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Arm ache, numbness in tongue, hand tremor and fatigue. Neuro needle test showed minor problem with nerves. Blood test and MRI normal.

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I have had bilateral arm ache which moves from tricep to forearm. Additionally have numbness in tongue, hand tremor, and fatigue. MRI a year ago showed nothing. Neuro needle test showed some minor problem with nerves but not muscles. ALS, parkinsons and MS ruled out by neuro doc. Blood tests for other neuro problems also negative. Neuro doc is stumped. I am wondering about cervical stenosis or hyperthyroid. Your thoughts? thanks
Posted Thu, 16 May 2013 in Brain and Spine
 
 
Answered by Dr. Nehal Shah 6 hours later
Hi XXXXXXX
Thanks for using healthcare magic.
I have gone through your history.
In cervical stenosis, tongue is usually not involved.
You should go for vitamin assay, vitamin B 12 in particular, and serum calcium level as deficiency of either of these may cause these symptoms.
Let me know if you had any dental problems or had dental procedures done.
Please rule out any endocrinological disorder like diabetes or thyroid dysfunction.
Please get back to me with your random blood sugar level and thyroid level reports.
I hope I am able to answer your concern.
Also, write to me if you have any follow -up question.
Thanks.
Above answer was peer-reviewed by
 
Follow-up: Arm ache, numbness in tongue, hand tremor and fatigue. Neuro needle test showed minor problem with nerves. Blood test and MRI normal. 13 hours later
Hi Doc, some more info on me. Age 68, history of CFS usually controlled. Last A1c was 8/12, score of 5.4. I am insulin resistant but not diabetic. B-12 on last test was 1375 (high). Calcium was 9.6. My symptoms of mild hand tremor, fatigue (caffein helps with fatigue), numbness in part of tongue, and bilateral arm muscle ache started in January 2013. It seems to be getting worse. Some specifics: tongue numbness is exacerbated when I eat and wanes when not eating. Bilateral arm discomfort is strange, always bilateral and exactly in the same place on both arms from shoulder to forearms. It also tends to wax and wane. Have had MRIs and xrays that show some stenosis comparable to my age. Nothing else remarkable. As I said earlier EMG was ok except for some low readings on hand nerves. Blood tests for Sjogrens and other neuro problems were normal. Have not had Thyroid test for about 3 years. Last one was fine. Thanks for any insight you can provide. Larry
 
 
Answered by Dr. Nehal Shah 8 hours later
Hi XXXXXXX
Thanks for reverting to me with more details.

As all other factors are ruled out, your symptoms can be attributed to Chronic Fatigue Syndrome.

I hope you are not taking alcohol regularly. Please rule out thyroid dysfunction.

You can get benefit by graded exercise therapy or cognitive Behavior therapy.

Drugs like Duloxetine or Milnacipran can be useful for Chronic Fatigue Syndrome.

Please revert to me in case if you have further query.

If you do not have any further query, please close the discussion and rate the answer.

Thanks
Above answer was peer-reviewed by
 
Follow-up: Arm ache, numbness in tongue, hand tremor and fatigue. Neuro needle test showed minor problem with nerves. Blood test and MRI normal. 12 hours later
Hello Doctor, I have dealt with CFS for over 20 years. The symptoms I experience now are quite unlike CFS. What would account for the continued bilateral arm ache and weakness? As I said, it is exactly the same on both arms. Numbness in the tongue and lips is almost constant now. Cortisol levels were very high when last checked. My neuro doc ruled out MS partly due to my age. Could cervical stenosis be the cause? thanks
 
 
Answered by Dr. Nehal Shah 18 minutes later
Hi,

Thanks for reverting me with additional information.

Tongue and lip numbness cannot be explained by cervical stenosis. You can consider repeating thyroid and cortisol levels.

If the tests are negative, I think you need to reconsider CFS. Treatment of CFS can be initiated under guidance of your doctor and watch the response.

I hope I have addressed your concern. Please revert to me in case if you have further queries.

If you do not have any question, please close the discussion and rate the answer.

Regards
Above answer was peer-reviewed by
 
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