What is causing my hand weakness, stiffness, and twitching?

Question

Hi doctor,

I recently started with a muscle twitch in my thumb, and then after a few days, I noticed some weakness when gripping things. This has progressed over the past four weeks, and my thumb and the area beneath it feel weak. All fingers except my pinkie feel stiff, too.

Since the initial twitching, I have not had any twitching again in my thumb but have had some fasciculations on the hand with the weakness, as well as other parts of my body. Sometimes my fingers feel slightly sore, too.

Please help.

Answer 1

Hi,

Welcome to icliniq.com

The symptoms you have described are quite significant. The initial fasciculations and subsequent weakness suggest a possible nerve issue affecting the muscles in your thumbs. In neurology, we first pinpoint the problem's location and then investigate its cause. A thorough clinical examination is crucial, followed by tests like nerve conduction studies or electromyography.

In your case, the first possible site of the problem is the median nerve that controls a significant number of muscles in the hand, as well as sensory data from the hand to the brain. However, as you mentioned, with some fasciculation in other body parts, we must also consider other neuronal problems with a broader effect.

Unfortunately, clinical examination is not possible during an online consultation. However, answering the following questions will help me determine the most likely diagnosis.

Before experiencing these issues, did you have any sensory symptoms, such as pins and needles, in your affected hand while sleeping or performing certain actions like holding a phone to your ear?
Do you experience any weakness when making a fist?
Can you form an OK sign?

Kindly reply so I can help you manage the condition better.

Answer 2

Hi,

Welcome back to icliniq.com

I understand your concerns.

I do not believe your symptoms currently suggest amyotrophic lateral sclerosis (ALS), as there are specific diagnostic criteria that must be met, and other possible diagnoses need to be ruled out first.

Your ability to make an "OK" sign indicates that your thumb muscle strength is likely not significantly impaired. Furthermore, the presence of sensory symptoms makes ALS less probable, as it primarily affects motor neurons, leaving sensory function unaffected.

Anxiety and stress can manifest in various ways, including sensory and motor symptoms. However, as a neurologist, I cannot attribute your symptoms to anxiety without a thorough clinical examination.

Regarding your description of bilateral hand weakness in your thumbs and the presence of some sensory symptoms, the most likely problem could be cervical discopathy with pressure on cervical nerve roots C6, as root C6 mainly innervates the nerves that control thumbs.

To investigate such a diagnosis, you need a thorough clinical neurological examination and a cervical magnetic resonance imaging (MRI). If the MRI is normal, and you still feel weakness, then a nerve conduction study and electromyography (NCS-EMG) are needed. You can share my recommendations with your primary care physician to arrange the necessary investigations.

Hope this answers your query.