Question: Dear Sir,

I am male, 6ft tall, 83kgs weight and will reach 40yrs by this march. Since 1.5 yrs I have been noticing thinning of hand/thigh/feet muscles and occasional twitches. No real weakness as of now and I can do whatever I have been doing so far in terms of physical activity (which is limited anyway, typical of 8-5 office goers). I can still walk 4-5kms, do some 40-50 pushups in 3 reps etc. I used to have a very active lifestyle till the age of 28 though!

I have seen two neurologists in past and has went through different tests. All were normal, including CPK levels in blood and a normal EMG. EMG was first performed only on bicep muscle and the second was done on first dorsal muscle and left leg quads. They put me to test doubting motor neuron disease and later ruled out the same. And opined that the twitches might be benign as it was not recorded on EMG. All other blood chemistry tests, liver fn test, renal parameters were normal as well.Full MRI (contrast) was done, which was also declared normal. They gave some vitamins and advised for a follow up by next year.

I am attaching photos of my hands and left thigh muscle. What is worrying me is the thinning of hand muscle. The ring on my finger has gone real loose by now and there are many wrinkles on fingers (like I have kept it in water for long). And I get occasional twitches on first dorsal muscle. Even the thumb shakes when twitches happen. I get twitches on calf/tibial and quad muscles of left leg and all at a particular location only. This happens for few hours intermittently. Sometimes once in a week or once in two weeks.

Case: 1: On the left thigh muscle I can see this little trough (marked in pictures) when I bend legs and this has increased considerably in last 1.5yrs. Is this some kind of atrophy? Or am I just losing subcutaneous fat all over my body? I can see my chest bones also these days very clearly which not the case was earlier. Please see the hand pictures attached as well and comment whether this looks like some serious atrophy or not. The skin on my hands looks like that of a 70+ man with wrinkles.

Case: 2 , Since last two weeks my little finger is a numb and has tingling sensation. I was on flight for 5 hours and had rested by hands on the hard hand rest throughout the flight. The numb/tingling sensation was on ring and little fingers along with the right side of palm below little fingers. Ring finger became normal within first week, but the tingling/ extra sensory feel on little finger and palm (below little finger) is continuing since then (2.5 weeks now).

My weight has always been between 79 to 83. Right now at 83. I am 6ft tall.

I would really appreciate your kind comments on both cases mentioned above.

Thanks and regards
XXXX

Sir,

Thank you for your quick response. On myopathies, could you please let me know which one of them it could possibly be. I am not looking for an exact diagnosis as I understand it needs a proper biopsy. But still, if you could give an opinion what all to look for, it would help me a bit.

Regards
XXXX