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Dr. Andrew Rynne

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What causes muscle weakness in legs and arms?

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Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4361 Questions

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Posted on Mon, 27 Oct 2014 in Medicines and Side Effects
Question: Hi Dr. XXXXXXX
A few months ago I asked for you consultation on some symptoms I was experiencing. I was experiencing muscle weakness in legs and arms on right side with spasticity in my fingers and toes..on my left side radiating heat and burning pain. I am still experiencing these sporadic episodes 6 months later and still have not been able to get any clear answers from my doctors. I saw a neurologist who diagnosed me with MS based on my symptoms but both MRI on my brain and spinal cord were normal so it is inconclusive. He has no other answers.. I have been tested for HLTV-1 which was negative. 2 years ago I was diagnosed with breast cancer in my right breast, had a lumpectomy, chemo and radiation. the caner was localized to the breast only..I am currently taking tamoxifen 20mg daily..the episodes lasts for about 1 minute in duration with intense burning pain..my right leg goes limp and weak and my fingers are stiffed in a weird position. I get weird sensations throughout my body at times and have general weakness if you could provide some direction or your opinion I would appreciate it. My doctors says that they not seen two different set of symptoms ocuring at the same time on both sides of the body..so it is very puzzling to them...thank you
doctor
Answered by Dr. Rakesh Madhyastha 4 hours later
Brief Answer:
Need more info

Detailed Answer:
Hello

Thanks for the query

It is good that MRI brain and spine was normal. Normal MRI and spine should typically rule out MS. However I would like a few specific answers in order to understand and help you

1. When you say 'weakness'. Does it mean you have loss of power in the limb or easy fatigueablity ?
2. How long does the spasticity of the fingers last? What do you do to make it go away?
3. Is there any change in sensation of the affected limb? Like for example change in the sensation of clothes over the area, a different feeling over the limb while taking a shower ,etc


Please get back to me, I might take about 3-5 hours to reply as its a busy day at the hospital

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha 19 hours later
Hi Dr. XXXXXXX

Thanks for your quick reply I can appreciate that you would need more details.. to answer your questions..
1. weakness meaning sensation of weakness a jelly like feeling in arms and legs but no actual loss of power, I can still use them but I feel that if I hold up my arms they would just fall back down..( never actually happen),,just the feeling.

2.Entire episode lasts about a minute on onset..spasticity wears off within a few seconds ..I usually just have to wait until it wears off ...my fingers are so stiff they feel as if I touch them it would break. it is like a circuit effect..the weakness starts in the right toes and legs spasticity in the right fingers and then burning pain along the left side starting from the middle of my back and travel down my lower back into my thighs and legs..then within a few minutes I feel normal again.. it is worse at night when I sleep..and seems to be triggered by sudden movements or movements that requires twisting, sudden turns like swimming or skipping..

3. There is no change in sensation when clothes touches the area or while showering...

Thanks
doctor
Answered by Dr. Rakesh Madhyastha 2 hours later
Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back to me with such great detail

From the history you have given me there are three possible lesions in you.

1. The jelly like feeling you are having is arising from the nerve.
2. The spastic feeling is not from the nerve but from the muscle. The fault could be in the muscle itself or due electrolyte disturbance, mainly hypocalcemia ( reduced calicum).
Here is how you go about it

1. I would like you to approach the neurologist again and ask for nerve conduction study of the affected limb and also for a muscle biopsy. I suggest these things to be done before diagnosing you as MS
2. I would also like you to get Vit b12, calcium and Vit D levels. Reduces levels of these essential vitamins and minerals leads to similar issues.

I hope I was of help, I wish you a speedy recovery. Please get back to me if you have any doubts. My next reply to you might take 3-5 hours as I have to go do my daily rounds of the admitted ward patients now.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha 18 hours later
Hi Dr. XXXXXXX

I sense that you are a very good doctor and listens to your patients ...my doctors are making me feel like this is all in my head and it is due to stress and paranoia. I Will most certainly do as you suggested and come back to you in few weeks when I have some results... just wondering if both MRI are normal where could the lesions be ....

Thank you for not making me feel like I am crazy.

doctor
Answered by Dr. Rakesh Madhyastha 57 minutes later
Brief Answer:
Follow up

Detailed Answer:
Hello

I believe that one should make an effort to think and rule out all possibilities before coming to a conclusion of an idiopathic or a psychiatric illness

Like I said in my earlier post, the possible lesion could be
1. In the nerves
2. Muscle
3. Electrolyte disturbance

Please get back to me, I am here to help.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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