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What Is The Cause For Unsteadiness And Trembling Of Legs, Arms And Fingers?

Posted on Fri, 6 Dec 2013

Question: Hi, I am wondering what could cause my left arm/hand and fingers to feel unsteady and even tremble. I can notice it when holding an item that the left arm is unsteady and the item moves. Also, when the palm is stretched out, the fingers sometimes twitch or move from side to side, especially the finger next to the little finger. There does appear to be some pain especially when bending the fingers down tightly. I also had a left leg muscle twitching issue, which has mostly subsided. However, the left side of my body still has a sense of unsteadiness. Thanks.

Answered by Dr. Ram Choudhary (3 hours later)

Brief Answer: neurology consult and MRI brain is imperative Detailed Answer: Hi XXXXXXX Welcome to healthcare Magic! The unilateral unsteadiness, weaknesses and tremor are suggestive of a neurological disorder. It can be a problem with blood supply in part of brain, a localized infection, start of multiple sclerosis, Parkinson disease or a neuropathy. Ideally you should get examined by a local neurologist and get a brain MRI imaging and follow. Delay may affect the scope of recovery. I hope the advise would be informative and useful for you. Take Care!

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

Follow up: Dr. Ram Choudhary (1 hour later)

Thanks Dr. Choudhary. I understand there are a number of possible causes but does the joint or finger pain narrow the causes down, perhaps to a disorder related to inflammation such as MS? I have had the muscle twitching investigated with EMGs and nerve conduction studies, which appeared normal in affected muscles. Do these tests rule out neuropathy as a cause? In any case, I will try to see a neurologist. Regards.

Answered by Dr. Ram Choudhary (13 hours later)

Brief Answer: Neurologist consult and brain and spine imaging Detailed Answer: Hi Mr XXXXXXX Welcome back to health care magic. The multiple sclerosis popularly called MS is a disease does not produce pain rather it produces unsteadiness and involuntary muscle fluttering. The EMG study and nerve conduction study definitely rule out peripheral neuropathy as a cause for your problem. The local pain seems unlikely to be the cause rather it may be also an effect of the same pathology. Ideally you should get workout for any brain disorder that can be sorted out by a detailed clinical examination by a neurologist of your locality and required imaging as indicated earlier. It is good that you have already a neurologist consultation in plan. I hope the advice will be helpful for you.

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

Follow up: Dr. Ram Choudhary (4 hours later)

Thanks Dr. Choudhary, I am wondering whether it is easy to diagnose any brain-related disorders possibly related at this early stage? I understand that both MS and Parkinson's are difficult to diagnose. Are there any tests that are possibly indicated, apart from imaging? Regards.

Answered by Dr. Ram Choudhary (6 hours later)

Brief Answer: neurological exam is the fold standard, MRI helps Detailed Answer: Hi XXXXXXX Welcome back. You are right, Parkinson and MS both are difficult to diagnose because they rarely give findings on imaging. But physicians have been diagnosing and treating them since the era when there was no MRI. A neurological assessment in person by a neurophysician is best test to diagnose these two. Other problems like vascular events, infection, degeneration and tumor etc are diagnosed by MRI. So you can go ahead with current plan. I hope the advise will be helpful for you.

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

Follow up: Dr. Ram Choudhary (18 hours later)

Thanks Dr. Choudhary, I have included two links of the finger/hand movement. I'm not sure if these are helpful in getting any idea of what could be involved. WWW.WWWW.WW WWW.WWWW.WW I'd appreciate any ideas before consulting a neurologist. Thanks.

Answered by Dr. Ram Choudhary (45 hours later)

Brief Answer: Need more investigations and review, hold MRI Detailed Answer: Hi XXXXXXX Welcome back. I assume that the video are of your hands. The abnormal movements are fine tremors and are not due M.S., Parkinsonism, neuropathy or myopathy. Such movements are mostly due to Anxiety neurosis, Thyroid gland hyperfunctioning, Metabolic disorders like hypercarbia, hyperammonemia in blood. Please get early morning empty stomach sample of TSH, free T3 and free T4, Arterial Carbon Dioxide and ammonia levels and also fasting blood sugar levels. The videos if they depict you there have much helped in making decision. Please let me know in follow up about the results. You can hold brain imaging time being. Take care.

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

Follow up: Dr. Ram Choudhary (6 hours later)

Thanks Dr. Choudhary, Thanks for viewing the videos and yes, they are taken of my hands. Would the tests you recommend all be blood tests and known by all neurologists in helping to determine the conditions you have mentioned? Regards.

Answered by Dr. Ram Choudhary (2 hours later)

Brief Answer: Yes the test and conditions are known to all neuro Detailed Answer: Hi Mr XXXXXXX Welcome back to healthcare Magic! Yes the tests are known to the neurologists but I think your problem will be more of a physicians domain. Do get evaluated by a neurologist and get further treatment by a physician at your locality. I hope the advise would be informative and useful for you. Take Care!

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

Follow up: Dr. Ram Choudhary (42 hours later)

Thanks Dr. Choudhary, Lastly, in order to cover the possibilities, I am wondering if the issue could be related to any pinched nerves. Also, I do sometimes get numbness related to the ulnar bone during sleep, which seems to lead to numbness more of the ring finger and little finger, which also appear to be the fingers which have tremors so the numbness could be related. I do have slightly high uric acid readings, which I understand could lead to gout and I also wonder if that can lead to joint inflammation, which may be related to the pain in the joints sometimes. I have noticed recently some tiredness or aching of the muscles when writing (I am left-handed) and holding chopsticks. This tiredness seems related to both the hand and the muscles further up the arm. Could you please consider the possibilites raised. Thanks. Regards.

Answered by Dr. Ram Choudhary (34 minutes later)

Brief Answer: get antigout treatment and investigations Detailed Answer: Hi XXXXXXX Welcome back to Healthcare Magic. The ulnar nerve compression during deep sleep is a common experience but is a momentary phenomenon and does not cause such findings. If you have neck pain and osteoarthritis of that area such tremors can be possible. High urate levels can cause joint pain and muscle problems and may result in tremulous movements but what you are having are fine tremors. In any case high uric acid levels must be treated to normalcy. I think you get evaluated and investigated as advised in earlier reply from me, then it will be easier to make a conclusion. Take care.

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