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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5401
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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My arms shake/trimmer.. I've had a brain MRI, a cervical

Customer Question

My arms shake/trimmer.. I've had a brain MRI, a cervical MRI, a thoracic MRI, an EEG test and an ENG (nerve) test done and all came back negative. Neither my neurologist or spine surgeon can seem to narrow down what's causing this condition. My neurologist
said it could be anxiety.. my spine doctor said it may be a physical reaction to pain in my body stemming from my back (i have minor scoliosis).. What can possibly be causing this condition??
Submitted: 2 years ago.
Category: Neurology
Expert:  Dr. Bob replied 2 years ago.
What part of your arms are affected by this? How long has it been going on?
Customer: replied 2 years ago.
been going on for about a year (started noticing it more about 6 months ago).. It effects from elbow down to the fingers.. When i am tired or anxious/excited it gets worse..
Expert:  Dr. Bob replied 2 years ago.
Is it a slow, steady, rhythmic shaking that moves the arm or hand slightly, or is it a more rapid, intermittent twitching that you can feel or see but does not appreciably move the limb?
Customer: replied 2 years ago.
it is rapid twitching and really only noticeable when lifting the arms/holding things it is also worse when the palm is facing upwards or inwards (holding an iphone).. at rest, the arm/hand does not shake.
Expert:  Dr. Bob replied 2 years ago.
I see. So it is not a true tremor...more like fasciculations. Have you heard this term? Do you agree with this?
Customer: replied 2 years ago.
i just wiki'd the term. That would be closer to what I am experiencing, however, the EMG test did not pick up on any of that.... what i really wonder is could this condition be a result of anxiety/lack of physical excersise?my spine surgeon mentioned the small chance it may be a reaction to muscle pain in my back and this is how my body is dealing with it.. he prescribed me "Cymbalta", but i am skeptical because the side effects are alarming and i don't think it's the right cure..Please let me know what u think on these 3 comments..
Expert:  Dr. Bob replied 2 years ago.
Fasciculations are very common, affecting just about everyone at one time in their life or another. They are almost always benign and transient (and migratory, meaning they may move from one spot to another, with common sites including the arms, legs and face).
They are heavily associated with health anxiety, which is often exacerbated by stress, fatigue, poor sleep, overwork, inadequate exercise, sometimes medications or caffeine). In the absence of other neurological symptoms such as weakness, atrophy, spasticity, loss of balance, they rarely turn out to be an actual disorder or disease process. When they are part of a disease process they are typically picked up by EMG, so a normal study is very reassuring.
Concentrated, persistent pain can be a risk factor for neuromuscular irritability which is the origin of fasciculations, so this may be one component. Cymbalta is a generally safe and effective medication for anxiety and its consequences, and often helps with chronic pain, so this seems like a reasonable measure. It may mitigate much of your anxiety and reduce or resolve your fasciculations.
Sometimes the only way to know if a medication will work is to try it for a few weeks or months. Most people that do so eventually get off the medication when circumstances (and one's anxiety) improve. :-)
Customer: replied 2 years ago.
i appreciate all of that informationhowever, with all of that being said... from all your clinical experience is there some way i can naturally reduce the amount of Concentrated & persistent pain in my back, which is causing the neuromuscular irritability, to a level that it will no longer cause fasciculations?.. rather than just have myself depend on medicines to do that.. ?
Expert:  Dr. Bob replied 2 years ago.
I think your best bet, in addition to regular exercise, a healthy balanced diet and 7-8 hours of good sleep every night, would be to work with some ancillary health care providers. Many individuals benefit from working with a physical therapist on stretching, strengthening, body mechanics, posture and good work (and computer) habits. In addition, many benefit from yoga and meditation, acupuncture, and even self hypnosis techniques. Most of these approaches can be very helpful and satisfying as they place control in your hands, as opposed to that of the pharmaceutical industry. :-)
Expert:  Dr. Bob replied 2 years ago.
Did you have any additional questions? If so, let me know and I'll do what I can to assist you further.