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DrRussMd
DrRussMd, Board Certified MD
Category: Neurology
Satisfied Customers: 65289
Experience:  Internal medicine doctor, diagnose and treat neurology patients, many years
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I'm a 35 year old male who experience a strangle spasm in my

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Hi,I'm a 35 year old male who experience a strangle spasm in my left thumb and index finger a few weeks ago - followed by some pain and soreness that went up my wrist into my forearm for a few days. A few days after that I woke up with numbness in the on the back of my thumb (which may be unrelated, and more to do with me sleeping with my wrist bent - I can cause pins and needles in this exact area by pressing on a certain spot on my forearm) I may have over compensated due to anxiety (done pushups etc) but over the next week or two the pain progressively moved up my arm into my forearm / bicep and shoulder. I saw a Neurologist, and presented a normal physical exam, but to rule out ALS (which was my fear) he ordered and performed an EMG. The NCV test was normal, but the needle test summary is as follows: "Needle evaluation of the Left abductor Pollicis brevis and the left first dorsal interosseous showed increased insertional activity, slightly increased spontaneous activity, and diminished recruitment. The Left low cervical paraspinal muscle showed increased insertional activity. All remaining muscled showed no evidence of electrical instability”other muscles tested: Pronator Teres / Bicep/ Tricep/Deltoid/Cerical parasp mid / Felx Carpi UlnMy grip remains very strong, my arm and hand feel sore and a little ‘off’ but I have no problem with any daily functions and my thumb and index finger grip are quite strong.According to the doctor, this rules out ALS and suggested sub-acute C8 radiculopathy. He told me I definitely do not have ALS and should start working about more important things, but I am a worrier and any second opinion insight into this would be very helpful toward my own piece of mind.Thank you.

Hi.
Welcome to just answer. I am here to answer questions for education and information. I will respond shortly with an answer, or a question for you

This finding is consistent with disc disease in the cervical spine.

You need an MRi of the spine so that you can get the correct physical therapy.

Such disc disease is common, and can be reversed.

If you leave it go, you will develop a more chronic problem and might wind up having surgery.

This is the real problem. You don't have ALS, but you do have a problem that needs immediate intervention.

OK, let me know if you have more questions.

Please also click a 5 on the rating scale. This gives me maximal credit with just answer, costs you nothing, but sees that I am credited and paid. I will be here for any follow up question. Thanks.

Customer: replied 28 days ago.
Thank you - What about this specific test eliminates ALS as a diagnosis? I made the mistake of reading about 'split hand syndrome" where these two particular muscles (abductor Pollicis brevis and the left first dorsal interosseous) were early indicators - that's what really scared me. I have an MRI scheduled for tomorrow. Also - do you suspect that the numbness on on the back side of my thumb that can be exacerbated by pressure in a specific area on my forearm (tinels sign i believe) is indicative or a separate issue?

It does not show anterior horn cell neuron disease in the spine.

It shows peripheral damage to do radiculopathy which is from disc compression of the nerve.

These symptoms are all part of the same issue.

ALS is not in the picture.

Please also click a 5 on the rating scale. This gives me maximal credit with just answer, costs you nothing, but sees that I am credited and paid. I will be here for any follow up question. Thanks.

Customer: replied 28 days ago.
Thank you, best $58 i've ever spent.

Please click a 5 or I am not fully credited or paid.

You have to do that on the rating scale.

Let me know if you do not see it.

thanks

DrRussMd and other Neurology Specialists are ready to help you

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Customer: replied 26 days ago.
Dr. Russ are you still available?

Hello.

What is the question?

Customer: replied 26 days ago.
I'm still having cramps in the muscles near my thumb and index finger, and I can't help but be a little putt off by them. Is this normal in the disc disease you mentioned? - Perhaps they are residual from the needle test (or even anxiety). Truthfully, the more you can hammer home to me that there is no POSSIBLE way this ALS the better. I can upload a pdf of the EMG test if helps. You have been very reassuring so far, unfortunately hand cramps are a constant worrysome reminder and hard to ignore.

You need further work up, but not for als.

Have your neurologist order an MRI of the cervical spine.

After examining the hand.

Disc disease can cause pain and fasciculations.

Customer: replied 26 days ago.
I had an MRI yesterday - awaiting results. So the information I provided you on the EMG 100000% rules ALS out?

Yes.

Customer: replied 26 days ago.
Thank you. I will make sure to take all steps needed to correct this issue. Provided the issue is disc disease, as it appears to be, is there any reason for me to curb activities like typing, video games, etc that use that thumb and finger? Other than the cramping it occasionally causes?

It depends on the physical therapy assessment and what the therapist tells you.Until then take it easy.

Customer: replied 26 days ago.
Got it. Last part to the question and I'll let ya run: I understand that nerves heal relatively slowly? i.e. Once the condition causing numbness on the dorsal side of my thumb is corrected it may take some time for the feeling to fully return? Could you maybe give me some insight on what to expect in that regard? I've always wondered, especially because I still have a distinct lack of feeling in my inner thigh almost 2 years post open inguinal hernia surgery. Doesn't bother me but i've always wondered. Thanks in advance!

Six months to a year once the cause is removed.

Customer: replied 26 days ago.
Thanks a lot. I appreciate your time and have a great night.

Any time.

Any questions.

Customer: replied 23 days ago.
Hi, I rec'd MRI results and would like to ask you a few questions about them. Happy to pay for the time.

Sure

Customer: replied 23 days ago.
The summary of the MRI is as follows:Mild degenerative changes of the cervical spine. No significant canal narrowing.Mild right foraminal narrowing at c3-c4No cord signal abnormality.So it appears not to be c8 radiculopathy as my Dr. suggested. what else would it be?
Customer: replied 23 days ago.
I can send you a copy of my EMG report, or this MRI report if needed.

Yes this is an indication for the correct manual medicine program. It is not any where near to a surgical problem.

It is not anything else. We have been over the EMG.

You don't have als.

However, degenerative disc disease will become a big problem in 10 years if you do not address it.

You need to see an MD specialist of physical medicine and rehabilitation. This doctor will give you a variety of modalities to build up the spine and get rid of any associated pain.

Customer: replied 23 days ago.
I have an appt. with a physical therapist. Overall i am feeling somewhat better, and I understand that i do not have ALS - i'm just wondering what would cause the reduced recruitment findings on the EMG? are they minor enough to be a fluke?

They are minor enough to be from nerve irritation from spinal degenerative disc disease.

Customer: replied 23 days ago.
does that happen? Like a nerve just gets "tweaked" and has a spasm like i had initially, and then just heals over time with therapy?ps. let me know how I can get you extra compensation from this.

Yes that is correct.

Customer: replied 23 days ago.
how can i pay / tip you for this time?

I have no idea.

Just find me by request in the future on a new post.

Customer: replied 23 days ago.
I will. Thanks.

anytime