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Dr Saghafi, Would Tightness In My Arm That Is Showing
Question: Dr Saghafi,
Would tightness in my arm that is showing perceived weakness be a sign of upper motor neuron activity? I feel tightness and tiredness after using it and an inbalance in arm strentgh of objects being lifted that are the same weight.
Would tightness in my arm that is showing perceived weakness be a sign of upper motor neuron activity? I feel tightness and tiredness after using it and an inbalance in arm strentgh of objects being lifted that are the same weight.
Dr Saghafi,
Would tightness in my arm that is showing perceived weakness be a sign of upper motor neuron activity? I feel tightness and tiredness after using it and an inbalance in arm strentgh of objects being lifted that are the same weight.
Would tightness in my arm that is showing perceived weakness be a sign of upper motor neuron activity? I feel tightness and tiredness after using it and an inbalance in arm strentgh of objects being lifted that are the same weight.
I’ve also experienced a tight locking like muscle contraction between my index and thumb that didn’t allow me to spread them completely. Had to massage it out. Happened tying shoe. Not liking this
I’ve also experienced a tight locking like muscle contraction between my index and thumb that didn’t allow me to spread them completely. Had to massage it out. Happened tying shoe. Not liking this
Brief Answer:
Direct answers to direct questions--
Detailed Answer:
So as a preface to your 1st question let's underscore that there is a difference in medicine between what is termed a NEUROLOGICAL SIGN and a SYMPTOM.
A SYMPTOM is a feeling or sensation describing the status of a body part or region compared to when it is at a baseline or normal state of affairs. A symptom is nothing that can be measured or seen by a clinician. It is what the patient REPORTS. It is their best description of "what's wrong" that they can give to the doctor in the hopes that the doctor recognizes what is being related and can see the similarity in what others have told him who have a known condition or problem. Make sense? What the patient tells us is wrong with them without being able to really measure, see, feel, image, or identify with labwork.
a NEUROLOGICAL SIGN on the other hand is precisely those movements of the body or those responses of the body to certain stimuli that can be controlled, initiated, and modulated (changed) by an examining physician. So a SIGN is something visible, touchABLE, feelABLE, measurABLE, reproducible, and when identified correctly is something that other physicians can also appreciate and see/feel/measure for themselves. Make sense? That's what a medical SIGN is all about.
So when you describe your describe to a physician the weak feeling you have or the tightness you have or that you have a headache or nausea, or blurry vision, or a hot flash, or a tremoring on the inside.....these are all NEUROLOGICAL SYMPTOMS which may hang together in some coherent way to point a doctor in some direction or another to conclude a possible diagnosis or more likely LIST of POSSIBLE diagnoses....make sense? Feelings of tightness, fatigue, and tiredness are SYMPTOMS and NOT signs of neurological dysfunction.
However, if the feeling of TIGHTNESS is related to the physician who then, examines the patient and notices a TAUT, MAYBE SWOLLEN, MAYBE BULGING muscle or group of muscles in an arm or leg, perhaps notices a HARD muscle in the leg such as a CHARLEY HORSE...then, there is a NEUROLOGICAL SIGN that the patient is exhibiting which can be verified and measured by the physician. In that respect the patient's SYMPTOM of tightness can definitely said to be a good indicator and barometer of their muscle spasm, increased tone, or spasticity which would all be NEUROLOGICAL SIGNS noted by, measured by,and verified by the physician. See that? But if a patient says that they feel tightness, or a cramp in a muscle (neck, calf, wherever) or that there is intense fatigue, tiredness, or soreness but upon examination the physician cannot appreciate or identify any type of muscle spasm, swelling, or increased tone in the muscles of the limb in question then, we cannot list the patient's SYMPTOM as a SIGN....see how that works?
Now, to your question...."Would tightness in my arm that is showing perceived weakness be a SIGN of UPPER MOTOR NEURON ACTIVITY?" Is this a possible description of an UPPER MOTOR SIGN?
>>>> Without any other positive information through the physical or neurological examination the answer is....NO....that is not an upper motor sign because what's being complained of is a FEELING/SENSATION that has no MEASURABLE CORRELATE by a 3rd party (namely clinician). The same thing goes for your description of "IMBALANCE in arm strength of objects being lifted that are the same weight." It is not the description of an UPPER MOTOR SIGN OF WEAKNESS unless the physician can identify (using neurological tests and techniques) actual something measurable which would be on a scaled degree of numbers (such as reflexes 0-5) or neurological strength (0-5) as measured and graded by the EXAMINER...not the patient.
If a physician had witnessed and verified the presence of the muscle contraction between the index and thumb that could be called a SPASM or DYSTONIA of the INTRINSIC HAND MUSCLE which prevented a full fanning out of the fingers THEN, that could've been reported as a NEUROLOGICAL SIGN but since it was not either witnessed or verified by a physician then it remains a SYMPTOM which may or may not be seen by the neurologist at some point.
Hope that's clear after all that wordy discussion! HAHA!
In conclusion:
1. Tightness and tiredness in arm felt to be weak by the patient is a SYMPTOM but it cannot be classified as nor is it an upper motor sign.
2. Locking muscle contraction between index and thumb which prevented normal ABDUCTION of the small muscles of the fingers is a SYMPTOM and NOT AN UPPER MOTOR NEURON SIGN because the phenomenon could not be captured, seen, or documented by a medical doctor or designated/qualified assistant.
All the best....I continue to stand by here in XXXXXXX if you feel it may be warranted to return for any reason.
Cheers!
This query required 46 minutes to read, analyze, and respond to on behalf of the patient.
Direct answers to direct questions--
Detailed Answer:
So as a preface to your 1st question let's underscore that there is a difference in medicine between what is termed a NEUROLOGICAL SIGN and a SYMPTOM.
A SYMPTOM is a feeling or sensation describing the status of a body part or region compared to when it is at a baseline or normal state of affairs. A symptom is nothing that can be measured or seen by a clinician. It is what the patient REPORTS. It is their best description of "what's wrong" that they can give to the doctor in the hopes that the doctor recognizes what is being related and can see the similarity in what others have told him who have a known condition or problem. Make sense? What the patient tells us is wrong with them without being able to really measure, see, feel, image, or identify with labwork.
a NEUROLOGICAL SIGN on the other hand is precisely those movements of the body or those responses of the body to certain stimuli that can be controlled, initiated, and modulated (changed) by an examining physician. So a SIGN is something visible, touchABLE, feelABLE, measurABLE, reproducible, and when identified correctly is something that other physicians can also appreciate and see/feel/measure for themselves. Make sense? That's what a medical SIGN is all about.
So when you describe your describe to a physician the weak feeling you have or the tightness you have or that you have a headache or nausea, or blurry vision, or a hot flash, or a tremoring on the inside.....these are all NEUROLOGICAL SYMPTOMS which may hang together in some coherent way to point a doctor in some direction or another to conclude a possible diagnosis or more likely LIST of POSSIBLE diagnoses....make sense? Feelings of tightness, fatigue, and tiredness are SYMPTOMS and NOT signs of neurological dysfunction.
However, if the feeling of TIGHTNESS is related to the physician who then, examines the patient and notices a TAUT, MAYBE SWOLLEN, MAYBE BULGING muscle or group of muscles in an arm or leg, perhaps notices a HARD muscle in the leg such as a CHARLEY HORSE...then, there is a NEUROLOGICAL SIGN that the patient is exhibiting which can be verified and measured by the physician. In that respect the patient's SYMPTOM of tightness can definitely said to be a good indicator and barometer of their muscle spasm, increased tone, or spasticity which would all be NEUROLOGICAL SIGNS noted by, measured by,and verified by the physician. See that? But if a patient says that they feel tightness, or a cramp in a muscle (neck, calf, wherever) or that there is intense fatigue, tiredness, or soreness but upon examination the physician cannot appreciate or identify any type of muscle spasm, swelling, or increased tone in the muscles of the limb in question then, we cannot list the patient's SYMPTOM as a SIGN....see how that works?
Now, to your question...."Would tightness in my arm that is showing perceived weakness be a SIGN of UPPER MOTOR NEURON ACTIVITY?" Is this a possible description of an UPPER MOTOR SIGN?
>>>> Without any other positive information through the physical or neurological examination the answer is....NO....that is not an upper motor sign because what's being complained of is a FEELING/SENSATION that has no MEASURABLE CORRELATE by a 3rd party (namely clinician). The same thing goes for your description of "IMBALANCE in arm strength of objects being lifted that are the same weight." It is not the description of an UPPER MOTOR SIGN OF WEAKNESS unless the physician can identify (using neurological tests and techniques) actual something measurable which would be on a scaled degree of numbers (such as reflexes 0-5) or neurological strength (0-5) as measured and graded by the EXAMINER...not the patient.
If a physician had witnessed and verified the presence of the muscle contraction between the index and thumb that could be called a SPASM or DYSTONIA of the INTRINSIC HAND MUSCLE which prevented a full fanning out of the fingers THEN, that could've been reported as a NEUROLOGICAL SIGN but since it was not either witnessed or verified by a physician then it remains a SYMPTOM which may or may not be seen by the neurologist at some point.
Hope that's clear after all that wordy discussion! HAHA!
In conclusion:
1. Tightness and tiredness in arm felt to be weak by the patient is a SYMPTOM but it cannot be classified as nor is it an upper motor sign.
2. Locking muscle contraction between index and thumb which prevented normal ABDUCTION of the small muscles of the fingers is a SYMPTOM and NOT AN UPPER MOTOR NEURON SIGN because the phenomenon could not be captured, seen, or documented by a medical doctor or designated/qualified assistant.
All the best....I continue to stand by here in XXXXXXX if you feel it may be warranted to return for any reason.
Cheers!
This query required 46 minutes to read, analyze, and respond to on behalf of the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Direct answers to direct questions--
Detailed Answer:
So as a preface to your 1st question let's underscore that there is a difference in medicine between what is termed a NEUROLOGICAL SIGN and a SYMPTOM.
A SYMPTOM is a feeling or sensation describing the status of a body part or region compared to when it is at a baseline or normal state of affairs. A symptom is nothing that can be measured or seen by a clinician. It is what the patient REPORTS. It is their best description of "what's wrong" that they can give to the doctor in the hopes that the doctor recognizes what is being related and can see the similarity in what others have told him who have a known condition or problem. Make sense? What the patient tells us is wrong with them without being able to really measure, see, feel, image, or identify with labwork.
a NEUROLOGICAL SIGN on the other hand is precisely those movements of the body or those responses of the body to certain stimuli that can be controlled, initiated, and modulated (changed) by an examining physician. So a SIGN is something visible, touchABLE, feelABLE, measurABLE, reproducible, and when identified correctly is something that other physicians can also appreciate and see/feel/measure for themselves. Make sense? That's what a medical SIGN is all about.
So when you describe your describe to a physician the weak feeling you have or the tightness you have or that you have a headache or nausea, or blurry vision, or a hot flash, or a tremoring on the inside.....these are all NEUROLOGICAL SYMPTOMS which may hang together in some coherent way to point a doctor in some direction or another to conclude a possible diagnosis or more likely LIST of POSSIBLE diagnoses....make sense? Feelings of tightness, fatigue, and tiredness are SYMPTOMS and NOT signs of neurological dysfunction.
However, if the feeling of TIGHTNESS is related to the physician who then, examines the patient and notices a TAUT, MAYBE SWOLLEN, MAYBE BULGING muscle or group of muscles in an arm or leg, perhaps notices a HARD muscle in the leg such as a CHARLEY HORSE...then, there is a NEUROLOGICAL SIGN that the patient is exhibiting which can be verified and measured by the physician. In that respect the patient's SYMPTOM of tightness can definitely said to be a good indicator and barometer of their muscle spasm, increased tone, or spasticity which would all be NEUROLOGICAL SIGNS noted by, measured by,and verified by the physician. See that? But if a patient says that they feel tightness, or a cramp in a muscle (neck, calf, wherever) or that there is intense fatigue, tiredness, or soreness but upon examination the physician cannot appreciate or identify any type of muscle spasm, swelling, or increased tone in the muscles of the limb in question then, we cannot list the patient's SYMPTOM as a SIGN....see how that works?
Now, to your question...."Would tightness in my arm that is showing perceived weakness be a SIGN of UPPER MOTOR NEURON ACTIVITY?" Is this a possible description of an UPPER MOTOR SIGN?
>>>> Without any other positive information through the physical or neurological examination the answer is....NO....that is not an upper motor sign because what's being complained of is a FEELING/SENSATION that has no MEASURABLE CORRELATE by a 3rd party (namely clinician). The same thing goes for your description of "IMBALANCE in arm strength of objects being lifted that are the same weight." It is not the description of an UPPER MOTOR SIGN OF WEAKNESS unless the physician can identify (using neurological tests and techniques) actual something measurable which would be on a scaled degree of numbers (such as reflexes 0-5) or neurological strength (0-5) as measured and graded by the EXAMINER...not the patient.
If a physician had witnessed and verified the presence of the muscle contraction between the index and thumb that could be called a SPASM or DYSTONIA of the INTRINSIC HAND MUSCLE which prevented a full fanning out of the fingers THEN, that could've been reported as a NEUROLOGICAL SIGN but since it was not either witnessed or verified by a physician then it remains a SYMPTOM which may or may not be seen by the neurologist at some point.
Hope that's clear after all that wordy discussion! HAHA!
In conclusion:
1. Tightness and tiredness in arm felt to be weak by the patient is a SYMPTOM but it cannot be classified as nor is it an upper motor sign.
2. Locking muscle contraction between index and thumb which prevented normal ABDUCTION of the small muscles of the fingers is a SYMPTOM and NOT AN UPPER MOTOR NEURON SIGN because the phenomenon could not be captured, seen, or documented by a medical doctor or designated/qualified assistant.
All the best....I continue to stand by here in XXXXXXX if you feel it may be warranted to return for any reason.
Cheers!
This query required 46 minutes to read, analyze, and respond to on behalf of the patient.
Direct answers to direct questions--
Detailed Answer:
So as a preface to your 1st question let's underscore that there is a difference in medicine between what is termed a NEUROLOGICAL SIGN and a SYMPTOM.
A SYMPTOM is a feeling or sensation describing the status of a body part or region compared to when it is at a baseline or normal state of affairs. A symptom is nothing that can be measured or seen by a clinician. It is what the patient REPORTS. It is their best description of "what's wrong" that they can give to the doctor in the hopes that the doctor recognizes what is being related and can see the similarity in what others have told him who have a known condition or problem. Make sense? What the patient tells us is wrong with them without being able to really measure, see, feel, image, or identify with labwork.
a NEUROLOGICAL SIGN on the other hand is precisely those movements of the body or those responses of the body to certain stimuli that can be controlled, initiated, and modulated (changed) by an examining physician. So a SIGN is something visible, touchABLE, feelABLE, measurABLE, reproducible, and when identified correctly is something that other physicians can also appreciate and see/feel/measure for themselves. Make sense? That's what a medical SIGN is all about.
So when you describe your describe to a physician the weak feeling you have or the tightness you have or that you have a headache or nausea, or blurry vision, or a hot flash, or a tremoring on the inside.....these are all NEUROLOGICAL SYMPTOMS which may hang together in some coherent way to point a doctor in some direction or another to conclude a possible diagnosis or more likely LIST of POSSIBLE diagnoses....make sense? Feelings of tightness, fatigue, and tiredness are SYMPTOMS and NOT signs of neurological dysfunction.
However, if the feeling of TIGHTNESS is related to the physician who then, examines the patient and notices a TAUT, MAYBE SWOLLEN, MAYBE BULGING muscle or group of muscles in an arm or leg, perhaps notices a HARD muscle in the leg such as a CHARLEY HORSE...then, there is a NEUROLOGICAL SIGN that the patient is exhibiting which can be verified and measured by the physician. In that respect the patient's SYMPTOM of tightness can definitely said to be a good indicator and barometer of their muscle spasm, increased tone, or spasticity which would all be NEUROLOGICAL SIGNS noted by, measured by,and verified by the physician. See that? But if a patient says that they feel tightness, or a cramp in a muscle (neck, calf, wherever) or that there is intense fatigue, tiredness, or soreness but upon examination the physician cannot appreciate or identify any type of muscle spasm, swelling, or increased tone in the muscles of the limb in question then, we cannot list the patient's SYMPTOM as a SIGN....see how that works?
Now, to your question...."Would tightness in my arm that is showing perceived weakness be a SIGN of UPPER MOTOR NEURON ACTIVITY?" Is this a possible description of an UPPER MOTOR SIGN?
>>>> Without any other positive information through the physical or neurological examination the answer is....NO....that is not an upper motor sign because what's being complained of is a FEELING/SENSATION that has no MEASURABLE CORRELATE by a 3rd party (namely clinician). The same thing goes for your description of "IMBALANCE in arm strength of objects being lifted that are the same weight." It is not the description of an UPPER MOTOR SIGN OF WEAKNESS unless the physician can identify (using neurological tests and techniques) actual something measurable which would be on a scaled degree of numbers (such as reflexes 0-5) or neurological strength (0-5) as measured and graded by the EXAMINER...not the patient.
If a physician had witnessed and verified the presence of the muscle contraction between the index and thumb that could be called a SPASM or DYSTONIA of the INTRINSIC HAND MUSCLE which prevented a full fanning out of the fingers THEN, that could've been reported as a NEUROLOGICAL SIGN but since it was not either witnessed or verified by a physician then it remains a SYMPTOM which may or may not be seen by the neurologist at some point.
Hope that's clear after all that wordy discussion! HAHA!
In conclusion:
1. Tightness and tiredness in arm felt to be weak by the patient is a SYMPTOM but it cannot be classified as nor is it an upper motor sign.
2. Locking muscle contraction between index and thumb which prevented normal ABDUCTION of the small muscles of the fingers is a SYMPTOM and NOT AN UPPER MOTOR NEURON SIGN because the phenomenon could not be captured, seen, or documented by a medical doctor or designated/qualified assistant.
All the best....I continue to stand by here in XXXXXXX if you feel it may be warranted to return for any reason.
Cheers!
This query required 46 minutes to read, analyze, and respond to on behalf of the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
You’ve answered what I have feared then doctor. I did have locking that could have been noted. I had to massage it out in order for it to relax. The fasics I have are increased and my feeling of fatigue is real. All things add up now. My inability to swallow French fries without multiple attempts and overall feeling of fatigue isn’t something that could be measured - I understand. I was choking on my food multiple times yesterday and has the feeling of some going up my nose from my throat. My swallowing feels empty and kind of hollow. The second note I sent was an add on to the first. Sorry for the confusion. I think you’ve done all you can do from here out doctor. What you explained is clear and evident and my changes physically have been very clear over the last week. I understand progression is expected to be more subtle in the case of a MND. I’m feeling like I’m declining quickly and have had some sharp pains in my legs when walking with my wife an led daughter yesterday. Very sharp cramplike feelings. As I type now, I can feel the fasics in my neck area. You are the best and I appreciate you. It’s not like a common cold where you can tell me to take and aspirin and measure my temp. So, I don’t know what else I can do aside from bother you from here which I don’t intend on doing. The muscle cramp in my hand was all I needed to see and have to rub out to know there is a change. Thank you for all you’ve done. Thank you for your patience and good will. Be well
You’ve answered what I have feared then doctor. I did have locking that could have been noted. I had to massage it out in order for it to relax. The fasics I have are increased and my feeling of fatigue is real. All things add up now. My inability to swallow French fries without multiple attempts and overall feeling of fatigue isn’t something that could be measured - I understand. I was choking on my food multiple times yesterday and has the feeling of some going up my nose from my throat. My swallowing feels empty and kind of hollow. The second note I sent was an add on to the first. Sorry for the confusion. I think you’ve done all you can do from here out doctor. What you explained is clear and evident and my changes physically have been very clear over the last week. I understand progression is expected to be more subtle in the case of a MND. I’m feeling like I’m declining quickly and have had some sharp pains in my legs when walking with my wife an led daughter yesterday. Very sharp cramplike feelings. As I type now, I can feel the fasics in my neck area. You are the best and I appreciate you. It’s not like a common cold where you can tell me to take and aspirin and measure my temp. So, I don’t know what else I can do aside from bother you from here which I don’t intend on doing. The muscle cramp in my hand was all I needed to see and have to rub out to know there is a change. Thank you for all you’ve done. Thank you for your patience and good will. Be well
Brief Answer:
Slight play on words....but remember...did the DOCTOR witness it?
Detailed Answer:
Thanks for responding and I'm sorry that what I said confirmed any "fears"....that was unintended....again, I'd like you to take a step back and see things from my perspective and acknowledge that my professional opinion is that you DO NOT HAVE upper motor neuron signs, nor LOWER MOTOR NEURON signs. Yes, you do fasciculations, clear and present....you may even have had a locking of the thumb (writer's cramp like phenomenon) but that doesn't mean that the mechanism producing these actions have to be pathologies in the upper or motor neuron lesions.
First off, since the cramping or locking up is something you witnessed then, for documentation and storytelling purposes....that REMAINS A SYMPTOM....it ain't a sign unless the DOCTOR WITNESSES....."could've" is not part of the language of what a MEDICAL SIGN is defined as in the Dorland's Illustrated Medical Dictionary. A sign is THAT WHICH IS ELICITED, WITNESSED, OR OTHERWISE, manipulated or modulated by an EXAMINING EXPERT upon a patient using STANDARD TECHNIQUES of either observation or by procedural maneuvers. Again, that is why the physical examination is always documented and conducted by a physician. We haven't gotten yet to the point where patients are allowed to WRITE THEIR OWN medical reports and turn them in to the doctor for credit! LOL!
And so, once again, all data considered and I'll even give you the locking up of the joint....no data yet moves me to make any call on you of motor neuron disease.
I am curious a bit about the cystic lesions in both the liver and kidney. If those are present from previously then, I'm not concerned further....but does your GI doc have an opinion on them at all? I know that the contrasted studies don't show any enhancement of any sort and it's a very good thing they did the contrast. Any feedback on those lesions other than what radiology said? Is the cyst in the nephrectomized kidney as a result of the surgery or an enlarged calyx? As a neurologist I plead a bit of ignorance.
Standing by here in XXXXXXX if you continue to have questions, have other needs, or till the governor calls out the National Guard to launch an offensive on a territorial grab basis so as to create more jobs and boost the state's economy.
Slight play on words....but remember...did the DOCTOR witness it?
Detailed Answer:
Thanks for responding and I'm sorry that what I said confirmed any "fears"....that was unintended....again, I'd like you to take a step back and see things from my perspective and acknowledge that my professional opinion is that you DO NOT HAVE upper motor neuron signs, nor LOWER MOTOR NEURON signs. Yes, you do fasciculations, clear and present....you may even have had a locking of the thumb (writer's cramp like phenomenon) but that doesn't mean that the mechanism producing these actions have to be pathologies in the upper or motor neuron lesions.
First off, since the cramping or locking up is something you witnessed then, for documentation and storytelling purposes....that REMAINS A SYMPTOM....it ain't a sign unless the DOCTOR WITNESSES....."could've" is not part of the language of what a MEDICAL SIGN is defined as in the Dorland's Illustrated Medical Dictionary. A sign is THAT WHICH IS ELICITED, WITNESSED, OR OTHERWISE, manipulated or modulated by an EXAMINING EXPERT upon a patient using STANDARD TECHNIQUES of either observation or by procedural maneuvers. Again, that is why the physical examination is always documented and conducted by a physician. We haven't gotten yet to the point where patients are allowed to WRITE THEIR OWN medical reports and turn them in to the doctor for credit! LOL!
And so, once again, all data considered and I'll even give you the locking up of the joint....no data yet moves me to make any call on you of motor neuron disease.
I am curious a bit about the cystic lesions in both the liver and kidney. If those are present from previously then, I'm not concerned further....but does your GI doc have an opinion on them at all? I know that the contrasted studies don't show any enhancement of any sort and it's a very good thing they did the contrast. Any feedback on those lesions other than what radiology said? Is the cyst in the nephrectomized kidney as a result of the surgery or an enlarged calyx? As a neurologist I plead a bit of ignorance.
Standing by here in XXXXXXX if you continue to have questions, have other needs, or till the governor calls out the National Guard to launch an offensive on a territorial grab basis so as to create more jobs and boost the state's economy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Slight play on words....but remember...did the DOCTOR witness it?
Detailed Answer:
Thanks for responding and I'm sorry that what I said confirmed any "fears"....that was unintended....again, I'd like you to take a step back and see things from my perspective and acknowledge that my professional opinion is that you DO NOT HAVE upper motor neuron signs, nor LOWER MOTOR NEURON signs. Yes, you do fasciculations, clear and present....you may even have had a locking of the thumb (writer's cramp like phenomenon) but that doesn't mean that the mechanism producing these actions have to be pathologies in the upper or motor neuron lesions.
First off, since the cramping or locking up is something you witnessed then, for documentation and storytelling purposes....that REMAINS A SYMPTOM....it ain't a sign unless the DOCTOR WITNESSES....."could've" is not part of the language of what a MEDICAL SIGN is defined as in the Dorland's Illustrated Medical Dictionary. A sign is THAT WHICH IS ELICITED, WITNESSED, OR OTHERWISE, manipulated or modulated by an EXAMINING EXPERT upon a patient using STANDARD TECHNIQUES of either observation or by procedural maneuvers. Again, that is why the physical examination is always documented and conducted by a physician. We haven't gotten yet to the point where patients are allowed to WRITE THEIR OWN medical reports and turn them in to the doctor for credit! LOL!
And so, once again, all data considered and I'll even give you the locking up of the joint....no data yet moves me to make any call on you of motor neuron disease.
I am curious a bit about the cystic lesions in both the liver and kidney. If those are present from previously then, I'm not concerned further....but does your GI doc have an opinion on them at all? I know that the contrasted studies don't show any enhancement of any sort and it's a very good thing they did the contrast. Any feedback on those lesions other than what radiology said? Is the cyst in the nephrectomized kidney as a result of the surgery or an enlarged calyx? As a neurologist I plead a bit of ignorance.
Standing by here in XXXXXXX if you continue to have questions, have other needs, or till the governor calls out the National Guard to launch an offensive on a territorial grab basis so as to create more jobs and boost the state's economy.
Slight play on words....but remember...did the DOCTOR witness it?
Detailed Answer:
Thanks for responding and I'm sorry that what I said confirmed any "fears"....that was unintended....again, I'd like you to take a step back and see things from my perspective and acknowledge that my professional opinion is that you DO NOT HAVE upper motor neuron signs, nor LOWER MOTOR NEURON signs. Yes, you do fasciculations, clear and present....you may even have had a locking of the thumb (writer's cramp like phenomenon) but that doesn't mean that the mechanism producing these actions have to be pathologies in the upper or motor neuron lesions.
First off, since the cramping or locking up is something you witnessed then, for documentation and storytelling purposes....that REMAINS A SYMPTOM....it ain't a sign unless the DOCTOR WITNESSES....."could've" is not part of the language of what a MEDICAL SIGN is defined as in the Dorland's Illustrated Medical Dictionary. A sign is THAT WHICH IS ELICITED, WITNESSED, OR OTHERWISE, manipulated or modulated by an EXAMINING EXPERT upon a patient using STANDARD TECHNIQUES of either observation or by procedural maneuvers. Again, that is why the physical examination is always documented and conducted by a physician. We haven't gotten yet to the point where patients are allowed to WRITE THEIR OWN medical reports and turn them in to the doctor for credit! LOL!
And so, once again, all data considered and I'll even give you the locking up of the joint....no data yet moves me to make any call on you of motor neuron disease.
I am curious a bit about the cystic lesions in both the liver and kidney. If those are present from previously then, I'm not concerned further....but does your GI doc have an opinion on them at all? I know that the contrasted studies don't show any enhancement of any sort and it's a very good thing they did the contrast. Any feedback on those lesions other than what radiology said? Is the cyst in the nephrectomized kidney as a result of the surgery or an enlarged calyx? As a neurologist I plead a bit of ignorance.
Standing by here in XXXXXXX if you continue to have questions, have other needs, or till the governor calls out the National Guard to launch an offensive on a territorial grab basis so as to create more jobs and boost the state's economy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had a follow up mri on both the liver and kidney last year. The liver findings have been there since 2015 or before the kidney cyst was spotted last year.
Last night I was awaken by profuse sweating and abdominal cramps that I felt the need to nearly call an ambulance. It was on the front of my rib case and I felt like vomiting. Earlier, I had a sizable amount of blood in my stool, likely from straining. I have been constipated for about three weeks with hardened stools. I likely tore skin in side or agrivated and vein. The blood was lighter in color, so it was likely from the rectum area. Today, again, I felt the food and water going upward into my sinus area when eating and drinking.
My hand that I’ve mentioned showing weakness has fasciculations on the rear above the wrist after any strenuous movement, like picking up a gallon container. This is just not normal. I don’t understand it and I take it as a weakened muscle trying to recruit more surrounding muscle to respond around it. Make any sense? As in the firing of a nerve? The first time I noticed this was about four weeks ago. Now it does it with lesser weight. Even a squeezing together of fingers caused it to fasciculate for a few minutes on and off today. I was looking to set up a video chat with you today, but the other format doesn’t appear to have the option - only messaging. I feel we could accomplish more there.
Last night I was awaken by profuse sweating and abdominal cramps that I felt the need to nearly call an ambulance. It was on the front of my rib case and I felt like vomiting. Earlier, I had a sizable amount of blood in my stool, likely from straining. I have been constipated for about three weeks with hardened stools. I likely tore skin in side or agrivated and vein. The blood was lighter in color, so it was likely from the rectum area. Today, again, I felt the food and water going upward into my sinus area when eating and drinking.
My hand that I’ve mentioned showing weakness has fasciculations on the rear above the wrist after any strenuous movement, like picking up a gallon container. This is just not normal. I don’t understand it and I take it as a weakened muscle trying to recruit more surrounding muscle to respond around it. Make any sense? As in the firing of a nerve? The first time I noticed this was about four weeks ago. Now it does it with lesser weight. Even a squeezing together of fingers caused it to fasciculate for a few minutes on and off today. I was looking to set up a video chat with you today, but the other format doesn’t appear to have the option - only messaging. I feel we could accomplish more there.
I had a follow up mri on both the liver and kidney last year. The liver findings have been there since 2015 or before the kidney cyst was spotted last year.
Last night I was awaken by profuse sweating and abdominal cramps that I felt the need to nearly call an ambulance. It was on the front of my rib case and I felt like vomiting. Earlier, I had a sizable amount of blood in my stool, likely from straining. I have been constipated for about three weeks with hardened stools. I likely tore skin in side or agrivated and vein. The blood was lighter in color, so it was likely from the rectum area. Today, again, I felt the food and water going upward into my sinus area when eating and drinking.
My hand that I’ve mentioned showing weakness has fasciculations on the rear above the wrist after any strenuous movement, like picking up a gallon container. This is just not normal. I don’t understand it and I take it as a weakened muscle trying to recruit more surrounding muscle to respond around it. Make any sense? As in the firing of a nerve? The first time I noticed this was about four weeks ago. Now it does it with lesser weight. Even a squeezing together of fingers caused it to fasciculate for a few minutes on and off today. I was looking to set up a video chat with you today, but the other format doesn’t appear to have the option - only messaging. I feel we could accomplish more there.
Last night I was awaken by profuse sweating and abdominal cramps that I felt the need to nearly call an ambulance. It was on the front of my rib case and I felt like vomiting. Earlier, I had a sizable amount of blood in my stool, likely from straining. I have been constipated for about three weeks with hardened stools. I likely tore skin in side or agrivated and vein. The blood was lighter in color, so it was likely from the rectum area. Today, again, I felt the food and water going upward into my sinus area when eating and drinking.
My hand that I’ve mentioned showing weakness has fasciculations on the rear above the wrist after any strenuous movement, like picking up a gallon container. This is just not normal. I don’t understand it and I take it as a weakened muscle trying to recruit more surrounding muscle to respond around it. Make any sense? As in the firing of a nerve? The first time I noticed this was about four weeks ago. Now it does it with lesser weight. Even a squeezing together of fingers caused it to fasciculate for a few minutes on and off today. I was looking to set up a video chat with you today, but the other format doesn’t appear to have the option - only messaging. I feel we could accomplish more there.
I found this article when searching about how my fasics are more synchronized than random twitching from BFS - especially in my shoulder and arm area. Now with the feeling of fatigue and my difficulty swallowing, and (non witnessed) tightness, I’m really pray for anything but mnd.
https://www.researchgate.net/publication/0000_Fasciculation_in_amyotrophic_lateral_sclerosis_Origin_and_pathophysiological_relevance
I’m not trying to teach the doctor, I’m trying to communicate my concerns from 600 miles away. I am also able to stimulate fasics my stressing the muscle group with lifting an object (behind my wrist area).
https://www.researchgate.net/publication/0000_Fasciculation_in_amyotrophic_lateral_sclerosis_Origin_and_pathophysiological_relevance
I’m not trying to teach the doctor, I’m trying to communicate my concerns from 600 miles away. I am also able to stimulate fasics my stressing the muscle group with lifting an object (behind my wrist area).
I found this article when searching about how my fasics are more synchronized than random twitching from BFS - especially in my shoulder and arm area. Now with the feeling of fatigue and my difficulty swallowing, and (non witnessed) tightness, I’m really pray for anything but mnd.
https://www.researchgate.net/publication/0000_Fasciculation_in_amyotrophic_lateral_sclerosis_Origin_and_pathophysiological_relevance
I’m not trying to teach the doctor, I’m trying to communicate my concerns from 600 miles away. I am also able to stimulate fasics my stressing the muscle group with lifting an object (behind my wrist area).
https://www.researchgate.net/publication/0000_Fasciculation_in_amyotrophic_lateral_sclerosis_Origin_and_pathophysiological_relevance
I’m not trying to teach the doctor, I’m trying to communicate my concerns from 600 miles away. I am also able to stimulate fasics my stressing the muscle group with lifting an object (behind my wrist area).
Brief Answer:
Additional details reviewed along with Researchgate publication
Detailed Answer:
Thank you once again for your input and I'm very sorry you had a bout of profuse sweating and abdominal cramping which was threatening enough that you were considering an ambulance ride. I'm not sure what to make of those symptoms. I think I might have opined in my previous response that I felt your bleeding episodes were due to hemorrhoidal concerns. I also have noted your report of pharyngonasal penetration of food and water while eating or drinking which clearly was not an issue at the time I examined you.
Consequently, I don't have an adequate explanation to give you for those symptoms except to once again reiterate that for me to be in a better position to comment on things that are occurring I would need to either update my examination done 2 months ago in XXXXXXX OR IN THE ALTERNATIVE review the findings and report of the most recent NEUROLOGICAL EXAMINATION conducted by a neurologist. I would also highly recommend a SWALLOWING EVALUATION be performed and to consider those results in the context of other events that are being referred by the patient.
I also read with great interest and thank you for helping me make that article a part of my resource library. It has a lot of really fine information in it that is important in helping understand some of the pathophysiology of fasciculations when discussing benign vs. malignant sorts of syndromes. BTW, the word "malignant" in this usage does not imply cancer of any sort...just making sure there are no misunderstandings..... I'm wondering if you may have read page 5 of that article where it talks about a syndrome called CRAMP-FASCICULATION syndrome which I had forgotten to mention to you may explain fascics and cramps you've experiencing in your forearm for example.
I must raise some exception to some things that the author raised in terms of the timing of fasciculations with respect to when ALS is first noticed or first presents in most patients. I will have the read the article through again and think about things before saying much more...but I think their treatment of CRAMP-FASCICULATION Syndrome (CFS) is germane to your case...don't know if that exactly explains EVERYTHING that's going on....but it works for at least some of your symptoms.
Feel free to direct my attention by sending a link or uploading an article in PDF format to any other articles you feel may be helpful to your case.
This query required 148 minutes to read, analyze, and respond to on behalf of the patient.
Additional details reviewed along with Researchgate publication
Detailed Answer:
Thank you once again for your input and I'm very sorry you had a bout of profuse sweating and abdominal cramping which was threatening enough that you were considering an ambulance ride. I'm not sure what to make of those symptoms. I think I might have opined in my previous response that I felt your bleeding episodes were due to hemorrhoidal concerns. I also have noted your report of pharyngonasal penetration of food and water while eating or drinking which clearly was not an issue at the time I examined you.
Consequently, I don't have an adequate explanation to give you for those symptoms except to once again reiterate that for me to be in a better position to comment on things that are occurring I would need to either update my examination done 2 months ago in XXXXXXX OR IN THE ALTERNATIVE review the findings and report of the most recent NEUROLOGICAL EXAMINATION conducted by a neurologist. I would also highly recommend a SWALLOWING EVALUATION be performed and to consider those results in the context of other events that are being referred by the patient.
I also read with great interest and thank you for helping me make that article a part of my resource library. It has a lot of really fine information in it that is important in helping understand some of the pathophysiology of fasciculations when discussing benign vs. malignant sorts of syndromes. BTW, the word "malignant" in this usage does not imply cancer of any sort...just making sure there are no misunderstandings..... I'm wondering if you may have read page 5 of that article where it talks about a syndrome called CRAMP-FASCICULATION syndrome which I had forgotten to mention to you may explain fascics and cramps you've experiencing in your forearm for example.
I must raise some exception to some things that the author raised in terms of the timing of fasciculations with respect to when ALS is first noticed or first presents in most patients. I will have the read the article through again and think about things before saying much more...but I think their treatment of CRAMP-FASCICULATION Syndrome (CFS) is germane to your case...don't know if that exactly explains EVERYTHING that's going on....but it works for at least some of your symptoms.
Feel free to direct my attention by sending a link or uploading an article in PDF format to any other articles you feel may be helpful to your case.
This query required 148 minutes to read, analyze, and respond to on behalf of the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Additional details reviewed along with Researchgate publication
Detailed Answer:
Thank you once again for your input and I'm very sorry you had a bout of profuse sweating and abdominal cramping which was threatening enough that you were considering an ambulance ride. I'm not sure what to make of those symptoms. I think I might have opined in my previous response that I felt your bleeding episodes were due to hemorrhoidal concerns. I also have noted your report of pharyngonasal penetration of food and water while eating or drinking which clearly was not an issue at the time I examined you.
Consequently, I don't have an adequate explanation to give you for those symptoms except to once again reiterate that for me to be in a better position to comment on things that are occurring I would need to either update my examination done 2 months ago in XXXXXXX OR IN THE ALTERNATIVE review the findings and report of the most recent NEUROLOGICAL EXAMINATION conducted by a neurologist. I would also highly recommend a SWALLOWING EVALUATION be performed and to consider those results in the context of other events that are being referred by the patient.
I also read with great interest and thank you for helping me make that article a part of my resource library. It has a lot of really fine information in it that is important in helping understand some of the pathophysiology of fasciculations when discussing benign vs. malignant sorts of syndromes. BTW, the word "malignant" in this usage does not imply cancer of any sort...just making sure there are no misunderstandings..... I'm wondering if you may have read page 5 of that article where it talks about a syndrome called CRAMP-FASCICULATION syndrome which I had forgotten to mention to you may explain fascics and cramps you've experiencing in your forearm for example.
I must raise some exception to some things that the author raised in terms of the timing of fasciculations with respect to when ALS is first noticed or first presents in most patients. I will have the read the article through again and think about things before saying much more...but I think their treatment of CRAMP-FASCICULATION Syndrome (CFS) is germane to your case...don't know if that exactly explains EVERYTHING that's going on....but it works for at least some of your symptoms.
Feel free to direct my attention by sending a link or uploading an article in PDF format to any other articles you feel may be helpful to your case.
This query required 148 minutes to read, analyze, and respond to on behalf of the patient.
Additional details reviewed along with Researchgate publication
Detailed Answer:
Thank you once again for your input and I'm very sorry you had a bout of profuse sweating and abdominal cramping which was threatening enough that you were considering an ambulance ride. I'm not sure what to make of those symptoms. I think I might have opined in my previous response that I felt your bleeding episodes were due to hemorrhoidal concerns. I also have noted your report of pharyngonasal penetration of food and water while eating or drinking which clearly was not an issue at the time I examined you.
Consequently, I don't have an adequate explanation to give you for those symptoms except to once again reiterate that for me to be in a better position to comment on things that are occurring I would need to either update my examination done 2 months ago in XXXXXXX OR IN THE ALTERNATIVE review the findings and report of the most recent NEUROLOGICAL EXAMINATION conducted by a neurologist. I would also highly recommend a SWALLOWING EVALUATION be performed and to consider those results in the context of other events that are being referred by the patient.
I also read with great interest and thank you for helping me make that article a part of my resource library. It has a lot of really fine information in it that is important in helping understand some of the pathophysiology of fasciculations when discussing benign vs. malignant sorts of syndromes. BTW, the word "malignant" in this usage does not imply cancer of any sort...just making sure there are no misunderstandings..... I'm wondering if you may have read page 5 of that article where it talks about a syndrome called CRAMP-FASCICULATION syndrome which I had forgotten to mention to you may explain fascics and cramps you've experiencing in your forearm for example.
I must raise some exception to some things that the author raised in terms of the timing of fasciculations with respect to when ALS is first noticed or first presents in most patients. I will have the read the article through again and think about things before saying much more...but I think their treatment of CRAMP-FASCICULATION Syndrome (CFS) is germane to your case...don't know if that exactly explains EVERYTHING that's going on....but it works for at least some of your symptoms.
Feel free to direct my attention by sending a link or uploading an article in PDF format to any other articles you feel may be helpful to your case.
This query required 148 minutes to read, analyze, and respond to on behalf of the patient.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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