Hello,
Thank you for posting your query at DoctorSpring.com
I have noted your symptoms and signs, which you have described in good detail.
First of all, I would like to reassure you that these symptoms are not suggestive of any serious disease, including amyotrophic lateral sclerosis (ALS).
The initial problem was suggestive of left cervical radiculopathy or brachial plexopathy, where the nerves arising from the (cervical) neck region get affected. These nerves supply sensations and strength to the muscles of hand.
MRI of cervical spine would exclude any compression of the neck nerves.
In addition, your other symptoms are non-specific and do not suggest any significant disease. However, conditions such as vitamin B12 deficiency, vitamin D deficiency or thyroid disorder should be excluded.
Nerve conduction studies should also be done to exclude peripheral neuropathy.
Please let me know the MRI report findings.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Patient replied :
Dear Dr Kumar,
Thanks for your response. I have been awaiting the results of my MRI in order to let you know, prior to continuing this assessment.
I should know this shortly as I have just spoken with the neurologists secretary who confirmed the paper work is with Dr Kolipara my neurologist.
In the meantime however I would like to just ask a couple of further questions based on my symptoms and your initial assessment -
1. I mentioned that I though there is slight atrophy noticeable on my left hand when compared with my right. This relates mainly to the crease between thumb and fore finger where the tendon is clearly noticeable to the touch on the left but not on the right where it appears clad completely in the muscle of this area. Also the bone connecting my ring finger knuckle to my wrist is markedly more prominent on the left hand than the right.
Although there is no weakness at all in the hand, the thumb is painful at the joint if pressure is applied pushing it backwards - whereas there is not similar pain on the right thumb.
Is this difference noteable or indicative of something other than C spine issues?
2. As mentioned in my initial description, my right thumb just started twitching just over a week ago - this is 3.5 months since the first symptom of a twitching left thumb was noticed. What if anything is the significance of this, can it also be attributed to C spine and if so why would there be such an intermission of time?
3. The intermittent buzzing sensation on my feet and now pain across the top of my right foot and to the outer base of the ankle - Can this also simply be attributed to C Spine?
4. The lacy (livedo reticularis) like rash still appears intermittently on the inside of both arms and on my legs and trunk to a lesser degree. When it does so, it brings with it an aching, turgid, inflamed sensation through both arms and hands and the redness on the back of both hands increases. This usually has a duration of 10 -30 mins but can linger at a lesser intensity for a while after before dissipating. Do you have any knowledge of a dermatological presentation such as I describe that could also be associated with the other more neurological type symptoms I have been experiencing?
I realize the first 3 questions may be better deciphered by the results of the MRI when it is available, however my concern has grown since my initial posting as no symptoms have abated and time is ticking on - at 3.5 months I can only assume whatever the cause here it is eluding to the definition of a chronic condition rather than an acute one which is worrying.
As always your professional diagnostic response would be greatly appreciated.
Many thanks,
Alex
Thank you for getting back and providing more information. Regarding your queries, my replies are below:
1. The mild wasting in your left had could be related to cervical radiculopathy.
2. Twitching of right thumb alone is not a specific symptom of any disease. It could occur in cervical radiculopathy as well.
3. Right foot symptoms can not be attributed to cervical spine. It could occur due to lumbar spine disease or a problem with peripheral nerve in the foot.
4. I do not know of any neurological condition associated with these skin findings.
Once the MRI report is available, I can give you more specific answers.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist