Right Hand Muscle Less Defined

[BandersnatchF]

The muscle on the back of my hand between the thumb and index finger seems significantly less well-defined on my right (dominant) hand than on my left. My right hand is the one that has most of the twitching, including that odd ring finger curling in after exertion. Of course, it's possible that the muscle has always been smaller, and I just never looked, or that it's more "spread out" so it just looks smaller. There's still a reasonable amount of muscle there, but I'm worried it's the start of worse atrophy.

How long after atrophy begins would strength start to be lost? I can't notice much strength difference between right and left hand, though it can be difficult to test the strength of that particular muscle in isolation.

It doesn't help matters that, the last time I talked (by phone) to my neuro, he said that we'd simply have to wait to see what develops. This is despite a squeaky clean EMG in the right arm in early August, after my ring finger had started twitching.

Anyone else notice smaller hand intrinsic muscles in their dominant hand?

 

[garymills]

If you haven't lost strenght, it most likely isn't atrophy. The self-examination that we all go through with this syndrome will lead to all kinds of little discoveries including muscle size differences. Generally they are issues that have always been there, but like you said, you just never paid attention to them before.

As for the neuro taking a wait and see approach after a clean emg, I would bet that he is just trying to cover his butt. I also think that many times, docs get tired of our anxiety and start to blow us off with comments like that. I know that one of my neuro's did the same thing. He said something like, "well you don't have als, but if you don't believe me, we'll have to wait and see what happens." He knew all along that I didn't have als, but I just wouldn't believe him so he kinda gave up. Could that be the situation in your case?

Take care,

Gary

 

[BandersnatchF]

Hard to tell if I've lost strength - the muscle is hard to strength test. I haven't lost an obvious amount of strength, since I still appear to have full function.

As for what the neuro thinks about me having ALS, I still have an unexplained ring finger curling problem in the same hand. This has gotten a bit worse since an EMG was done on that arm / hand in early August, though it does wax and wane on a weekly basis. After the EMG, the neuro was emphatic that I "do not have ALS at this time - stop worrying." When I asked on the phone yesterday if a clean EMG should help wrt the current symptom (and the EMG was very clean, according to him), he said "wait and see". Needless to say, at my GP visit tomorrow for an unrelated problem, I'm asking for a referral to a university hospital (UCSF and Stanford are easy driving distance) so that someone can (hopefully) explain why my finger curls down or, failing that, get a "don't worry about it" from someone more highly trained than a local neuro. I'm also talking with someone about the anxiety .

 

[garymills]

I'm a firm believer that one should seek out the most skilled neuro's they can find if they have any lingering doubt about their dx. That was the only way I could get past my fears (that and the passing of time). You do have to be ready for the anxiety that goes along with those types of appointments, as it can be severe.

One last thing, waxing and waning sxs are definitely not indicative of mnd. So you should take comfort in that.

Take care,

Gary

 

[CosmicVisitor]

ditto gary,
it was the visit to see the ALS specialist at Cleveland Clinic that did it for me. I went in there twitching like never before(anxious) when I left I went almost the entire day without any.
Do it... its worth it

Doug

 

[Drewbacca]

I really do not think that your finger curling thing is a big deal at all.
This is a standard Neurological strength exam for testing the finger extensors (i.e. the extensor digitorum muscle innervated by posterior interosseous nerve from C7/C8 root level) :
Extend your fingers straight and try to push them at the IP joints. It should hold stable.
Your hand/forearm EMG tells us that you will have a normal exam.

 

[BandersnatchF]

The finger curling has now become sporadic - it got worse in mid-August, and has gotten better recently (less frequent). I know it's not extensor weakness - I can often see the flexor muscle twitch when the finger curls.

My concern over the 1DO is that the right hand looks smaller than the left there. Upon closer examination, it may be that it's just less prominent on the right because the whole hand is a bit bigger. No apparent weakness, though my right hand (especially ring finger and pinky) feel "off" when I'm typing. I suspect ulnar nerve issues - I've had tingling in pinky and ring finger, and pain in wrist and elbow as well as shoulder. I see a different (local) neuro on the 29th.

BTW, my GP isn't concerned; he's convinced I don't have any serious disease. Intellectually, I agree, but the anxiety is still there. Besides, I think there's a real and treatable nerve ailment that I'd like dealt with before my hand function gets worse.