

I know the whole story about the probability of this all happening and I'm probably in for a lambasting, but knowing what I do after all the studying I've done on the nervous system, I keep alternating between abject dread and deciding it's absolutely nothing and the atrophy is unremarkable. If I had any paresthesia, I would immediately conclude that it is carpal tunnel syndrome or some other nerve entrapment, but there is no pain, tingling, or numbness; just twitching, cramping, and atrophy. This is probably a case of just knowing too much for my own good, and I realize nothing I post here matters until I can reinstate my insurance and get some final testing done, but I was hoping someone here might be able to tell me if their progression was similar (sans the three year old scare) or if they know a way I might objectively test this myself until I can get to my doctor.

 

[momap53]

Sounds like it could be just a matter of overuse from the video games.
Good luck at your appointment

 

[fitzroy]

I'm not a doctor or a medical student, but I honestly don't think there is any way to objectively test atrophy, much less weakness on your own. Also, asymmetry does not equal atrophy or wasting. Even in the APB. My advice is to simply not worry about this. If things get progressively worse to the point that you are losing functions then get to a doctor whether or not insurance is there. But my guess would be that's likely to be awhile.

For what it's worth, I have clinically confirmed atrophy in my APB and FDI with associated weakness. Do a search on that. I can have a hard time removing fresh pasta from a plate with my fingers. Not much control. Left hand ahead of the right by a few months. Still, I don't have ALS and most likely not even neurogenic problems.

Again, I wouldn't worry about this until it goes beyond a curiosity. What could you do about it anyway?

 

[NeuroMinded]

Sounds like it could be just a matter of overuse from the video games.
Good luck at your appointment

It's nice to hear this from you. My family all tells me the same, and I've been doing well just assuming that's the case thus far. In my opinion, neurological diseases comprise some of our greatest fears, whether the condition mostly affects sensory, motor, or cognitive function. I can only hope my experience will help me to better care for patients one day.

 

[notme]

HI

Get it checked by a hand specialist--it is possible to have a nerve issue even without all the expected symptoms. Cramping could be from using the hand too much?

Don't worry until you've had it checked. Sounds like an NCV may be in order.

 

[Alyoop]

I am sure all that medical training would have also told you that it could be caused by many other things. It's always better to look at the most common causes first. If you cough, you probably have a virus ......not a rare type of lung cancer.....get the idea.

Or, I suppose it could be ALS. If it is you will find lots of support here.

 

[NeuroMinded]

HI

Get it checked by a hand specialist--it is possible to have a nerve issue even without all the expected symptoms. Cramping could be from using the hand too much?

Don't worry until you've had it checked. Sounds like an NCV may be in order.

Thank you for this. You were absolutely right - so right that I thought I'd share what I've figured out so far. Fair warning: this makes me look pretty foolish, but maybe it'll be instructive for some other people.

When I first noticed the atrophy, it was early in the day before I had done anything on the computer. I immediately stopped using the computer to see if it would help, but ironically enough this caused more problems than it solved! You see, I actually am experiencing paresthesia, but only when putting pressure on my elbow, which I was no longer doing since I had stopped using the computer. The atrophy, however, was very real and fixating on it lead to tunnel vision on my part. I was wrong about the muscle, however; it is actually the adductor and not the abductor muscle, which would explain the tremors and cramping without real weakness when trying to grip certain things since it opposes abduction. Assuming the wrong muscle to begin with, I tried provoking paresthesia from the median nerve with the reverse phalen's maneuver, which of course accomplished nothing.

Yesterday, I gave in and decided to use my desktop again, which eventually led to some elbow pain and tingling in my pinky and ring finger. I have never been so relieved to feel pins and needles! Suddenly, everything clicked in my head and I realized my error. I feel terribly ashamed for my thoughts, though I can at least console myself with the fact that I didn't imagine it all. I've certainly learned my lesson about assumptions, and I'll be putting some extra time in studying anatomy seeing now how difficult it is to identify overlapping structures. I just hope my doctor doesn't glare too hard after I tell this story.

 

[notme]

cubital tunnel--trapped ulnar nerve in the elbow. You need to see a surgeon and have a NCV done. The elbow pain is classic for this condition--and I'll warn you--the atrophy will worsen without treatment.

 

[notme]

sent to mods, sigh.
Ulnar nerve is trapped at the elbow. Atrophy will worsen. See doc for NCV

 

[Polar]

https://www.alsforums.com/definitions/thenar-atrophy.html

 

[NeuroMinded]

https://www.alsforums.com/definitions/thenar-atrophy.html

For some reason this doesn't mention ulnar innervation. I might send an email to request it be added. Also, the issue is complicated by the presence of several relatively prevalent anastomoses of the median and ulnar nerves like Riche-Cannieu anastomosis in the hand.