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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5222
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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on-going fasciculation in same muscle

Resolved Question:

on-going fasciculation in same muscle for 2 years

Index finger and thumb.  I have stiffness. I don't notice weakness.

So confused

I originally went to chiropractor who said I have an issue with my neck. But other than aching pain from neck I don't have other symptoms like pain down the arm etc.

Submitted: 2 years ago.
Category: Neurology
Expert:  Dr. Bob replied 2 years ago.
Dr. Bob :

If this has been going on in the same muscle group for 2 years without progression, this is reassuring. :-)

Customer: Could this be caused by an issue in my neck?
Dr. Bob :

Fasciculations are typically the result of irritation or hyperexcitability in the motor unit. This can result from numerous causes, most of which are benign.

Dr. Bob :

The chance of it being related to a pinched nerve in the neck is pretty low, but not zero.

Dr. Bob :

have you ever injured your neck?

Customer: So in a sinister condition, 2 years is a very long time?
Dr. Bob :

Most serious neurodengenerative conditions progress steadily....so one would expect worsening of the condition over 2 years...either greater severity of the existing symptoms or progression to other motor units around the body.

Customer: Originally I went to a chiropractor who said I had some issues (c5/c6) from what I remember. Initially the only fasics I had were after I contracted the muscle in my hand (between thumb and index) it would twitch like it couldn't calm down
Dr. Bob :

This is a common site for benign fascics because it is being used all the time (at least when we are awake) and the risk of overuse, or strain, or injury is pretty high.

Customer: I have stiffness in my hand. But I don't notice weakness
Dr. Bob :

A C5/6 cervical lesion would be expected to cause symptoms a bit higher up the arm.

Customer: I can also trigger the fasics by lightly contracting the muscle. Looks like it's going mental under the skin
Dr. Bob :

If there were ongoing damage in the C6 nerve, for example, one would expect some forearm involvement over a 2 year period, probably weakness and even atrophy.

Dr. Bob :

have you had a cervical mri?

Customer: No
Dr. Bob :

This would provide an added layer or reassurance, if normal.

Customer: My obvious concern having spent time on Google is something more serious
Dr. Bob :

Ah yes...you have Googlitis! :-)

Customer: I try to re assure myself that had the same muscle of twitched for 2 years I wouldn't be "doubting" anything....
Customer: I do indeed :)
Dr. Bob :

another option would be to get nerve conduction tests (i.e EMG and NCV).

Dr. Bob :

this would reveal any worrisome features in the nerves or muscles.

Customer: Generally speaking (and from what I have read) fasciculation is not normally a presenting symptom? And if so is normally associated with sever weakness?
Dr. Bob :

That is correct.

Dr. Bob :

and when it does occur, it tends to be more widespread

Customer: And if a muscle had twitched for 2 years, sorry for sounding mad here, you would expect severe symptoms nothing "slight"
Dr. Bob :

you would expect progression...

Customer: What does progression mean?
Dr. Bob :

increasing severity, increasing frequency, increasing number of affected sites, new symptoms such as weakness or atrophy...those types of things.

Customer: Ok the reason I ask is you read online people saying serious conditions progress quickly and you would have severe weakness within months.
Customer: There would be no doubt if a muscle had twitched for a year for example
Dr. Bob :

yes, that's generally the case in progressive neurological diseases...certainly by 2 years.

Customer: Ok so you think after two years there would be substantial symptoms normally in the hand muscle and very obvious weakness and atrophy
Dr. Bob :

yes, or elsewhere in the body.

Dr. Bob :

i think it would helpful for you to get one more layer of reassurance...nerve conduction testing is the way to go, in my estimation...though it is very likely to be normal.

Customer: Can benign fasics cause stiffness?
Customer: And is it normal for bfs to be focused on one muscle area continuously?
Dr. Bob :

The stiffness is often a result of the underlying process causing the fascics...either injury or overuse or hyperexcitability.

Dr. Bob :

bfs is usually more widespread...but it is a spectrum disorder ranging from very mild and localized to very severe and widespread.

Customer: Ok thanks :)
Customer: Can overuse be a trigger for bfs. I have had big thumping twitches all over the place
Customer: But they come and go depending on stress
Customer: The hand thing is the constant
Customer: When I lightly contract the muscle it certainly looks hyper excitable!
Dr. Bob :

yes, overuse can be an important factor...as can stress...fatigue...poor sleep...imbalanced diet...electrolyte imbalances...too much caffeine, etc

Customer: Ok final question. I've read that the weakness you'd expereience after fasics is onerous isnt subtle, it would be being unable to hold something or turn a key. Only based on what I read but if after this time it was more stiffness rather than any clear weakness, do you think that's a fair assumption?
Dr. Bob :

i think this is correct.

Customer: Ok thanks for your help!
Customer: can bfs cause any loss of subcutaneous fat on the hand?
Customer: Last one :)
Dr. Bob :

you're welcome...glad to help...bfs does not normally involve any loss of subq fat. :-)

Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5222
Experience: Neurology & Int Medicine (US Trained): 20 yrs experience
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