HomeAnswersNeurologymuscle atrophyI have body twitching and pain in my fingers. Kindly help.

Can body twitching and pain between my fingers be due to atrophy or ALS?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Hitesh Kumar

Medically reviewed by

iCliniq medical review team

Published At January 5, 2023
Reviewed AtOctober 11, 2023

Patient's Query

Hello doctor,

Over the last few months, I have been dealing with body-wide twitching, arm sensations, and, recently, hand pain, particularly in my thumbs and between my thumb and index finger. An EMG was conducted with normal motor nerves and minor ulnar neuropathy on my left arm. It came normal. I have noticed a spot on the left arm's hand, and I am concerned about atrophy and ALS. Currently, I am taking Losartan and Cymbalta. What could be the reason for hand pain and possible atrophy?

Kindly help.

Thank you.

Answered by Dr. Hitesh Kumar

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:

  1. MRI (magnetic resonance imaging) of the cervical spine and bilateral brachial plexus with contrast.
  2. ANA- IFA (testing for antinuclear antibodies using an immunofluorescence assay).
  3. MRN (magnetic resonance neurography) left arm (to look for the left ulnar nerve).
  4. CSF (cerebrospinal fluid) examination.
  5. Kindly revert to the information mentioned above for better understanding and further judgment.

    Thank you.

Patient's Query

Hello doctor,

I have been feeling the twitchings for five months, but I have had it going on for much longer and never noticed it. It moves around. I have it all over the feet, legs, arms, back, hands, and almost everywhere. They are usually visible. I do not have the arm sensations much currently, but when it first happened, it felt like a “nervous energy” running from shoulder to hand on both arms. Also, I have had perceived weaknesses. I can still do all things by myself, but I feel weaker. I still work out and can do daily tasks fine. Most mornings after waking up, I get tingling and pins, needless, in my hands and arm to shoulder. Hand pain has been occurring in both hands. It started two months back when I had my EMG. It comes and goes. Some days are better than others but fairly consistent. Most pain is around the wrists and thumb, but I have felt it in other fingers and joints. I noticed webbing simultaneously with the hand pain, which has become bigger. There is no neck pain. A little pain is there when I tilt my head back so that my head rests on my back.

I initially did an MRI of the head and shoulders and found nothing. I had been working out lifting weights, but no known injury that I can tell. I do not have any known co-morbidity other than high blood pressure. I have had frequent canker sores, but that is more anecdotal. I have had some pain in my feet and knee pain at times, but nothing consistent.

Thank you.

Answered by Dr. Hitesh Kumar

Hello,

Welcome back to icliniq.com.

As per your description, you first had twitching (if they are visible by eyes, they are possibly fasciculations) followed by some pins and needle sensation and pain in both arms intermittently, followed by noticed guttering near the thumb area. EMG (Electromyography) did not pick those twitchings or fasciculations. Your nerve conduction study found only mild ulnar nerve involvement. The twitching or fasciculations can happen in many other conditions, like anxiety or benign fasciculation syndrome. You deny any weakness in muscle activity by hand. By this, I can assume you have LMN (lower motor neuron) symptoms in the left upper limb. This detailed information does not fit the clinical diagnosis of definite ALS (amyotrophic lateral sclerosis). A clinical examination is also a must. Other possibilities can be -

1. Cervical myelopathy or radiculopathy.2. Nerve root or brachial plexus involvement.3. Ulnar neuropathy.4. Mononeuritis multiplex.5. Associated anxiety.6. Benign fasciculation syndrome.

If symptoms and signs increase with time, some other clues may be found.

Hope this helps.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Hitesh Kumar
Dr. Hitesh Kumar

Neurology

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