Distal Arm Weakness

2018 ◽  
Author(s):  
Aziz Shaibani
Keyword(s):  
Joint Pain ◽  
Distinct Group ◽  
Multifocal Motor Neuropathy ◽  
Motor Neuropathy ◽  
Loss Of Function ◽  
Cerebellar Disease ◽  
Hand Muscles ◽  
Normal Strength ◽  
Intrinsic Hand Muscles ◽  
Lateral Sclerosis

Distal arm weakness may be caused by involvement of the intrinsic hand muscles (interossi, thenar and hypothenar muscles, lumbricals) or extrinsic hands muscles (long fingers flexors and extensors). Amyotrophic lateral sclerosis (ALS) is typical of the former type, and inclusion body myositis (IBM) is typical for the later type. Incoordination of skilled finger movement due to cerebellar disease is associated with normal strength. Poor mobility due to joint pain and swelling should not be confused with muscle weakness. Mononeuropathies such as ulnar, radial, median, and anterior interosseus nerve lesions usually cause differential loss of function. Myasthenia gravis sometimes causes weakness of the wrist and finger extensors. A small but distinct group of distal hereditary myopathies should always be kept in mind. Progressive sensorimotor neuropathies are usually associated with sensory symptoms. Multifocal motor neuropathy can be a challenging diagnosis.

Distal Arm Weakness

2015 ◽  
Author(s):  
Aziz Shaibani
Keyword(s):  
Distinct Group ◽  
Multifocal Motor Neuropathy ◽  
Finger Movement ◽  
Motor Neuropathy ◽  
Loss Of Function ◽  
Cerebellar Disease ◽  
Diagnostic Challenge ◽  
Hand Muscles ◽  
Normal Strength ◽  
Intrinsic Hand Muscles

Distal arm weakness may be caused by involvement of the intrinsic hand muscles (interossi, thenar and hypothenar muscles, lumbricals) or extrinsic hand muscles (long finger flexors and extensors). ALS is typical for the former type, and IBM is typical for the latter type. Incoordination of skilled finger movement due to cerebellar disease is associated with normal strength. Poor mobility due to joints pain and swelling should not be confused with muscle weakness. Mononeuropathies such as ulnar, radial, median, and AIN,lesions usually cause differential loss of function. Myasthenia sometimes causes weakness of the wrist and finger extensors. A small but distinct group of distal hereditary myopathies should always be borne in mind. Progressive sensorimotor neuropathies are usually associated with sensory symptoms. Multifocal motor neuropathy can be a diagnostic challenge.

scholarly journals Amyotrophic Lateral Sclerosis versus Multifocal Motor Neuropathy: Utility of MR Neurography

Radiology ◽  
2019 ◽  
Vol 292 (1) ◽  
pp. 149-156 ◽  
Author(s):  
Moritz Kronlage ◽  
Karl Christian Knop ◽  
Daniel Schwarz ◽  
Tim Godel ◽  
Sabine Heiland ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Multifocal Motor Neuropathy ◽  
Motor Neuropathy ◽  
Mr Neurography ◽  
Lateral Sclerosis

scholarly journals Nerve ultrasound for differentiation between amyotrophic lateral sclerosis and multifocal motor neuropathy

2015 ◽  
Vol 262 (4) ◽  
pp. 870-880 ◽  
Author(s):  
Alexander Grimm ◽  
Bernhard F. Décard ◽  
Ioanna Athanasopoulou ◽  
Kathi Schweikert ◽  
Michael Sinnreich ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Multifocal Motor Neuropathy ◽  
Motor Neuropathy ◽  
Nerve Ultrasound ◽  
Lateral Sclerosis

Disorders of single nerves, roots, and plexuses

2016 ◽  
Author(s):  
Kerry R. Mills
Keyword(s):  
Nerve Conduction ◽  
Cervical Radiculopathy ◽  
Multifocal Motor Neuropathy ◽  
Nerve Conduction Studies ◽  
Motor Neuropathy ◽  
Vasculitic Neuropathy ◽  
Brachial Neuritis ◽  
Pressure Palsies ◽  
Lateral Sclerosis

The role of electromyography (EMG) and nerve conduction studies in disorders of single nerve, root, and plexus lesions are discussed. The motor and sensory anatomy underpinning diagnosis is described and a scheme presented showing the key muscles to be examined using EMG to differentiate nerve, plexus, and root lesions. The main causes of mononeuritis multiplex, of either axonal degeneration or demyelinative pathology, are covered, including diabetic neuropathy, vasculitic neuropathy, multifocal motor neuropathy with block, and the Lewis–Sumner syndrome. The confirmatory role of EMG and nerve conduction studies in the investigation of cervical and lumbar radiculopathies is highlighted as is the use of transcranial magnetic stimulation to differentiate cervical radiculopathy with myelopathy from amyotrophic lateral sclerosis. The neurophysiological hallmarks of traumatic cervical plexus lesions, including obstetric causes, inherited and acquired brachial neuritis, hereditary liability to pressure palsies, the cervical rib syndrome, and radiation plexopathy are also covered.

Comparative study of peripheral nerve Mri and ultrasound in multifocal motor neuropathy and amyotrophic lateral sclerosis

2016 ◽  
Vol 54 (6) ◽  
pp. 1133-1135 ◽  
Author(s):  
Bas A. Jongbloed ◽  
Wieke Haakma ◽  
H. Stephan Goedee ◽  
Jeroen W. Bos ◽  
Clemens Bos ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Peripheral Nerve ◽  
Comparative Study ◽  
Multifocal Motor Neuropathy ◽  
Motor Neuropathy ◽  
Lateral Sclerosis

scholarly journals One nerve suffices: A clinically guided nerve ultrasound protocol for the differentiation of multifocal motor neuropathy (MMN) and amyotrophic lateral sclerosis (ALS)

2020 ◽  
Author(s):  
Kai F. Loewenbrück ◽  
Robin Werner ◽  
René Günther ◽  
Markus Dittrich ◽  
Robert Klingenberger ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Diagnostic Accuracy ◽  
Site Selection ◽  
Multifocal Motor Neuropathy ◽  
Receiver Operating Curve ◽  
Motor Neuropathy ◽  
Nerve Ultrasound ◽  
Convenience Sample ◽  
Clinical Deficits ◽  
Lateral Sclerosis

Abstract Objective To investigate diagnostic accuracy of a nerve ultrasound (US) protocol that is individualized to a patient’s clinical deficits for the differentiation of amyotrophic lateral sclerosis with predominant lower motoneuron disease (ALS/LMND) and multifocal motor neuropathy (MMN). Methods Single-center, prospective, examiner-blinded, diagnostic study in two cohorts. Cohort I (model development): Convenience sample of subjects with ALS/LMND or MMN according to revised El-Escorial or EFNS guidelines. Cohort II (model validation): Consecutively recruited treatment-naïve subjects with suspected diagnosis of ALS/LMND or MMN. Cutoffs for 28 different US values were determined by Receiver Operating Curve (ROC) in cohort I. Area Under The Curve (AUC) of US was compared to nerve conduction studies (NCS). Diagnostic accuracy of US protocols, individualized according to clinical deficits, was compared to former rigid non-individualized protocols and to random examination site selection in cohort II. Results 48 patients were recruited. In cohort I (28 patients), US had higher ROC AUCs than NCS, US 0.82 (0.12) (mean (standard deviation)), NCS (compound muscle action potential (CMAP) 0.60 (0.09), p < .001; two-sided t-test). US models based on the nerve innervating the clinically most affected muscles had higher correct classification rates (CCRs, 93%) in cohort II than former rigid protocols (85% and 80%), or models with random measurement site selection (66% and 80%). Conclusions Clinically guided US protocols for differentiation of ALS/LMND from MMN increase diagnostic accuracy when compared to clinically unguided protocols. They also require less measurements sites to achieve this accuracy.

A 54-Year-Old Male with Right-Hand Weakness

2016 ◽  
Author(s):  
Jeffrey A. Cohen ◽  
Justin J. Mowchun ◽  
Victoria H. Lawson ◽  
Nathaniel M. Robbins
Keyword(s):  
Clinical Course ◽  
Multifocal Motor Neuropathy ◽  
Clinical Syndrome ◽  
Motor Neuropathy ◽  
Spinal Disease ◽  
Spinal Level ◽  
Mri Scan ◽  
Tunnel Syndrome ◽  
Lateral Sclerosis ◽  
Rule Out

Early in its course, amyotrophic lateral sclerosis (ALS) is mistaken for a number of other neuromuscular problems, including spinal disease, multifocal motor neuropathy, and even carpal tunnel syndrome (CTS) when the weakness is distal and focal. In our patient CTS or cervical spine disease was considered. MRI scan of the appropriate spinal level is important to rule out spinal disease. Nerve conduction studies (NCS) and electromyography (EMG) help to exclude other possibilities and point to the diagnosis of ALS. Later in the clinical course, the clinical picture is pathognomonic with upper and lower motor neuron signs. The differential diagnosis of focal weakness is discussed, as is recognition of the more typical ALS clinical syndrome and familial ALS. NCS and EMG findings in ALS are discussed.

Sign in / Sign up

Export Citation Format

Share Document