Atrophy in Right Hand Worries Me

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XinaMae535

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I definitely have atrophy going on in my right hand. It's not a matter of if this atrophy or not, it's there, all my friends and family can see it and it worsens everyday, despite the hand gripper exercises I've been doing. It's happening around my thumb on the dorsal side. Not the webby part between thumb and index finger, but the thumb itself. I've been frantic about this, trying so hard to enjoy my vacation and time with family, but I'm somewhere else in my mind.I just want to know, if anyone knows, what can cause this atrophy if it's not related to MND?Also, my left leg after the cortisone shot on Friday helped with some pain, but I am STILL walking weird, like with a lameness. I had to pick it up with my hands to help get it into my bed the other day.My friend who's father died of ALS said as far as she knows, ALS affects one limb/place at a time. With her dad, his one leg started to get weak, then his other leg, then spread to upper body. I believe when I googled about ALS before, I read similar, so this information is what is keeping me from going over the edge. I feel my leg and hand issues, if related, it's something else other than ALS.On all the pics taken so far, where my hand is shown, you can obviously see this atrophy, so really need to know what this can be if not ALS. I did google this, but did not get much luck in results and then I stopped because I started to panic.
 
What else causes atrophy? In general, any process affecting the respective nerve.If that was really a neurogenic atrophy, you would have at least some degree of weakness or worse dexterity in the thumb. With MND (or if there was a lesion close to the anterior horn cells), unstable, complex fasciculations would be present.I think the first step you need to do is to visit a doctor and check whether that is really an atrophy - could be loss of subcutaneous tissue. You would not be the first person here to drive yourself crazy only to find out that it was unnecessary (actually, that happens to most of us).
 
Thank you! The loss is worsening, but the strength is not. It was a little weird when I was sewing a hole in my dress the other day, but I got it done no problem. Does not seem like worsening of dexterity, but some dexterity issue is there. No twitching. I get like two random twitches in my Thenar per day, along with other random twitches all over.The beginning loss was present for a couple weeks already when I had a nerve conduction test, and that was normal, so does that mean any nerve issues are ruled out, or could it have been too early to detect?I woke up this morning and I felt like my hand was sunburned around my thumb where this is happening, but it's not sunburned. Like a heat under my skin, but it wasn't very bad. Could this mean something like tendon problems? Is that what would cause subcutaneous tissue loss?
 
You're welcome, Xina.The absence of fasciculations is certainly an important indicator that the atrophy is not caused by anterior horn cell disease, i.e. MND of some kind. The same goes for the lack of weakness. As for the NCV, it is not that simple - to rule out neurogenic lesion, both NCV and EMG (meaning the needle part) need to be done. In MND (not exclusively), a clue might be a decrease in the F wave persistence. As your issues are in the thenar muscles, n. medianus F wave persistence should be above 80%. But as your NCV was fine, I assume this was OK.As for the sensory issues, I really do not know, especially if your NCV was clear.If it is really worsening, you should seek a doctor. I think it is very reassuring that the muscle does not lose its strength.
 
Hard to explain. Wish it was easy to send a picture. Not the Thenar and not the webby muscle on the back of the hand between the index finger and thumb. It's the thumb knuckle itself, where thumb meets palm of hand. It's prominent meaning the bone and veins are sticking out more and more. Looks like I took a potato peeler and shaved around my knuckle 4 times, looks square. And then from the knuckle follow that down to the snuff box, snuff box is deeper and then continue from box to wrist, also deeper. And if I twitch it's a random 2 per day and only in my Thenar (but my Thenar is totally fine, no changes. It does hurt every now and then).
 
Hi Xina,I do have also something that Looks like atrophy in my Hands. I can see it in my thenar on both Hands. I know that because you can see great dents in it if I spread them away from my Hands. This dents where surely not there before I got BFS. The dent on my right side is greater than the dent on the left one. My neuro don´t know what is the cause of that. My strenght is like it was ever before and she won´t make an EMG again. She says that this may be fat loss but nothing sinister. Sometimes my thenar hurts on the next day when I used them to hold things for a Long time, or when I used them for normal things like clean my room or something like this. The same is with my pinkie.....I hope my post is usefull for you.Andreas
 
Dear Xina,I have also atrophy in my hand. Exactly between thumb and forefinger. My neuro saw it first. I did not realize that time. Then, after taking cortisone for a while, this muscle indeed declined very fast, so much that I now see and really feel weakness in my thumb. I went to MND expert last monday and he saw - no difference to last time. He also did an NCV (including thumb). And it was perfect. He saw no reason to give me an emg. But I am now sure, as my neuro, that there is indeed atrophy. My hands look so different now. Left stronger than right. I read that cortisone can 1. reduce muscle in extremities, 2. reduce subcutanous fat in extremities...I don't know whether this could be an explanation also for you? How often did you got cortisone? In my case cortisone made situation worse (also my antibodies against nerve system went up- it should have done the diffent way). And I had atrophy in hand two years ago, before twichtes have begun. And it went away by grip training....so this is to proof that there can be indeed other explanations for atrophy in hands than MND in general. Now grip training does not help any longer (and I did overact, because now I have a swollen tendon). I have no explanation for that process, though.I have also no fasciculations in hands. There was for a while, but not the last time...I also don't know what's going on and feel likely the same as you do.GErman2
 
Xina, Two things:1. Enjoy your vacation! You need it and deserve it. Did you not just have some reassuring news/doctor report prior to your vacation?2. This is an interesting discussion. I and others on this board note loss of subcutaneous fat in hands and feet. There is no mistaking a rather rapid change in the appearance of my feet and hands since bfs onset. Could it be due to the adrenaline we all have rushing around damaging nerves and causing the hyperexcitability? Could it be that cortisone mimics this a bit or something? I know steroids affect adrenal glands. I have always suspected some form of thyroid involvement as many of us who have the fat loss also have thyroid issues. My test has always been negative and yet I am strongly suspicious of other issues with the thyroid as I have about 10 of 12 symptoms. Need more specific testing I guess of TS3 and TS4 or something like that...my next avenue to explore. Currently on my fingers I can pinch the skin on the top and the pinch form will stay, on the long bone part, or on the knuckle. I suspect dehydration sometimes. In any case...NO WEAKNESS. This is the main thing. I saw a spine doctor last week who gave me a full neuro exam (a pleasant surprise for me) and I heard him dictate "No weakness and no atrophy." I have to remember this and repeat to myself now as the past couple days have been full of so many disturbing symptoms.
 
Xina, Two things:1. Enjoy your vacation! You need it and deserve it. Did you not just have some reassuring news/doctor report prior to your vacation?2. This is an interesting discussion. I and others on this board note loss of subcutaneous fat in hands and feet. There is no mistaking a rather rapid change in the appearance of my feet and hands since bfs onset. Could it be due to the adrenaline we all have rushing around damaging nerves and causing the hyperexcitability? Could it be that cortisone mimics this a bit or something? I know steroids affect adrenal glands. I have always suspected some form of thyroid involvement as many of us who have the fat loss also have thyroid issues. My test has always been negative and yet I am strongly suspicious of other issues with the thyroid as I have about 10 of 12 symptoms. Need more specific testing I guess of TS3 and TS4 or something like that...my next avenue to explore. Currently on my fingers I can pinch the skin on the top and the pinch form will stay, on the long bone part, or on the knuckle. I suspect dehydration sometimes. In any case...NO WEAKNESS. This is the main thing. I saw a spine doctor last week who gave me a full neuro exam (a pleasant surprise for me) and I heard him dictate "No weakness and no atrophy." I have to remember this and repeat to myself now as the past couple days have been full of so many disturbing symptoms.
 
I have atrophy in my left hand, I have been feeling a bit depressed about it lately because I was clearing some brambles and undergrowth on my allotment, swinging a machete around, and I transferred it to the left hand to reach something more convenient for that side and I could barely keep hold of it let alone do any effective work with it.Lot's of things cause it, most usually nerve compression. Deterioration in the C spine or other joints is a lot more common than diseases like ALS or MS. Of course it does not make it feel any better to know that, but at least it isn't going to kill you.What I have lost is mostly strength and feeling, not agility however.
 
Xina,rapid knuckle protrusion along with more visible weins is due to loss of subcutaneeous fat.as fellows already mentioned here, there is no major motor muscles above the first finger joint, and, as we all know, the only meaningful atrophy is that one between the thumb and index finger.Sinve you seem not to have that, you may feel easy about this
 
Hi All,Sorry to respond now. I am still on vacation until Monday, but I found time here to take and post pictures of my hand, which was not so simple for me, so I hope someone takes the time to look and respond. These are posted on an old blog of mine about my dog, so please do not mind that.These pics are of my right hand now, when I just kind of hang my hand and then when I make a hard “C” with my thumb and index finger. The indenting of my thumb knuckle is what was mostly bothering me, you can see the grooves around my veins. These are not on my left hand and gradually appeared on my right hand over the last couple of months.The other place that is wasting is that area from my thumb to my wrist, over the anatomical snuff box. That’s gotten more prominent/deeper also, as the knuckle was changing.My thenar muscle has not been getting smaller from what I can tell, but, it will pulsate occasionally and feel like I have a tens unit patch on it or like I can feel my blood flowing through it. It may be sore at times.I DIDN’T really have twitching in this hand when I wrote my first message, but I do get twitches on both sides in that hand now, in random places. Comes and goes. Yesterday when I was driving 16 hours, it twitched often (like once every hour), and today, I did not notice any twitches. The new thing that has been making me nuts, is when I compared the muscle on the back of my right hand between thumb and index finger to pictures of it from April (pictures with the red background), there is a bump in the April pictures, but it’s not there anymore, so now I am freaking out that this muscle is getting flatter. :eek: :( :crying: :crying: NowAprilI can make a fist, push, pull etc., without problems, but when I grab something, it is weak. The degree of weakness varies day to day. One day, I hardly notice it, but today, it’s definitely there and freaking me out.My step mother is a retired nurse and she said she’s seen patients with Thoracic Outlet Syndrome (TOS) with these types of symptoms. I looked it up and it could maybe fit, not sure. I do have chest pain on that side, that has been going on since my hand started changing. The intensity of the chest pain comes and goes and I can’t stretch/move in certain ways without pain.Big thing I’ve been in panic about too, is that my voice started cracking over a week ago. I do not have any slurring or swallowing problems, but my voice is hoarse, and varies. I also have weird sensations in my neck, sometimes feels like it is swollen due to a cold or is strained, hard to describe. But it’s not going away and I am out of my MIND about it!!! :crying: :crying: I had two cortisone shots in my lower back mid-August, which has helped my leg pain. The weak feeling or gait problem I have with that leg has been better, though has also returned, but not so bad. I am not sure if that would affect my hand since the knuckle issue and chest pain came before the shots.So I DO have twitches in my hand, although random and not many, weakened grip AND what looks like it could be a flattening muscle between the thumb and index finger. This has been making me so so so sick!! :crying: :crying: I also have chest pain on that side of my body (for many months now) and a hoarse voice (lately).I am not bothered by my left leg (at this point anyway), but the issue is not totally gone.Does anyone know about TOS? Could it cause these symptoms I am having (twitching, fat wasting, muscle atrophy, hoarse voice, chest pain, pulsating and sore thenar)?? I did read it can cause weakened grip. My left side (chest, arm and hand) are totally OK. Wouldn’t the nerve conduction test at the beginning of Aug. detect TOS if that is what is happening??Wrist X ray was normal. Clean EMG at end of May. Normal nerve conduction tests on my right arm and hand in June and August, and in August the nerve test was done on all limbs.I have to go back to work on Monday, still in the US, and am only going back to Germany (my home) in 3 weeks and cannot see a doctor until I am back, so I thank you all for your thoughts, support and advice!I am finding it hard to do ANYTHING except worry my life away. I’ve been trying so very hard to enjoy the present, but I am just not there. :crying: :crying:
 
TOS is not really any different to any other kind of nerve compression, wherever the nerves are compressed there will be damage and what follows it. I get chest pains as well, sometimes they are really severe.
 
Dear Xina,I have similar problems with that muscle between thumb and index finger and my grip. I was also freaking out about it! What you asked regarding TOS: I am suspected to have it.My NCV was totally fine, but from orthopädic point of view there is a squeeze unter my first ridge, can bee seen in the x-ray.I don't know whether this is exactly the reason for my decline. But could be...But with me, not only this muscle is affected but also the muscle (or and subcutanous fat) above hand back where pinky and ringfinger are. Both sides. And this part of the hand get numb every night.In addition I have those GM1 and Gd1b antibodies..so I am suspected to have a motor neuropathy....These two circumstances might explain, that there are symptoms similar to MND but it could also have ohter explanations...That is what I hope becaus MND ambulance ruled out MND three weeks ago for a second time....I will PM you also!GErman2
 
And Xina, I have forgotten to mention that I also have the pulsating and twichting feeling on my thenar from time to time. Some month ago, my whole thumb was moved by it the whole day.
 
Hi German, thanks for sharing your experience. So the ortho could tell from a chest X-ray? Or what kind of X-ray was it? Do you have any chest pain in that side? When I do some TOS stretching exercises, I can hardly do them because my chest pulls/hurts so bad! And then the pain and sensations go all the way into my hand, mostly thumb, but not as bad as my chest.Also, for the antibodies: was that a simple blood test? And was it evaluated by your primary doc or someone like a rheumatologist?Thanks!!And this weak grip is making me totally insane. I keep trying to live life, and in the present, and I'm ok doing that with the twitches but I can't ignore this weak grip. Also sick to my stomach about my voice being hoarse and cracking. :crying:
 
Dear Xina,it was a rheumatology doc who did the x-Ray from my spine and lung (can give you name and adress if you like. He is not very humble person, very arrogant, but the examinations are very thorough...). What the antibodies is concerned it was testet by a blood test at my neuro (I gave you his name already).I can understand your feelings. My hand gets also weaker and weaker every day. All my joints are clicking, hurting. So my muscles do..Nothing feels ok in my body any more.I don't have such a strong effect with the TOS exercises. Just my 4./5.th finger are getting numb when I lay down. Especially left hand which is weak now.I will follow up my story from hospital, which I am going to check-in tomorrow...Cheers, Deutsche
 
Thank you, German. I am so sorry for the things you are going through. I really wish you all the best in the hospital and for some answers and treatment to help you feel better. For my hand, it's not getting better, or worse, seems like. Twitching there seemed to have died down or stopped, for the most part.My voice is still cracking and has some weird sensations, though. Making me a real mess. :crying: I am taking more anti-anxiety medicine to help keep my panic down.
 
Hi Xina,is anyone else realizing this with your voice? Or just you? I would make an appt. with the neuro I recommended to you. He is checking a bit more than others. Without him, I would never know about my antibodies..My left wrist is hurting now and my left leg feels like tins and needles this morining. Both legs starting to feel a bit weak. Good that I am leaving now for hospital. But I am very anxious...!Deutsche
 

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