Scratching My Head

[Corriel]

Ugh, I hope everyone is fairing OK in the nasty weather we have had as of late.  After about 6 weeks of on and off right hand pain and loss of dexterity I got to the point of substantial muscle weakness yesterday. I typically have spasticity in my arms and my right side takes the brunt of most of it but I usually have more trouble in my bicep or forearm with only occasional hand pain/cramping.

I mustered up the courage to call my neuro's office and he asked me to come in right away. Definite muscle weakness in my right hand and he did a few other neuro tests but I am unsure what he was looking for or if he found anything notable.

My c-spine MRI in July 2014 was clear but he ordered another brain/c-spine scan to be done in the next 30 days and he also ordered an EMG. He says that if there is still no lesion on the c-spine then my weakness is not MS related and we will need to look at other causes.

I have been having issues with my arms on and off now for about a year and half but since nothing showed on the 2014 MRI I am guessing this one will be clear as well.

I'm scratching my head because I can't really get an idea for what this is if it isn't MS. Has anyone else had unilateral hand weakness or something similar?

Confused and frustrated,

Corrie

[Corriel]

I should add that according to my last MRI there was no demyelination around the brain stem either.

The bulk of my lesions are in left parietal, left frontal, both sides of corpus callosum and left pervientricular area.

Since the left parietal is still 2 cmx 8 mm I figure it may be in a prime location to cause a lot of my issues. :)

[Corriel]

Thanks ladies!

Poppy, thanks for validating what I was wondering. If the brain lesion can cause spasticity, why not weakness too? Too bad our MRIs here are only 1.5T. I don't hold out much hope that a lesion will show.

JJ, no falls or mishaps thank heavens. I do take Baclofen at night (since August 2014) but only 10 mg so I hope that isn't causing such an issue at that dosage. :)

Thank you both for the links too! I was so sure this was spasticity related somehow and surprised that he is insisting if there is no c-spine lesion then it isn't MS when he admits it is "possible" for my brain lesions to be causing my spasticity.

I will hopefully have the MRI in the next couple of weeks and then I meet with him again. Might even get the EMG before I see him too. It would be nice to go over all results with him at once.

Corrie

The hand in question is my right hand and I am right handed and although I baby it a bit for issues requiring a firm grip, I am writing/typing/driving/doing housework like I normally do but maybe more of a workout is needed.

[supermum_ms]

Hey Corrie

Hmmmmm muscle weakness is exceptionally common in MS........i think arm issues as you've mentioned are generally upper motor neuron signs, which from memory when to do with MS, are lesions in either the brain stem or spinal cord its self.    

Assuming you haven't recently had a bad fall, car accident etc to exacerbate any pre-existing or create any new structural damage to your spinal column.....

If you've started taking or increased a muscle relaxant medication for your upper arm (bicep or forearm) spasticity, muscle relaxants are a potential explanation for notable muscle weakness, in not only the spastic muscle(s) but additionally below or else where in your bad limb(s).

Any hand weakness in your bad arm, could even be due to de-conditioning from lack of use, limiting usage etc over a prolonged period, which is more common than you'd probably think. If you're unconsciously protecting that limb, trying to reduce, trigger, exacerbate the spasticity, pain, spasms etc the limb naturally gets weaker, deconditioning takes many weeks though.

It's possibly damage to the nerve fibers (demyelination) that's causing the weakness, impaired nerve conduction can with every day life, repetitive use, targeted exercises eg weight/strength training etc, unfortunately also increasing weakness and muscle fatigue.

This is a good neurologically based information link, chapter 12 is specifically on weakness and you might find it worth reading....

http://www.dartmouth.edu/~dons/part_2/chapter_12.html

Cheers...........JJ

[Poppy7402]

Hi Corrie
Sorry to hear you are having issues with hand weakness.  What an absolute nuisance for you.

When I had leg weakness last year I was told that it was actually coming from my brain (motor control area).  I haven't had time to investigate the hand thing but I wonder whether, despite what your Neuro says, something similar could be at play with you, if you MRI doesn't show a spinal lesion.

On a quick look though, this website may be a good starting point in your investigating:

http://brainconnection.brainhq.com/2013/03/05/the-anatomy-of-movement/  

If I get some more time later today I'll see whether I can anything else for you.

Best wishes


Poppy