Helped Over 500,000 patients with 98%+ satisfaction.

Connect & Get Personalized 1-to-1 Answers from Expert Doctors

DoctorSpring > Question Home

Frequent twiching in PALMAR & THENNAR area. EMG/NCS.

Resolved Question:

I am a 41 year old female from Northern Ireland.
In 2006, I started having twitching and buzzing which started in my feet and calves. I saw a neurologist who felt it could be post viral and would subside as clinical exam was normal. The twitching progressed and became fairly frequent in my left thenar, palmar and forearm area. I sought another neurologist exam which was normal. I had EMG/NCS in 2007 on the thenar and forearm (if I remember correctly), it noted contract fasciculations but as there was no weakness/atrophy a benign diagnosis was given. The twitching eventually subsided, for years.
In Dec 2012, I felt my left hand was losing dexterity and then twitching became very persistent in my left elbow area. It kept me awake at night and caused at lot of anxiety. I saw 2 different neuros in Jan 2013, who completed full neuro exams which were normal. I pressed to have another EMG/NCS to alleviate my fears. The EMG was done on all four limbs and carried out in Feb 2013. It came back completely normal.
Fast forward to April 2014, I felt the odd twitch in my first dorsal interosseous muscle. This twitch is still very localised to the Left FDI area but has been twitching constantly, non stop, 24/7 for the last 12 weeks!!!! I notice much less bulk in this left FDI compared to the right. I have not noticed any weakness. I saw the original neurologist from 2006 on 23rd July 2014, he did not even want to do an exam and basically said that I have a relapsing and remitting benign condition. I asked him to do a neuro exam, which he did, but I felt it was rather rushed and superficial. He said he detected no abnormalities and that my left hand was strong. Unhappy with this consultation I made another consultation to see him 6th Aug 2014 and asked for an EMG/NCS, which I am still waiting for.
The annoying thing is that on both ocassions I saw the neuro the twitching in the FDI stopped for a very brief time so he did not see or feel the twitching. I have since seen my GP who was able to see and feel the twitching. My neuro is convinced that these current symptoms are associated and related to my twitching history, however, I am not so sure based on the fact that this twitch is relentless, persistent and always there in the FDI muscle. It has become less 'strong' and less annoying, in that I can't feel it unless I place my right index finger on it, in fact, it currently feels like a pulse but is much much faster. If i place my palm out flat on the table I can see it too.

Basically I would like advice on whether this twitch could still be benign even with such a persistent presentation?
Could this episode be unrelated to my twitching history, ie the start of ALS?
Am I right to push for another EMG?
Going out of my mind with worry.

Category: Neurologist, Medical

Ask Your Own Question

Category: Pediatric Neurologist
 23 Doctors Online

Thank you for posting your query at
I have noted your detailed history and the list of evaluations and EMG.
I am of the opinion that your symptoms are not suggestive of ALS and they are related to benign fasciculations.
For your peace of mind, however, you are right in pushing for a repeat EMG study to conclusively rule out ALS.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Patient replied :

Dr sudhir kumar, Thank you for your response. Is it not more ominous that this twitch is a) so persistent and b) the fact it is in the left FDI? Also, it is possible that this twitch is unrelated to past history? Finally, as I had EMG 1.5 years old patientago, which was normal, is that reassuring regarding this twitch or was that too long ago. I do have body wide twitching but this is very intermittent and moves around all over in little, short bursts. Thats why the FDI twitch bothers me so much. Its there, very fine, all of the time. I dont know how long I will have to wait for EMG. Thank you in advance Mand

Thank you for getting back.
I know it is annoying to have a constant twitch, however, I would like to reassure you that it is not ominous and does not signify ALS, if that is your concern.
I agree one and a half years old patientis too long ago, and it may be preferable to repeat an EMG. However, there is no emergency to do it and you can do it whenever you get the appointment.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
Dr. Sudhir Kumar and 4 other Medical Specialists are ready to help you

Users who read this, also read:

Make informed and better medical decisions.

Join the 500,000 people who found a smarter, quicker way to get Answers, Recommendations & Expert Opinions.

Expert Doctors at fingertips

Recommendation on next step. Second-opinion.Multi-specialty.

Save Time

Average time for answers: 6 hours.

Save Money

$35 for typical specialist consult vs. $120 for a local appointment.

Free Follow-ups

Clarify, ask further questions for free in private conversation.

100% Satisfaction

Money back guarantee for the 1st reply. MEDNET Quality Board.

Start My Consultation



Doctor Spring is a novel online Doctor consultation platform where you can get your medical questions answered by leading Doctors. Just Submit your question and rest assured that you will consult a Doctor easily. Once you submit the question, the Doctor from the concerned specialty will reply within hours. You can always ask more questions or add details with follow-up question options and make it an online doctor chat. You may use this service to consult a specialty or for getting medical second opinion. All paid services come with a MEDNET quality assurance and 100% money back guarantee.

DoctorSpring in news