which fingers?

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Active member
Dec 22, 2007
Loved one DX
somewhere in

For those of you whose als began with the arms/hands, I was curious as which fingers were first affected by als - did you experience the same fingers first on both hands? Did you experience fingers before wrist/forearm/bicep? thanks. Or to those of you whose als began somewhere other than the arms/hands, when it reached your arms hands, where did you first notice it? My fathers bulbar began with his speech and fingers, the index and middle..


Mine began with speech and right hand--primarily little finger and ring finger. Those 2 are so curled under now that the "resting position" hand brace I wear at night no longer keeps them straigtened out. Now index finger is bad too. My right arm is weak now too and my left hand is becoming weak, but I can't yet tell which of its fingers are worse.

I guess this means everyone can be different. Sorry about your dad.
Thanks ilgal.

I am also sorry for your diagnosis as well. I am concerned with some symptoms I have been experiencing, and that is the reason for the question. The skin on the backs of my hands is paper thin, and I can see all of veins/tendons etc. I do not think that i have any weakness though - cant tell whether it is genuine weakness/stiffness, or whether i am just paranoid after caring for my father and watching him progress.

take care,

My experience: the left thumb went first, then he rest of the left hand, then the left arm up to about one inch BELOW the elbow. It was the big "thenar" muscle on the palm side of the hand that noticibly wasted away first. I could tell the backs of both the hands had lost tissue and become bony, but I don't think the doctors observed that.

I began really looking at other (healthy) people's hands and noticed that what is "bony" for me is normal for some people. I think thats why I could ascertain atrophy where the doctors were unsure.

Now, two years later, the right hand is going. Also beginning with the thenar ("thumb") muscle.

Theres two main motor nerves that actuate the hands: the ulnar (pinky and ring finger) and median (thumb, index and middle finger). Which nerve deteriorates first will determine which fingers atrophy first. So, it will vary from patient to patient.

Nerve cells are enormously long--one nerve cell stretches all the way from your spine to your finger. I think that the ulnar nerve (for example) is composed of several nerve cells in parallel, each connecting the spine to the fingers. When a given nerve cell dies, other nerve cells will try to grow new axions to innervate (connect to) the muscles that were innervated by the now dead cell. Its not likely that you can grow a replacement nerve cell, as they only grow a few millimeters per year. When a cell grows so many axons that it has taken over the work that should be distributed across a number of cells, that cell becomes stressed and may die. When we lose too many of those parallel nerve cells, we loose the ability to contract the muscle and it will atrophy.
oh, it looks like theres a third nerve--the "radial" that innervates the back of the hand. I suppose damage to this radial nerve ould make the back of the hand thin.

I think each of these nerves contains "motor" and "sensory" nerves--i.e. there are ulnar motor nerves and ulnar sensory nerves. ALS, of course, only affects the motor cells in these nerves.

thank you so much for your very detailed description of the nerve and nerve cells.

I am also looking at other peoples hands. I am trying to see if they are as bony as mine - but i keep looking at chubby hands, so that is not helping much:mrgreen:
I am trying to look discretely, but I dont think i am doing that well either - maybe i should try not tilting my head....

thanks again for your helpful response.

My speech went first, now swallowing is getting more difficult. At the same time, my fingers lost the ability to "pinch," but I still have a strong grip.
I stated with speech now pinky finger and ring finger on both hands are the weakest pat
The thenar muscle that Ahands refers to is one place where one can notice atrophy. Al has placed a few photographs of his hands at the top of this discussion and these are good for noticing the loss of muscle tissue in the thenar prominence. As it turns out, that is also where I see muscle loss, especially on my left hand. What used to have muscle, now looks like folds of skin have taken over.

Yet, there is also much individual variation in hand muscles even in individuals with no pathology, so it is often difficult to clearly identify atrophy. Ahands, you have not been diagnosed correct? Do you have profound weakness in your hands? It seems that atrophy and weakness should go hand in hand (no pun intended), but sometimes one does not see this correlation.
Mom's little finger and ring finger left hand then the whole arm then 12 months latter her right fingers , then hand and now arm. Now her voice and it's harder for her to walk.
For me it began with an overall loss of dexterity in my left hand. I could thread a nut on a bolt and things like that. Shortly after I realized that I could pull my left pinky into my hand. If you lay your hand flat on a table and squeeze the fingers together my pinky was being anti-social and wouldn't join the crowd. Right around the same time I noticed some slight atrophy and weakness in the thenar muscle in that hand as well as weakening pinch strength.

I personally haven't had issues with curling or straightening my fingers yet. My problems have been pinch strength, dexterity and lateral movement.

When you mention pinch strength loss, how do you measure that? For example, could you hold a half-gallon carton of milk at the top with either hand and not have it drop? Is that the type of objective measurement you are referring to? Thanks.
No I mean pinch like walk up and pinch somebody. One of the simple neurological tests they do is have you make the OK sign and they put there finger in the hole and try to pull it between the thumb and index finger. They succeeded easily with my left hand, right hand is getting weaker but I still have enough to make the wife jump :-D
My Physical Therapists had a tool to measure my grip strength and my pinch strength. It registered how much pressure I could place when gripping and pinching. The trouble is, my strength gets weaker with exercise, so they suspended PT for me. So there is an objective way to measure some muscle strength, I guess.
I started with bulbar, legs and now am losing hand and arm. It started with my left pinky curling and then my index finger, my left ring finger does nothing, no curling no movement.
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