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weakened thenar muscles
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weakened thenar muscles


  Hello-
  I have learned alot by reading all the posts, however, I seek some more information pertaining to my particular situation. The thenar muscles in my hand remain very weak and "shake" when I try to use my thumb. This problem has persisted after 2 carpal tunnel surgeries, thumb ligament repair and joint releases. The last cp surgery was 11 months ago, a tissue graft, the tingling is just about gone, but the weakness persists (a few years now) even with exercises. My pinch strength is only about 10% of my good hand. The abductor pollicus brevis in particular, shows some atrophy with visible twitching, and alot of shaking when I try to oppose it. (The joints remain stiffened also, with limited range of motion.)  Things fall out of my hand because my thumb shakes and is weak. I can't "thumb" through a magazine or book like I used to! The muscles/tendons on forearm have to work harder. The last EMG said there was "poylphasia" and tremor, but didn't go into detail, as they were more concerned with confirming carpal tunnel, then with finding out the cause/reason for this problem. My PT says it is either a nerve or muscle problem. One doctor/friend said there was selective innervation, so that some muscles were working, some were not. I will be seeing a neurologist next month to hopefully find out what's wrong.
  Could the motor nerve fibers be damaged or not re-routing right or missing?
  How does something like this get better? Are there procedures to add more muscle/nerves?
  I have "complex regional pain syndrome" in the hand, and am being treated simultaneously at a pain clinic, which includes using a TENS unit. Sometimes I place the electrodes on the thumb area. Is this helpful? So far, I don't see any difference. I would really like my thumb to stop shaking, be stronger, and bend. How can it get better? Thank you very much.
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Dear Susan:
A careful neurological examination, and a review of the details of your prior EMG (and probably even another EMG) would be required for determining the cause of your hand troubles. Your symptoms could result from weakness of your hand muscles because of loss of nerve supply; contrarily, such symptoms may even result from a neurological problem quite remote from the peripheral nerves (such as a focal dystonia or tremor). Appropriate treatment cannot be advised, nor can prognosis be determined, unless a very precise diagnosis is made.
Neurological involvement with complex regional pain syndrome (also termed reflex sympathetic dystrophy) is controversial and debated. There have been numerous reports of dystonia of the limb in association with this pain problem, but causation is not proved with any certainty.
With your complicated history, I think you would have the best chance of being correctly diagnosed if you are seen by a neurologist specializing in neuromuscular problems, and by a neurologist specializing in movement disorders, at a major academic neurology department near you.
Good luck!




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