Jump to content
helplinedonate
  • Announcements

    • ForumAdmin

      Frequently Asked Questions - Step by step guides

      Do you need assistance registering, logging in, posting, etc? Please visit the all new Frequently Asked Question Forum for step-by-step guides. Click the link below to access these helpful guides. Frequently Asked Questions
    • ForumAdmin

      Recursos Nuevos en Español

      http://www.parkinson.org/ayuda   http://www.parkinson.org/espanol    
    • ForumAdmin

      Línea de Ayuda 1-800-473-4636

      Línea de Ayuda 1-800-473-4636   ¿Qué es la línea de ayuda 1-800-4PD-INFO (473-4636) de la Fundación Nacional de Parkinson? Es un número de teléfono gratuito que ayuda a las personas con la enfermedad de Parkinson, sus familiares, amigos y profesionales de salud, a solucionar diferentes inquietudes.   La línea de ayuda ofrece: Información actualizada Apoyo emocional Referidos a profesionales de salud Recursos comunitarios Amplia variedad de publicaciones gratis    
Sign in to follow this  
jessieyx

Ringer finger tremor

Recommended Posts

jessieyx    0

I am a 29 years old female, who is a graduate student. Here is my situation.

 

One morning in March I suddenly noticed that my right hand ring finger was twitching side to side as long as I spread out my hand. Initially it would stop after a few seconds, but soon it became a non-stop twitching. Moreover, recently I find my right thumb will twitch when I bend it. However, neither of the two fingers

twitches when completely at rest.

 

I went to see a GP, who at first suggested it might be due to overuse of hands since I worked in front of computers a lot (I had wrist pain several months before the tremor and it has disappeared after some rest). He prescribed some vitamin (Neurobion) and muscle relaxation medicine. It did not improve at all after a week so he referred me to a neurologist, but I've only got to see him in July.

 

I have done some research on tremor and kept on observing mine:

1. It does not respond to alcohol (rule out essential tremor?)

2. I have neck pain sometimes but it is not severe.

3. Sometimes I have a slight numb sensation at finger tips.

4. I have wrist pain after using mouses and computers for sometime (I don't have wrist pain when first noticing the tremor)

 

I am quite anxious about it and worried whether it is possibly Parkinson's disease. I attach one short video of the fingers twitching for your reference.

 

 

It would be very appreciated if you can share some of your ideas. Many thanks.

 

Jessie

Share this post


Link to post
Share on other sites
Dr. Okun    411

The video reveals mainly a postural tremor of the fingers (more than one involved). It would be useful to see the hand at complete rest and then at action, finger to nose-finger to examiner finger.

 

With neck pain and this tremor it is possible this is dystonic tremor and dystonia of the neck (pain).

 

Also, alcohol unresponsiveness does not rule out essential tremor.

 

I would probably seek a movement disorders expert opinion to decide dystonia versus essential tremor versus PD.

 

This will require a full body examination and careful history including a family history.

 

Nice video!

Share this post


Link to post
Share on other sites
jessieyx    0

Dear Dr. Okun,

 

Thank you for the reply. Below are the follow-ups for your reference.

 

Respond to your question: There is no tremor at all when the hand at complete rest. Finger to nose examination is normal. No family history of essential tremor. Currently I am perfectly fine except the tremor.

 

I have seen one neurologist who initially suggested that it could be due to a compressed nerve and hence performed a few tests.

 

Thyroid screen - normal

Nerve conduction studies - normal

MRI at cervical spine - normal

 

However, all the test came back normal and the doctor could not draw a diagnosis.. Thus he ordered an EMG which would be done next week and referred me to a movement disorder specialist.

 

I wonder if you can share some ideas on this?

 

Thank you very much!

 

Jessie

Share this post


Link to post
Share on other sites
Dr. Okun    411

The next step is indeed a movement disorders specialist and usually not a EMG.

 

Usually a medication trial of a dopamine agonist or sinemet can help sort out if PD is suspected. The other common diagnosis is essential tremor.

 

An expert will be able to make the call 95% of the time.

Share this post


Link to post
Share on other sites
jessieyx    0
Update on Finger Twitch

 

Hi Dr. Okun, 

 

Thank you very much for your advice. It has been more than three years since our last exchange. I would like to update you with my diagnosis and progress regarding the finger twitch.

 

Soon after our exchange in June 2011, my right hand postural tremor has spread to my left hand. The tremors at both hands are very similar, except that the tremor on the right hand is more severe. In August 2011, I saw a movement disorder specialist at a university hospital, who diagnosed me with essential tremor (without a medication trial). I was not given any medication for it though, as the doctor suggested that my situation didn't interfere with daily activities. 

 

Since the initial diagnosis, the doctor and I have been following up on it yearly. The tremors had been completely postural without any other symptoms until 5 months ago when I noticed something.

 

1. I had muscle jump at the first dorsal interosseous muscle of my right hand. The muscle jump was so severe that it caused my index finger to move side by side. The muscle jump lasted for one week and disappeared. 

 

2. I started to have occasional resting tremor in two situations

 

a) When I am falling asleep or when trying to wake up, one finger on either of my hands started to twitch. It usually lasted for a few seconds and disappeared after I was fully conscious. The situation happened a few times. 

 

B) When I am resting, one finger on either of my hands starts to twitch suddenly. It is a sudden tremor where the finger only moves once, and it only happens if I don't move the hand for some time (The longest duration I have tested was 20 minutes and no twitch happened). I managed to record a video for it, when my right middle finger moved (please forward to 1:25: https://www.youtube.com/watch?v=eTBrf_3lytk ). The sudden twitch can happen to any finger and the occurrences on my right hand fingers are more frequent than my left hand fingers.

 

Due to the onset of new symptoms, I visited the doctor again last week. He did the routine examination, such as asking me to write on a paper, and concluded that I had essential tremor and myokymia, and it was definitely not Parkinson's. 

 

However, I was not relieved and would like to seek your opinion regarding my best course of action. Do you think the resting tremor is normal? or Should I consult another neurologist and request for a dopamine trial? I don't think DaTScan is available here in Singapore unfortunately...

 

I also attach a video showing the postural tremor of both hands for your reference. https://www.youtube.com/watch?v=Ucy2nG9z6YU

 

Thank you very much. 

 

Best regards, 

Jessie

Share this post


Link to post
Share on other sites
Dr. Okun    411

The sudden jerks are not typical in Parkinson's disease.  It is reassuring that progression has been slow over 3 years.  If there is a question of PD, then a dopamine challenge and maybe a DAT scan could be useful in the future.  Thanks for the videos.

Share this post


Link to post
Share on other sites
Bills    20

The video reveals mainly a postural tremor of the fingers (more than one involved). It would be useful to see the hand at complete rest and then at action, finger to nose-finger to examiner finger.

 

With neck pain and this tremor it is possible this is dystonic tremor and dystonia of the neck (pain).

 

Also, alcohol unresponsiveness does not rule out essential tremor.

 

I would probably seek a movement disorders expert opinion to decide dystonia versus essential tremor versus PD.

 

This will require a full body examination and careful history including a family history.

 

Nice video!

Dr what are u looking for in finger to nose test?.. What makes the test normal and abnormal?

 

Thanks.

Share this post


Link to post
Share on other sites
Dr. Okun    411

We are looking at the intention of the movement and whether there is a tremor during the movement or an incoordination.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

Sign in to follow this  

×