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Pain with muscle atrophy in shoulder. DIAGNOSIS?

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Neurological symptoms needing a diagnosis..?

I am a 42 yr old male, desperately looking for answers to symptoms that I'm experiencing: starting over the last 3 months. I would be most appreciative of your comments and opinions on the symptoms I describe below:

3 Months ago I had intense pain deep in the left shoulder which radiated down left arm. This has subsided very slowly over last 3 months and although not completely gone, it is only a shadow of the pain it was initially. 

At the same time as the above, the thumb on left hand began to twitch. The twitching ceased after a couple of weeks, however I noticed that I could feel the tendon in the crease of my left hand between thumb and forefinger - it is very pronounced and although it doesn't look much different from the right hand, to touch it you can clearly feel the difference - as you cannot feel the tendon in the crease in the right hand at all.
I have examined both hands closely and it appears that there may be a very slight sign of atrophy on the left hand as opposed to the right but it would probably not be noticeable to anyone else...
Also on my left hand, the thumb knuckle and left little finger knuckle produce an aching pain when tensed. This has remained the same for the last 3 months. However there is no weakness.
In the last few days my right thumb has began to twitch (up till now all hand symptoms have been confined to left hand). Also in the last few days I have stiffness and aching in my left wrist and up the underside of my forearm. I also have a stiff ache in my right ankle and up my right calf.

Another symptom that started 3 months ago is a twitch in the lower lid of my right eye. This is intermittent but happens everyday. Over the last 3 months the intensity of the twitch has decreased but it remains present (and is twitching as I write this).

2.5 months ago I started having a very noticeable intermittent 'buzzing' feeling in my feet. Both feet 'buzz' but not usually at the same time. The buzz is through the centre of the foot and around the ball of the foot just back from the toes. This was very intense initially and is still present on and off on a daily basis but has subsided in intensity.

Also 2.5 months ago I noticed an ache in my left big toe, especially if I place pressure on it when walking.

3 weeks ago I noticed pain from the outer blade of my right foot across the top of my right foot and to the ankle. This is only noticeable when I roll onto the outer foot when walking and remains the same today, however as I mentioned above I also now feel a stiff ache in my right ankle and up my right calf.

I have also experienced tremors throughout my whole body on occasion over the last 3 months this usually happens late at night whilst laying in bed.
A new symptom from the last few days is a twitch in my left upper thigh.

The last point to make is that I had a rash which started approx 3.5 months ago (before the first 'neurological' symptom of a twitching thumb) - it affected most parts of my body including the trunk, chest arms and legs and presented as a lacy mottled rash - most intense on my arms (the underside of the arms). A dermatologist I saw described it as Levido Reticularis. This still comes and goes with a mild burning and inflamed sensation. Not sure if this is relevant to the above but thought best to include it. 

I was referred by my doctor to a neurologist who examined me and sent me for an MRI of C Spine for which I am awaiting the results. However from all the reading I have done I cannot see how an issue with the C spine could explain all the symptoms above. 

Once again any appraisals, opinions or points of wisdom that can be handed to me at this point would be gratefully received.

Many thanks for taking the time to read through.

Alex


Category: Neurologist, Medical

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Category: Pediatric Neurologist
Dr. Sudhir Kumar is online now

Expert:  Dr. Sudhir Kumar replied 4 Days.

Hello,
Thank you for posting your query at DoctorSpring.com
I have noted your symptoms and signs, which you have described in good detail.
First of all, I would like to reassure you that these symptoms are not suggestive of any serious disease, including amyotrophic lateral sclerosis (ALS).
The initial problem was suggestive of left cervical radiculopathy or brachial plexopathy, where the nerves arising from the (cervical) neck region get affected. These nerves supply sensations and strength to the muscles of hand.
MRI of cervical spine would exclude any compression of the neck nerves.
In addition, your other symptoms are non-specific and do not suggest any significant disease. However, conditions such as vitamin B12 deficiency, vitamin D deficiency or thyroid disorder should be excluded.
Nerve conduction studies should also be done to exclude peripheral neuropathy.
Please let me know the MRI report findings.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Patient replied :

Dear Dr Kumar,
Thanks for your response. I have been awaiting the results of my MRI in order to let you know, prior to continuing this assessment.
I should know this shortly as I have just spoken with the neurologists secretary who confirmed the paper work is with Dr Kolipara my neurologist.
In the meantime however I would like to just ask a couple of further questions based on my symptoms and your initial assessment -
1. I mentioned that I though there is slight atrophy noticeable on my left hand when compared with my right. This relates mainly to the crease between thumb and fore finger where the tendon is clearly noticeable to the touch on the left but not on the right where it appears clad completely in the muscle of this area. Also the bone connecting my ring finger knuckle to my wrist is markedly more prominent on the left hand than the right.
Although there is no weakness at all in the hand, the thumb is painful at the joint if pressure is applied pushing it backwards - whereas there is not similar pain on the right thumb.
Is this difference noteable or indicative of something other than C spine issues?
2. As mentioned in my initial description, my right thumb just started twitching just over a week ago - this is 3.5 months since the first symptom of a twitching left thumb was noticed. What if anything is the significance of this, can it also be attributed to C spine and if so why would there be such an intermission of time?
3. The intermittent buzzing sensation on my feet and now pain across the top of my right foot and to the outer base of the ankle - Can this also simply be attributed to C Spine?
4. The lacy (livedo reticularis) like rash still appears intermittently on the inside of both arms and on my legs and trunk to a lesser degree. When it does so, it brings with it an aching, turgid, inflamed sensation through both arms and hands and the redness on the back of both hands increases. This usually has a duration of 10 -30 mins but can linger at a lesser intensity for a while after before dissipating. Do you have any knowledge of a dermatological presentation such as I describe that could also be associated with the other more neurological type symptoms I have been experiencing?
I realize the first 3 questions may be better deciphered by the results of the MRI when it is available, however my concern has grown since my initial posting as no symptoms have abated and time is ticking on - at 3.5 months I can only assume whatever the cause here it is eluding to the definition of a chronic condition rather than an acute one which is worrying.
As always your professional diagnostic response would be greatly appreciated.
Many thanks,
Alex



Expert:  Dr. Sudhir Kumar replied 3 Days.

Thank you for getting back and providing more information. Regarding your queries, my replies are below:
1. The mild wasting in your left had could be related to cervical radiculopathy.
2. Twitching of right thumb alone is not a specific symptom of any disease. It could occur in cervical radiculopathy as well.
3. Right foot symptoms can not be attributed to cervical spine. It could occur due to lumbar spine disease or a problem with peripheral nerve in the foot.
4. I do not know of any neurological condition associated with these skin findings.
Once the MRI report is available, I can give you more specific answers.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Dr. Sudhir Kumar
Category: Pediatric Neurologist
Experience: 
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
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