twiching right pinky finger
by MickDPT, Feb 01, 2011
Hello, I am a 35 year old physical therapist who developed a twitching pinky finger on my right (dominant) hand in the beginning of December 2010.  The twitches were so infrequent that I hardly noticed them.  Late in December I took a whirl wind trip that included 6 hours of flying, helping family move and driving 15 hours back home all in 30 hours.  For the following week the twitching in my pinky greatly increased, I thought I could reduce the symptoms by adjusting my posture.  The twitching again reduced back to no more than once or twice a day for a few seconds until I went to a funeral the second week in January and again after the driving and poor sleeping and stress the twitch resumed, and again with in a week the twitch reduced to a few times a day for a few seconds each.  I contacted my primary care who found no clinical findings and ordered an EMG and several plain C-spine X rays including obloquies.  The X rays and the EMG were normal.  The neurologist who conducted the EMG suggested some type of peripheral nerve compression, further reporting that my symptoms were not connected to anything serious and was just a nuance.  
As of today the twitch occurs a few times a day for a few seconds each, but some new symptoms have developed including some mild burning pain in my neck, with discomfort in my R upper trap, and shoulder.  I also have a slight pressure/burning sensation on the lateral aspect of my humerus.
My past medical history is normal save traumatic L AKA from my time in the USMC. I have never been prone to anxiety but must admit being very disturbed by my symptoms.  Though I try to convince myself that this is a soft tissue injury of sorts with some type of  nerve compression, I can’t seem to get past the other possibilities (as a PT I have enough medical knowledge to get into trouble with my thoughts!).
Thank you for you time and comments.

by Christopher R Newey, DOBlank, Feb 05, 2011
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

It must be emphasized that in the majority of cases muscle twitches are benign meaning that they are of no consequence and are not resulting from a serious cause. In such cases, the twitches may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake. Tremors of the hands can be physiological that is exacerbated by stress/anxiety and caffeine.

Benign fasciculation syndrome is a condition in which there are involuntary twitches of several muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low. When this condition is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

\There are other causes of muscle twitches, but they are usually associated with other neurological deficits. This group includes ALS; however, your symptoms based on your description is not consistent.

Another nervous system problem, neuropathy, may also lead to fasciculations. There will again be associated weakness or sensory changes. It would be interested for you to discuss this with the neurologist who did the EMG to see if the “compressed nerve” innervates the area that is twitching (e.g.,ulnar, C8 root, plexus, etc).

Like you mentioned, these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve.

Lastly, have you had any blood work completed such as CBC, CMP, TSH? Metabolic changes can cause muscle twitching.

I suggest follow up with you follow up with a neurologist. It would be useful to have a thorough examination.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

Related Discussions
Member Comments (3)
by BobDAV, Feb 03, 2011
I have similar symptoms due to degenerative disk disease/stenosis @ C6/C7. Twitching is almost always neurogenic & that you have radiant pain in your trap & humorus makes me lean towards a dyskinesia caused by pinching @ the nerve root in the neck. Some gentle stretching might help. You said you're a Marine (Semper Fi), do you have any medical records from your service as a comparison? Also, the VA might be able to help.
by thelma160, Sep 17, 2012
A related discussion, right hand pinkie twitching was started.