Q. I have muscle weakness in the left hand and leg when compared to the right side. Please help me.

Answered by
Dr. Hitesh Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 13, 2021

Hello doctor,

I am a 25-year-old male. I am 6'1 inches by height and 131 lbs by weight. I am twitching in lower extremities, cramps, feeling weakness in the left hand and leg, and comparatively less so on the right side. The left-hand feels hard to use, but I can still use it. It looks like the left-hand muscles are weak.



Welcome to icliniq.com.

I would like to know some further information about your symptoms. Since when you started to have these symptoms? Also, please describe your symptoms in sequence, like what were the first symptoms and involved which body part? And then it progressed to which body part? Is this twitch visibly by eyes (to others and to self in the mirror)? or is it only perceived by you? Are twitches persistent 24x7? or is it intermittent? If intermittent, have you noticed any particular trigger factor or aggravating factor for these twitches? Cramps involve which body parts? Are they visible by eyes or only perceived inside by you? Are they painful or painless? One episode of cramp lasts for how long duration? Since when you noticed wasting of the left hand? Have you had any neck pain or back pain? Any history of weight loss? Have you consulted a neurologist for these symptoms? If yes, can you please send a neurological assessment sheet and also send any investigations reports (if done). How is your day-to-day mood these days? Is it happy or neutral or towards the sad side, or toward the worried side? How is your sleep these days? Do you get sleepy soon after lying in bed? Once you get sleepy, do you have a sound sleep? Or you have frequent awakenings? In the attached small video (attachment removed to protect the patient's identity), there looks like no pronation of any hand. It is difficult to judge atrophy by looking at a picture or video (need to be seen physically). Twitching and cramps are commonly by some benign causes (anxiety or hyperthyroidism or benign fasciculation syndrome), but you mention weakness and atrophy of the hand, which may point toward other etiology. I would also suggest you consult a neurologist physically for a detailed neurological assessment (assessment of power or deep tendon reflexes or any atrophy visible clinically or fasciculations), along with getting the mentioned investigations.

Investigations to be done:

MRI (magnetic resonance imaging) whole spine, NCV (nerve conduction velocity) + EMG (electromyography) all four limbs, TSH (thyroid-stimulating hormone), serum vitamin B12, serum vitamin D3, serum parathyroid hormone, serum calcium (ionic).

Differential diagnosis:

Benign fasciculation syndrome, anxiety disorder, hyperthyroidism, cramp fasciculation syndrome, motor neuron disease.

Thank you doctor,

I will answer the questions below. It started about a week ago for the weakness, the cramps, and some pain type feeling in certain limbs has been going on 2-3 months. Weakness wise it started in the left hand (feels like it locks up, I can still lift the thing and all of that, but things like typing and holding cell phone feel bad) and is strongest there, right after my legs started feeling weak and my balance felt off, I can walk and run and jump, but I feel tired (have not fallen) in right hand and arms followed about four days after. Some twitches are visible to the eye (the ones that are intermittent, and they are in arm or hand or thigh). I have one in the side of my feet that is constant but is perceived I cannot really see it. Persistent in feet, intermittent in other parts of the body. Nothing, in particular, seems to trigger them. Cramps are intermittent, happen all over but mostly in the upper arms on both sides and sometimes in the neck. They happen when I move them too much, which is very painful for the last 10-15 seconds. Wasting in hand, I noticed a few days ago, and I am not sure if actually wasting or not. It seems that way from the palm side, but not so much when palm down. I have had intermittent neck and back pain preceding the weakness, about 2-3 months. I have lost about 10 pounds over the last few months, but I have gained it back and lost it multiple times in that period. I have not. Currently trying to find one in the area, and the mood is bad, very anxious, and scared of symptoms. Ever since I read, they may be constant with motor neuron disease. I do not sleep very well at all, and I wake up every 40 mins or so, many times a night. I notice that the weakness in the hand comes from the wrists sometimes. I guess it is a kind of cramp, but not that cramping feeling, more a tired or locked feeling. I have a weird type of shoulder pain that radiates, and no painkillers help. How noticeable is muscle wasting? Can it be hard to tell, or should it be obvious to even the untrained eye? How is weakness defined? If I feel weak and things feel hard to do or hard to move, but I can still move them or lift them fine, is that still weakness? Thank you, I will investigate all of your suggestions.



Welcome back to icliniq.com.

As per your description, your history is a short duration (1 week), and major symptoms look like twitches (fasciculations), cramps, and pain in the shoulder area, along with severe anxiety, which is disturbing sleep. I do not know if weakness and atrophy are really there or you were feeling it due to pain and cramps. With such short history, motor neuron disease is a less dominant possibility. Weakness in neurological terms is assessed by decreased power of holding objects or lifting arm or leg at different joints. A few times patient confuses it with decreased effort due to some pain in the limb. Atrophy, if obvious, can be visible to the patient. But if it is not that obvious neurologist or physiotherapist can look it better way. Atrophy also can develop in particular muscle groups of limbs.

Investigations to be done:

MRI (magnetic resonance imaging) whole spine, NCV (nerve conduction velocity) + EMG (electromyography) all four limbs, TSH (thyroid-stimulating hormone), serum vitamin B12, serum vitamin D3, serum parathyroid hormone, serum calcium (ionic).

Differential diagnosis:

Benign fasciculation syndrome, anxiety disorder, hyperthyroidism, cramp fasciculation syndrome, motor neuron disease.

Treatment plan:

I suggest you meet a neurologist in person for a detailed clinical examination. Meanwhile (till you meet a neurologist and get investigated), you can try some calcium supplements and anti-anxiety medications (Etizolam or Alprazolam), which may reduce associated anxiety symptoms and may reduce fasciculations and cramps, and improve sleep.

Preventive measures:

Also can try some meditations and yoga to get relief in associated anxiety.

Regarding follow up:

Revert with neurologist detailed assessment and investigation reports for further understanding.

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