Hello,
Welcome to icliniq.com.
I would like to know further details about your symptoms:
1. Since when you started to have body twitching?
2. These twitchings occur in which part of the body?
3. Are the twitchings visible or only felt by yourself?
4. In which arm and part of that arm do you feel sensations?
5. What kind of sensations are these? Is it tingling, pins, needle, burning or warmth, electric, current-like sensation, decreased feeling to touch, or something else?
6. Hand pain occurs in which arm and which part of the arm? Also, please tell me what kind of pain you feel and since when?
7. Since when did you notice the spot of atrophy between the thumb and the index finger?
8. Do you have any neck pain also?
9. Have you undergone a cervical spine MRI (magnetic resonance imaging)?
10. Did you have any recent injury or fall before these symptoms?
11. Do you have any other co-morbidity besides high blood pressure?
12. Have you had any symptoms pertaining to autoimmune disease or connective tissue diseases, like photosensitivity, blushing of the face in sunlight, recurrent mouth ulcers, joint pains involving small or large joints, ulceration at fingertips, or dry eyes?
The photograph you attached (attachment removed to protect the patient's identity) shows the atrophy of the first dorsal interosseous muscle, though it needs to be clinically examined. The ulnar nerve supplies the first dorsal interossei muscle. ALS (amyotrophic lateral sclerosis) is usually painless and does not involve the sensory system. So arm sensation and pain do not fit in. Twitching or fasciculations can happen in any denervation situation, including ALS. ALS is a gradually progressive disease, and there is no particular investigation to rule it out. It is diagnosed clinically (based on its clinical criteria after ruling out other mimicking possibilities). All clinical findings may not be present initially, and often the diagnosis is made by repeated clinical examination after further symptoms or signs develop. You can undergo physiotherapy as a preventive measure.
Kindly, get the following investigations done:
- MRI (magnetic resonance imaging) of the cervical spine and bilateral brachial plexus with contrast.
- ANA- IFA (testing for antinuclear antibodies using an immunofluorescence assay).
- MRN (magnetic resonance neurography) left arm (to look for the left ulnar nerve).
- CSF (cerebrospinal fluid) examination.
Kindly revert to the information mentioned above for better understanding and further judgment.
Thank you.