Dr. Hitesh Kumar
Neurology
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Patient's Query
Hello doctor,
My left shoulder is smaller than my right and tires more easily from exercise. However, I feel pain in my wrist and the back of my palm whenever I drive. My little finger is forming a split hand sign. Does this mean ALS? Is this a split-hand sign? Why is my little finger deviating? Do I have motor neuron disease? Is there any atrophy of my hands? Kindly suggest.
Helllo,
Welcome to icliniq.com.
1. When did you start to have symptoms of early tiring from exercise, and when did you start to have pain in the wrist and back of your palm while driving?
2. Since when did you notice that your left shoulder is smaller than your right?
3. Do you have difficulty in holding smaller objects with your left thumb and index finger?
4. Do you have difficulty in lifting some objects overhead by your left arm?
5. What kind of pain do you get on the back of your palm - stretching, heaviness, burning, tingling, electric current-like, or something else?
6. Do you have neck pain?
7. Do you also notice some thinning of muscle in your left hand or arm? If yes, please describe.
8. Have you undergone any neurological clinical examination for these symptoms? If yes, please send the neurological examination sheet.
9. Do you have any other associated medical history or ongoing treatment?
10. Do you have intermittently visible muscle twitchings over the left hand or arm?
11. Do you have any impairment in the sensation of touch in your left hand or arm?
Thank you.
Investigations to be done
Treatment plan
Regarding follow up
Patient's Query
Hello doctor,
1: Pains in my wrist and back of my palm started about two weeks ago, I would not say early tiring as it is disproportionately early, it is more like it gets sore easier, since a month.
2: Approximately one month ago, I got it checked and muscle wastage of the shoulder and pectoralis was noted.
3: I do drop items at work sometimes but for example, I was able to carry a 4-pack of drinks approximately 60 meters using just the pincer grasp of my left hand. My left side is a little more uncoordinated but I am able to pinch small items like mints, and I do suffer from autism, which affects my hand and eye coordination.
4: My job requires this motion fairly regularly and those weights are often in excess of 10 kg, which I often support on my left arm.
5: It varies. Though usually, it is a stabbing pain in the top center of my wrist that moves into the middle of the top of my hand. Recently I have been experiencing a tightness pain running along the side of my forearm ending in my elbow and woke up this morning with the left-hand little finger and ring finger tingling. When the limb is in direct use, however, it becomes forearm and elbow tightness pain.
6: I used to have neck pain on the left side, which has now cleared up.
7: Yes, specifically along the knuckle of the first finger of my left hand the bone protrudes further and surrounds my pinky finger where the skin appears to have sunken. Along my left arm, I have noticed a thinning of muscle on the outward side of my forearm. However, I have consulted two doctors and neither has confirmed it as atrophy. Around three months back I did suffer two cramps over two days in the affected area, with the opposite shoulder beginning to twitch. The twitching has now subsided to once or twice a night and only for a few seconds, but it is now in my left shoulder. It has not been cramped since then.
8: No, however, I will soon be going for an EMG of the affected limbs.
9: No related history to this sort of condition. However I have had my reflexes checked, and reflexes are normal.
10: Very occasional, and I never see them, localized to a specific line in the middle of my shoulder, but I have not seen the twitches. It seems to specifically happen at night.
11: No, this morning I woke up with tingling in my two last fingers but otherwise senses of heat, cold, pain, etc are intact. I know that it is not a good sign for disproving motor neuron disease. However I have also noticed a decline in my hand-eye coordination when it comes to typing and other such activities. But activities such as catching and handling objects have somewhat improved. I have also lost strength in my left arm, but not significantly. Overall I have been concerned for the last four months.
Hello,
Welcome back to icliniq.com.
As per your description, pain and tingling sensation with slight incoordination of movements with or without atrophy of left arm muscles are the main symptoms. Also, there has been a history of pain on the left side of the neck. In ALS (amyotrophic lateral sclerosis), the patient does not present with pain or sensory tingling symptoms. Atrophy of muscles with sensory symptoms may point toward involvement of the spinal cord, exiting nerve roots, brachial plexus, or nerves of hands.
Thank you.
Investigations to be done
Treatment plan
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Neurology
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