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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Exp 50 years

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What causes numbness and twitching in bicep muscle of a young adult?

Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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Posted on Mon, 22 Aug 2016 in Brain and Spine
Question: Hi

I am concerned about my son who is in his early twenties and has just been referred to a neurologist for loss of power in his bicep muscle which is twitching. He plays a lot of sport at a high level including football and golf, he also does a lot of weight training and noticed that he has went from benching 80kgs to 65kgs. He recently went to osteopath and he wouldn't work on him and said that he was scared to make things worse and that he should go to a doctor. In addition to this he has had about 6 episodes of loss of his peripheral vision, he went to the doctors again who said they think it is a retinal migraine and doesn't think it is linked to the muscle twitching. The other day he has blood tests taken from him to check his calcium levels , B12 levels , vitamin D levels and is seeing an optician tomorrow.
My son also was in hospital about 8 - 10 weeks ago with gastritis and has a bad tummy but on holiday so has lost a lot of weight too.
Initially I wasn't worried about this as I thought it would be a trapped nerve on his bicep until I went on-line and was extremely worried by what is was saying it could be. Since reading the on-line information I have been in a state of terrible anxiety for 5 days. Please help and provide a logical answer to this.

Very worried mum
doctor
Answered by Dr. Dariush Saghafi 10 hours later
Brief Answer:
So sorry that there are additional issues. Let's look at them, shall we?

Detailed Answer:
Thanks so much for sending your questions to me. I'm very sorry that things weren't quite as straight forward as they seemed.... The same thing is happening on this side of the pond when it comes to trying to figure out to prevent either Trump or Hilary from getting to the White House! Not as straight forward an answer as one may initially think!

Now, is it just ONE biceps that seems to be weakened or is it both as this makes a bit of a difference to one's thinking as to what could be going on. Perhaps, you can clarify for me if an OSTEOPATH in XXXXXXX is the same as it is here....because in the States the osteopathic doctor has the medical title of Dr. as well and his credentials are D.O. as opposed to the traditional M.D. But, he is clearly a DOCTOR OF MEDICINE with all the rights, privileges, and standards of excellence for the practice of medicine as an MD.....but perhaps over there the osteopath is a different sort of professional?

You are correct in stating that a reduction of weight lifting potential from 85 Kg to 65 is significant. You say that he's had 6 losses of vision of his peripheral vision. Do you mean that he suddenly loses what he sees on ONE SIDE of his body or the other? Or do you mean he can't see properly to the OUTSIDE OF BOTH SIDES of his body at the same time....OR do you mean he is complaining of seeing what he describes as a CURTAIN COMING DOWN over his vision...or that he vision grays out or becomes fuzzy over a period of several minutes and then, just as suddencly comes back? Could you give me a bit more information?

Has he gotten any laboratory or imaging studies done of the head to this point? Retinal migraine would be fine if he were seeing a lot of sparkling, flashing dots that typically would start in the PERIPHERY of his vision and then, over a period of seconds or minutes distribute over his entire visual field followed by NO HEADACHE or other funny symptoms for the duration?

I would encourage:

1. Lab work to include BLOOD with measurements taken of:

a. FT4, TSH, ELECTROLYTES (full panel), ESR, CRP, fibrinogen, d-dimer, fibrin split products, PTT, PT, Hemoglobin, Hematocrit, CBC with blood count, urinalysis, toxicology screen (I realize you promised that he is good lad....but checking for substances has nothing to do with not KNOWING that he is a good lad...it's just to be sure he doesn't have certain toxic chemicals in his system that could cause some of what you're describing.

Why not also share with me what from the internet is particularly burdening you and let me see if I can disspell a few of the scarier thoughts you've run across....although truth be told my dear lady.....we CANNOT know anything PERFECTLY about his situation until we can know that he's been thoroughly reviewed and worked up by a neurologist and has probably had IMAGING STUDIES of the head such as an MRI and MRA of the brain and neck with gadolinium contrast.

For the gastritis problem....he was IN THE HOSPITAL for 8-10 weeks? Really? That strikes me a bit as odd for such as relatively uncomplicated problem. Did they do an endoscopy to verify the diagnosis or a barium swallow, or how exactly did they make that diagnosis? That part of the story sounds a bit gray to me.

I'll let you respond back with some information so I have a bit more information. Has he lost weight? If so, how much and how does he "look" to you? Any discoloration in the skin, a tinge of yellowing, or anything?

Take some deep breaths mum....and let's look at some more facts in the case and leave a bit of the worry at the front door for right now.... ;)

This query has utilized a total of 40 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 17 hours later
Dear doctor

What I an terrified of and out of my mind with worry is ALS / MND. I have t ate/ slept or drank since I came across this on the Internet.

To clarify a few points.

Loss of vision- is mainly of the outside of his views. He doesn't see stars or anything. He has just came back from the Optician and they haven't found anything wrong with his eyes. Blood flow is good. he had a big came yesterday and was well hydrated so his vision was fine yesterday.

Osteopath, not a medical doctor he, but my son advised that he thinks it is a deep trapped nerve and that is why he is scared he will make it worse. That gave me a slight comfort.

Hospital he was only in for 2 days with Gastrits but no scope was done. He has lost weight since then and a bad tummy bug,.


,I believe he has noticed both arms being weaker but feels this is due to the right arm being weak and that the left will responds to weight training.

He is due to get the results of the blood test this week.

Can you give me anything that will help me to not be in such a state of panic. He is still really fit , cardio wise and the whites of his eyes are pure white,s

Worried sick mum
doctor
Answered by Dr. Dariush Saghafi 13 hours later
Brief Answer:
So sorry that you're worrying yourself once again

Detailed Answer:
I must remain firm in my advice to avoid the use of the internet to look up isolated symptoms of your son without taking into context the clinical situation....I would trust in his doctors who I believe are likely very sensitive to the possibly of things such as MND and especially ALS....just about all physicians (in my opinions) are very up on making the right calls with respect to those types of disorders and missing it...especially if he's seen a neurologist by now....is something I would consider highly unlikely.

Of course, you must know that my diagnosis of your son is a far cry from what most people in general would consider OPTIMAL in order to make judgements regarding this sort of thing.....one really should be HANDS ON with the patient....or at least have access to medical notes by either his primary doctor who examined him or the neurologist to see how they describe his functioning and the examination findings.

Here are a couple of good reasons to think that ALS is NOT the diagnosis:

1. Age is far too young.....most cases of ALS begin after age 55 and more commonly after age 65...and more in the 70's when you just look at the cross section of most PREVALENT age group.

2. Symptoms TYPICALLY began in the legs and work themselves up toward the upper torso AND then, the UPPER EXTREMITIES.

3. Visual symptoms have nothing to do with the symptoms you're describing of upper extremity weakness.


ALS is an exceedingly rare....and even a MEDICALLY REPORTABLE/REMARKABLE condition if it were to be found in a 24 year old person.....not impossible.....but definitely NOT at the top of my chief possibilities.

Do feel free to breathe some breaths of relief.....and once again, I strongly urge you to follow my recommendation of avoiding the temptation of becoming an Internet Diagnostician since I can think of very few diseases I've ever met that are so perfectly fitted into a person's body that they are literally defined by what is stated in either a list of symptoms or somebody else's description on a telemedicine network, etc.

I believe that your son's chances of motor neuron disease are exceedingly low.

Cheers!

If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 56 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 2 hours later
Dear Doctor

Thanks for coming back to me and I am slowing starting to breathe again.

A further update - all the blood tests have come back ok and our own doctor is pushing to get an appointment with the Neurologist fast tracked. I did notice that when he was sleeping the fasiculations were not happening, only seems to be when he is awake. If he flexes his arm they seem to stop too.

The fasiculations are worse when his arm is extended, giving him shooting pains when he is trying to do a press up and hold his body.

There is clearly something wrong with his right arm, but not Please not ALS.
doctor
Answered by Dr. Dariush Saghafi 13 hours later
Brief Answer:
Glad you're letting the air IN and OUT....IN and OUT..... ;)

Detailed Answer:
My dearest worried mum....let's wait and see what the neurologist thinks of the problem but I must continue to remind you that your son's picture is in no way consistent with motor neuron disease.

He could have a condition known as BENIGN FASCICULATION SYNDROME (BFS). This is not an uncommon disorder which is mostly transient but can still last for weeks or months.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 78 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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