Q. I have intermittent twitching in hypothenar muscle. Should I be worried about ALS?

Answered by
Dr. Aida Abaz Quka
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 22, 2018 and last reviewed on: Nov 29, 2022

Hi doctor,

I am worried about ALS. I have had a twitch in my left hypothenar muscle intermittently for three weeks or so. Perhaps a few twitches per hour followed by hours of no twitching. I also have twitches in other parts of my body quite regularly though this one is focal and the others are diffuse. I have not dropped anything. Doing self-tests, my left pinky seems a bit weaker. Though I think I have atrophy in the hypothenar, I have had three general practice doctors tell me it is just asymmetrical with my dominant right hand. The doctors have also performed basic finger strength tests (spread fingers and resist) and they say they are normal. Reflexes are normal. No tripping, dropping, slurring, etc. Should I be worried about this given the above scenario and that doctors have told me no atrophy and no weakness?

Thank you.



Welcome to

I read carefully your question and would explain that your symptoms are not typical of ALS (amyotrophic lateral sclerosis). Benign fasciculation syndrome, an electrolyte imbalance or thyroid gland dysfunction could mimic this clinical situation.

Coming to this point, I would recommend performing some tests to investigate possible causes:

  1. An EMG to exclude ALS.
  2. Vitamin D levels for a possible deficiency.
  3. Blood electrolytes for possible imbalances.
  4. Thyroid hormone levels for thyroid dysfunction.

Consulting with a neurologist may be needed in case of abnormal EMG.

Thank you doctor,

What are your thoughts on the perceived weakness and atrophy? As mentioned, they looked closely at my hands and performed strength tests. Do you think that my next step is to have an EMG for the twitching, but that the weakness and atrophy have been adequately assessed by three doctors? Thank you for your care.



Welcome back to

Atrophy and asymmetry may be a part of a normal individual. It can be assessed by a general physician. But you should know that it is necessary to perform a careful neurological exam for other neurological signs (like pathological reflexes, or low reflexes) which are indicative of certain neurological disorders like peripheral neuropathy or ALS, etc.

The EMG and nerve conduction studies are the main tests to objectively evaluate the nerves and muscles.

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