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Peripheral neuropathy and nerve damage - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Brain and Spine
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1724 Questions
User :   My wife's right hand has drawn fingers, dropped wrist and constant tremoring when awake. She has had muscle loss for months before these symptoms started. She has had a MRI of brain, neck, shoulder and nerve study. All only showing some nerve damage in hand. Now her left hand fingers are beginning to draw. She had a wreck a year and half ago breaking collar bone requiring plate to repair. All doctors say plate is not causing problem. Her muscle loss in hand seems signifcant. 2 neurologist are puzzled. Any idea?
Doctor :   hi
Doctor :  
let me read
User :   Any thoughts
Doctor :   where is the muscle loss it is on the thumb side or on the little finger side?
User :   both. she has had physical therapy but when tremors got worse they stopped PT
Doctor :   where is the nerve damage according to the nerve conduction study?
User :   right hand
Doctor :  
yeah where is the level usually they say it has ulnar nerve median nerve and radial nerve or mixed type
Doctor :  
so which one is the nerve or nerves affected?
User :   All those nerves did not show damage. They did mention a nerve stretch injury in radial plexes. I'm not sure if they know exactly where damage is or to what extent.
Doctor :   it is brachial plexus
Doctor :  
ok
Doctor :   so the level of injury in the form of stretch is in the brachial plexus
User :   Maybe. Not sure. I know that doesn't help but we have heard so much medical terms we are brain dead.
Doctor :   did they mention any thing about the cause for the STRETCH injury?
User :   They assumed from wreck when collar bone broken. She rolled a vehicle and hit steering wheel we assume to cause break. Was pretty bad wreck.
Doctor :  
did the weakness and gradual muscle loss in the hand followed immediately after the injury?
User :   I would say yes since she was in sling and favor right side. Her job is constant wrting and typing on computer
Doctor :   ok
Doctor :  
so there is the peripheral nerve injury of the right hand at the level of brachial plexus
Doctor :   and this is due to the stretch injury
Doctor :  
now what are they planning to do any nerve transplantation procedure considered?
User :   No discussion of this. Why would it take over a year to show up if it was from stretch injury from wreck and why would it move to left hand?
Doctor :  
the peripheral nerve injury will show up in the following ways
Doctor :  
in acute stage where the entire nerve is damaged
Doctor :  
there will be total loss of the movements immediately and then followed by the gradual muscle loss what we call muscle wasting
Doctor :   in less severe injury like over stretching the functional loss will vary and gradually the loss of the movements increase and the muscle loss also will become prominent gradually
Doctor :  
so it takes time
Doctor :  
also because of the injury around the nerve region there will fibrosis
Doctor :  
this fibrosis might also causes tightening around the nerve what we call the compression on the nerve resulting in the gradual loss of nerve function and muscle wasting
Doctor :   in the left hand is it again the entire hand which is affected or it is the thumb side or on the little finger side it is affected?
User :   her ring finger and middle finger are the ones drawing. Muscle loss is not as severe but there may be some. Her hands are weak with little us of right. Her nerve study shows up as no compression
Doctor :   the ring and middle finger involvement in the form of drawing up is more likely to be median nerve involvement.

Doctor :  
are you sure the little finger is spared?

Doctor :   hi
User :   Her little finger is somewhat affected. Not as much
Doctor :  
0k
User :   Any more thoughts
Doctor :   just one minute please

Doctor :  
what about the sensation over the hand?
User :   Right now her left and right hand are drawing down severly and have severe cramping sensations.I can see her tendons on underside of wrist pulling
Doctor :   ok
User :   her left hand is also spasming
Doctor :  
have u checked blood calcium levels?
User :   her blood work on 2 test were normal. I assume they checked calcium
Doctor :  
ok
Doctor :  
what is her age?
User :   43
Doctor :  
ok
Doctor :   is her blood pressure normal?
User :   at 3 doctors it was considered good especially being nervous
Doctor :  
ok
Doctor :  
is she suffering from diabetes?
User :   no
Doctor :  
is she having uncontrolled muscle twitching visible under the skin?
User :   it looks more like tendons and veins twitching. She had has exteme tight tendons on backs of legs for years
Doctor :   what about her bladder control?

User :   not great. She urinates alot
Doctor :   ok
Doctor :   can u get nerve biopsy and skin biopsy done?
Doctor :  
she is suffering from peripheral neuropathy
Doctor :  
in this condition the treatment options are very less
Doctor :  
and there is no guarantee for permanent cure
Doctor :  
though there are many experiments going on ,still there is no specific treatment available
User :   i guess. If we can not get anwers soon we are probably going to Mayo Clinic
Doctor :  
u can defenetly go for 2 nd opinion
Doctor :  
but peripheral neuropathy she is suffering is due to injury to the nerves
User :   how confident are you on peripheral neuropathy
Doctor :   90 percent
User :   Thanks for your time
Doctor :   welcome
Doctor :  
is there anything else i need to help u with?
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