Dr. Hitesh Kumar
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have noticed an electric shock feeling in my wrists when tapping on them or twisting too much. That comes and goes, and might be normal. But I have also noticed a little bit of pain in my right wrist, and I have noticed a crease (see attached picture) in the wrist area of my palm. The crease worries me. I have also had some widespread muscle twitching (none in this area), so I am scared of ALS or MND. This crease is not atrophy, is in it? I do not have any noticeable weakness.
Hello,
Welcome to icliniq.com.
I would like to know some details about your symptoms:
1. Since when you started to have these symptoms of electric shock feelings and since when pain in the right wrist?
2. As you mention electric current like feeling, I would like to know which area you feel that electric current sensations precisely? and it occurs after tapping at exactly which place? (You can attach pictures with finger kept at those areas)
3. What kind of pain you feel in the right wrist? is it in the wrist joint area or some other? (you can click pictures of that pain area also and attach here).
4. Do you also have right wrist joint swelling or redness or painful movement at the wrist?
5. Have you pain or swelling in other joints of hand or arm or leg?
6. In which body parts you feel muscle twitching. And since when they started?
7. Are these twitching's continuous or intermittent?
8. In which situations, those twitching's get worsened?
9. Have you any difficulty or weakness in hand grip?
10. How is your day-to-day mood? - Happy or just fine or toward the sad side or worrying side.
11. Have you any difficulty in swallowing liquids or solids?
It is difficult to comment on the attached picture (attachment removed to protect patient identity). Better judgment can be made after examining the patient thoroughly.
Investigations to be done
Regarding follow up
Patient's Query
Thank you, doctor, for your reply.
The electric shock feeling gradually became apparent about six months ago. It is not very strong and only occurs if I tap the center of my wrist (see attached picture) or try to use my hand while bending tightly at the wrist. Over the past six months, the feeling has come and gone, and I have not felt it much lately. I have also felt it in the left wrist, but not as much. Some have told me that this is a familiar feeling.
The pain in the right wrist is very mild (1/10) soreness. It does not happen very much. It occurs at the same spot as the electric shock (see attached picture). There is no swelling or redness anywhere. Other than the electric shock sensation, the wrist is not painful to move and does not feel weak. About 14 months ago, I suddenly started having sharp pain in my right index finger when pushing it sideways. That pain went away six months ago. At about the same time, my left thumb had a similar sharp pain when gripping something tightly. That thumb pain is still there. But I have not experienced any weakness at all. Both hands, thumbs, and all fingers can even grip tightly.
The muscle cramps started about 12 months ago. They jumped right after a prolonged period of extreme stress and anxiety. The cramps were intermittent and were in my arms, fingers, torso, legs, calves, and eyelids. The first and most common twitch was in my right bicep. But it went away six months ago. My right ring finger twitched a lot for several months, but it went out six months ago, as well. I have not had many twitches lately. I have been told that some twitching is normal, and I think the amount I have now might be normal.
I did go to a chiropractor for adjustments when the cramps were still more frequent, so maybe that helped. I also have been taking magnesium, vitamin D, K2, and B12 supplements for about a year, in hopes that it would help.
My mood has been mostly stressed and anxious for the past year. I cannot get the idea of ALS out of my head. The fact is that I have pain and no weakness and that the cramps have mostly gone away from ALS. Is that right?
I have not had any trouble swallowing. I also had some other symptoms. I think I have post-micturition dribble. And my left hand has felt a little bit tingly for a few minutes a couple of times additional the past month.
Please note that I have added a picture of my hand with my muscles relaxed. In this picture, the crease is not visible. So this would not be atrophy, then, right, if it disappears when my muscles are not tight?
Hello,
Welcome back to icliniq.com.
As per your description, there may be a possibility of entrapment neuropathy at your wrists. There can be an electric shock-like sensation at the wrist and finger or thumb oversupplied areas of that nerve. However, it can also be a regular phenomenon to get an electric current feeling hitting a nerve. These can happen in anxiety and other conditions regarding the muscle cramps (which may be fasciculations). Only fasciculations (without any weakness or thinning of muscles) do not point directly toward ALS, though it is the only symptom in ALS's early stages. I am not sure about thinning or atrophy of your hand muscle; for that, I suggest you meet a neurologist physically for physical examination of any muscle thinning or power in different segments of muscles or deep tendon reflexes. We need to evaluate for underlying reasons for your symptoms. ALS is a clinical diagnosis and is made when it fulfills the laid criteria of diagnosis. Those may come in a later stage with time, so close clinical monitoring is suggested. A particular investigation can rule out ALS, though studies should rule out other possible etiologies. If no organicity is found in investigations, it can try anxiolytics under a neurologist or psychiatrist's guidance. If we find something significant in investigations, we will plan accordingly. You should also meet a neurologist physically for a neurological examination.
Investigations to be done
Differential diagnosis
Preventive measures
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