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What causes hand tremors with severe abdominal cramps and shoulder pain?

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Posted on Thu, 7 Jan 2016
Question: Post Halloween – noticed small tremor in my right hand – immediately got nervous and started to google what it could be. During this process, I saw three potential things were (Parkinson’s, MS, ALS). Continued to google symptoms and started to get twitches on the bottom of my feet around 11/7/15.
At this point I started to become so consumed by this that it was all I could think about. Continued to google to the point I had convinced myself that I have something serious. Never really have had anxiety in the past, but I feel like I have tons of anxiety and stress due to this issue. During the day, I do not have thoughts of anxiety, but think that this is what it could feel like.
My wife made an 11/23/15 appointment for me at a GP to get the tremor checked out and outside of having high blood pressure – he said it was a VERY small tremor and did not really seem too concerned about it. I had an overall physical and got magnesium, potassium and electrolytes levels checked – all came back normal. During this, I received Flu shot, Pertussis shot, and tetanus shot. Can’t remember what shots were in which arm, but I have had thoughts maybe this is what is causing some of the soreness I am experiencing on my right side, shoulder/back/leg etc..
I stopped thinking about problems that day, but eventually continued to google ALS because twitches did not stop and saw more and more things that people had at the beginning of their disease around the twitches. Twitches got worse as I started to google more and more and twitches have been pretty steady on the soles of my foot, but recently have been randomly in calves, leg, eyes, shoulder.
It was almost like I would see some had something and I would start to feel that. If someone had a cramp at the start of ALS all of a sudden I had cramps in my legs. If they had sore muscles, I had sore muscles. If they had a stomach cramp, I had a stomach cramp (stomach has been upset for about 2 weeks now).
It has now been about 2 weeks (date is 12/15/15) and I have had upset/crampy/yucky stomach (feel like this is ALS) muscles on right side of body seem sore, especially my calf, shoulder, arm upper back. Arm/shoulder pain has come and gone for the two weeks. Sometimes it is fine, most times it is there. Today has been significantly worse. Sore back, constantly worried, stomach pain, etc.
Also, I have always been a runner, but have recently gotten more into lifting weights – right around the time that the tremor started as I just finished a long race and wanted to start a new workout routine. I am now constantly trying to test my muscles to see if I can do things, thinking if I can lift my leg, or grab something that is a good sign, but I think it may just be making my muscles more sore. Lifting has become something I do to ensure I still have strength. Running seems to make my legs MORE sore now, even if I only do three or four miles and now, for some reason my hamstrings hurt after runs.
I do feel like the grip on my right hand is much weaker than my left and am constantly thinking I am going to drop something or it is just going to stop working. I find it really weird that only my right side has really been affected from a muscle soreness perspective (main area of twitching has been left foot)
Overall, it has been a month and a half and I cannot stop thinking about ALS. The more I think about it, the more depressed I get, the more things seem to be going wrong with my body. I have been getting a lot less sleep, both by being worried about this, and I have a year and half old at home. I also have recently gotten sick (cold/sore throat/cough) and feel like it is due to me worrying about this. I want to find a way to stop thinking about this. I want to know what is causing all these symptoms. Is it a neuro thing?? Could it all be anxiety? Overall, I would say I am a healthy 34 yr old male, however, recently I have noticed my BP is on the high side of normal. Do I go back to GP and give him this story?
doctor
Answered by Dr. Olsi Taka (52 minutes later)
Brief Answer:
No neurological condition

Detailed Answer:
I read your description carefully and I am sorry about what you have been going through. As a neurologist I believe to be well qualified to address your concern.

Regarding ALS I would say with plenty of confidence that it is not your case. First your age is not typical at all. There are exceptions but typically it appears after the age of 45, personally in 7 and a half years in the neurology field I do not recall any patient under 35.
Even disregarding the age issue the evolution of your symptoms is not typical of ALS at all. ALS is a very insidious condition, symptoms appear first in one area, initially going often unnoticed and progressing over many months to other motor areas of the body. Your quickly evolving widespread evolution is not indicative of ALS at all.
Among other conditions you have been worried....the same reasoning applies to Parkinsons, appear usually much later in life, slow progression over years, and while it involves tremor does not involve twitching.
MS is a condition which can typically appear at your age, but neither tremor nor twitching are typical initial manifestations of the condition.

In my opinion looking also at the influence that reading information has on your manifestations and the stress and anxiety it is most probable you have developed health anxiety. You should try relaxation techniques, outdoors physical activity (light intensity), activities like yoga which helps relaxation. Avoid caffeine or other stimulants, try regular sleeping hours. Only if these measures fail perhaps you should consult your GP again to try perhaps some anti-anxiety medication for a time.
Looking at the tests you have had I would like to add thyroid function tests to the ones you have already done, high thyroid function can manifest with tremor and anxiety.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka (1 hour later)
Thank you very much Dr. Taka. This is quite reassuring. in addition to the soreness on my right side, it has seemed today that my shoulder muscle and bicep have been extremely tight/sore. Is this something that could be explained by anxiety?

Also, it seems as though there is a vein bulging in my right arm (not noticeable on my left) and I get worried about atrophy (another initial symptom of ALS as I have read) as I feel like this muscle looks smaller than my left arm. Now, I did not notice this in the past or even have looked at it prior to these episodes, so I am sure I may be just reading into more of what I researched on-line, but is it possible for atrophy to happen even if the muscle does not seem to be getting weaker, and is this a reason it may be sore as compared to my left side?

I also do hold my kids on my right side which may be causing more soreness or pain.
Thanks
doctor
Answered by Dr. Olsi Taka (19 minutes later)
Brief Answer:
Read below

Detailed Answer:
Thank you for the feedback.

As to whether the additional symptoms can be explained by anxiety, yes, anxiety can mimic any symptom of any disease.

Of course that doesn't mean that I dismiss every complaint my patients have as anxiety, but since your GP hasn't found any abnormality during his visit, laboratory check-up was fine and your awareness of anxiety and influence reading information has on your symptoms makes me think the combination indicates anxiety. Also the combination of your symptoms and their quick evolution doesn't fit. While you are seemingly alarmed by the quick progression, I am actually relieved from the ALS worry as it is very slow evolving.

As for the relation of atrophy and weakness, because weakness evolves slowly and is difficult to quantify, it may go unnoticed and atrophy be noticed first, however some degree of weakness is there (think about it, you can't lose muscle cells - atrophy and preserve the same strength). So while I can't examine you physically when I read about you lifting weights I really doubt there being atrophy, should be some weakness, might have enough strength for simple actions (holding a spoon, writing etc) and not notice, but not lift weights or hold your kids. So my opinion on ALS remains the same.

If I may add something I would add creatine kinase to the thyroid function tests I mentioned. It is a pretty routine test, perhaps you've already had it, it checks the level of an enzyme which raise would accompany muscle conditions like for example myositis (not ALS). Again I doubt it should have more weakness, but since it's a simple cheap test can make sure.

I hope to have been of help.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka (14 hours later)
Thank you again. I just have a couple more follow ups. I think my biggest concern has been the stiffness/pain in my right calf that has also come and gone from my hamstring. It has been there for the better part of two weeks and has gone away, but seems to be somewhat constant. This morning when I woke up, my left calf was sore as well. I know this could be from dehydration, but I have not have this in the past. The pain in my side/stomach is concerning as well. For the most part that has been pretty constant for a week and mainly focused on the right.

Finally - the thing that really started my search/panic was the twitching. Again, it was mainly focused in my feet, but has recently moved to other parts of my body (most times only for brief periods of time) and last night/this morning it seemed to be quite a lot in my calves. Just is concerning overall. I have read about BFS, is this something that could cause the twitches and muscle soreness? I always seem to go back to ALS, however I do know that is very rare.

I appreciate any follow up and thank you for helping me start to put my mind at ease a bit.
doctor
Answered by Dr. Olsi Taka (4 hours later)
Brief Answer:
Read below.

Detailed Answer:
Hello again!

I am sorry that you are still worried. I understand that you do not feel well, that is why I suggested those extra tests I mentioned for muscle involving conditions to explain those aches and cramps you describe. If those tests still are not enough for you an EMG would be one last exam to have to ease your worry.

However I do not see why you are stuck with ALS. I understand that Dr Google has its downsides but if you insist on using it try not to look only at the names of the symptoms you are interested in. When you read those sources try to look at age, at the fact that progression doesn't move to other parts of the body this quickly, that it has no relation ship whatsoever with stomach pain. In medicine one has to look at things as a whole, otherwise one would end up thinking of every headache as a tumor, every cough as lung cancer and so on. In your case as I mentioned before nothing suggests ALS.

Yes BFS (benign fasciculation syndrome) is something which would explain your symptoms. It is not so much a condition in itself BFS, just a name to encompass fasciculations when all tests reveal no particular cause, often thought to be influenced by stress and anxiety which we already discussed to be your case.

I hope you will feel better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka (4 hours later)
Thank you very much. I appreciate the feedback and assistance and expertise. The only reason I think I was concerned about ALS is because I had read post/posts that the start of the disease was somewhat like the symptoms I am feeling (soreness in muscles/twitches/cramps) and it would then eventually evolve to starting to affect total muscle control in one limb and move from there.

Any thoughts on this?
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Read below.

Detailed Answer:
I have nothing to object to what you state there. Twitches and cramps can surely be symptoms present in ALS patients. But as you confirm yourself start usually in a limb on only one side and then spread from there, a process which is a very gradual one, over the course of many months.
It happens in a very insidious way, actually often patients haven't even noticed fasciculations (twitches) and it is only when you specifically ask that they think of that.

So as I said information is considered as a whole, your quick evolution and spreading speaks firmly against ALS (along with other already mentioned factors such as age, influencability by reading and distress, stomach pain).

Wishing you good health.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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What causes hand tremors with severe abdominal cramps and shoulder pain?

Brief Answer: No neurological condition Detailed Answer: I read your description carefully and I am sorry about what you have been going through. As a neurologist I believe to be well qualified to address your concern. Regarding ALS I would say with plenty of confidence that it is not your case. First your age is not typical at all. There are exceptions but typically it appears after the age of 45, personally in 7 and a half years in the neurology field I do not recall any patient under 35. Even disregarding the age issue the evolution of your symptoms is not typical of ALS at all. ALS is a very insidious condition, symptoms appear first in one area, initially going often unnoticed and progressing over many months to other motor areas of the body. Your quickly evolving widespread evolution is not indicative of ALS at all. Among other conditions you have been worried....the same reasoning applies to Parkinsons, appear usually much later in life, slow progression over years, and while it involves tremor does not involve twitching. MS is a condition which can typically appear at your age, but neither tremor nor twitching are typical initial manifestations of the condition. In my opinion looking also at the influence that reading information has on your manifestations and the stress and anxiety it is most probable you have developed health anxiety. You should try relaxation techniques, outdoors physical activity (light intensity), activities like yoga which helps relaxation. Avoid caffeine or other stimulants, try regular sleeping hours. Only if these measures fail perhaps you should consult your GP again to try perhaps some anti-anxiety medication for a time. Looking at the tests you have had I would like to add thyroid function tests to the ones you have already done, high thyroid function can manifest with tremor and anxiety. I remain at your disposal for other questions.