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Suggest Treatment For Atrophy In Hand Of A Person With Cognitive Damage
Question: 58 year old spouse with cognitive damage due to 6 years of inhaling chemicals in an Xray clinic, has NOT returned to work on disability since 2005. Had shoulder operated on 7 years ago for a torn rotor cuff. Now has no use of the right hand and arm displays atrophy. cannot cut food, feed with right hand, chop, pour ,cannot shake bottle etc............ when at rest arm and hand curls close to body. No tingling, no pain..........just cannot use right hand specifically.
Brief Answer:
Possible brain lesion.
Detailed Answer:
I read your question carefully and I am sorry about your wife's condition.
It seems there is an isolated involvement of the motor functions in one limb. Usually that would be related to peripheral nerve damage but the lack of sensory changes and the normal nerve conduction studies speak against that diagnosis. I assume she's had needle electromyography (conducted at the same time as nerve conduction studies) to rule out motor neuron disease (like ALS).
Now that leaves two hypothesis. The first is a central nervous system lesion like a small stroke, tumor or abscess affecting only the area of the brain surface responsible for the right upper limb. That curling of arm and hand close to the body would speak in favor of that due to development of spasticity.
Another hypothesis given the history of rotator cuff injury you mention, if symptoms appeared after that, would be atrophy due to the prolonged lack of use by limitation of movement.
I believe a physician can easily differentiate the two, because in the first case as I said there would be spasticity as well as increased reflexes. If that is the case brain imaging with CT or even better MRI is recommended.
I hope to have been of help.
Possible brain lesion.
Detailed Answer:
I read your question carefully and I am sorry about your wife's condition.
It seems there is an isolated involvement of the motor functions in one limb. Usually that would be related to peripheral nerve damage but the lack of sensory changes and the normal nerve conduction studies speak against that diagnosis. I assume she's had needle electromyography (conducted at the same time as nerve conduction studies) to rule out motor neuron disease (like ALS).
Now that leaves two hypothesis. The first is a central nervous system lesion like a small stroke, tumor or abscess affecting only the area of the brain surface responsible for the right upper limb. That curling of arm and hand close to the body would speak in favor of that due to development of spasticity.
Another hypothesis given the history of rotator cuff injury you mention, if symptoms appeared after that, would be atrophy due to the prolonged lack of use by limitation of movement.
I believe a physician can easily differentiate the two, because in the first case as I said there would be spasticity as well as increased reflexes. If that is the case brain imaging with CT or even better MRI is recommended.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your informative response. She did have a needle electromyography to rule out ALS. When she met with the top neurologists in Toronto approx. 2010 and underwent a SPECT SCAN she noted brain lesions. Then she was sent to a specialist in MS which was ruled out. The neurologist diagnosed her with frontal subcortical cognitive impairment. Over the last 6 month period she has great difficulty recalling conversations and is constantly looking for words and names,her short term memory is virtually nil, she has had several hard falls over the last six months and has told me she feels unbalanced. I do not know if this would shed further light on the issue. The issue with her hand has been during this 6 month timeframe I await your reply. With thanks
Brief Answer:
Read below.
Detailed Answer:
Thank you for bringing some more info.
That picture you describe goes against a peripheral issue and reinforces the possibility of a brain origin given also the other phenomena. I spoke before of a small lesion which would include only the upper limb area but her cognitive and balance issues would lead to something more. The hypothesis remain the same, a stroke, tumor, infection or a degenerative issue like corticobasal degeneration, they all can cause such symptoms. MS is unlikely at her age.
In order to make a diagnosis an exam by a neurologist is necessary as there will most probably be other neurological signs on examination you are not aware of which could help the diagnosis. Of course brain imaging with MRI should be needed as well.
I hope to have been of help.
Read below.
Detailed Answer:
Thank you for bringing some more info.
That picture you describe goes against a peripheral issue and reinforces the possibility of a brain origin given also the other phenomena. I spoke before of a small lesion which would include only the upper limb area but her cognitive and balance issues would lead to something more. The hypothesis remain the same, a stroke, tumor, infection or a degenerative issue like corticobasal degeneration, they all can cause such symptoms. MS is unlikely at her age.
In order to make a diagnosis an exam by a neurologist is necessary as there will most probably be other neurological signs on examination you are not aware of which could help the diagnosis. Of course brain imaging with MRI should be needed as well.
I hope to have been of help.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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