Involuntary Finger Tremors and Weakness: A Neurological Perspective

The middle finger experiences involuntary twitching?

I started experiencing tremors in my left hand at the age of 19, and recently, over the past month, I've noticed that my body sometimes shakes as well.
Although it's not very visible externally, I can feel the tremors.
Additionally, when using the mouse with my right hand, my middle finger involuntarily presses the right-click button after about ten minutes or so.
When my right hand is resting, I also feel a twitching sensation in my thumb, which moves slightly side to side, but not as rapidly as the tremors in my left hand.
It seems like my right hand is also starting to tremble slightly.

Two weeks ago, I felt a general weakness throughout my body, to the point where going up and down stairs felt strange, and my limbs were sore.
This muscle weakness seems to improve significantly after a few hours and into the late night.
When walking, I often feel a sensation of my feet stopping when going slightly uphill.
I went to the hospital for an examination, and the doctor checked my potassium levels, CPK, thyroid function, and liver enzymes, all of which were normal.
However, I haven't felt the same since.

I feel like my coordination has worsened; I find it easier to bump my hands against door frames when passing through.
Previously, I could run two laps around the campus without issue, but now I feel muscle fatigue after just one lap, to the point of trembling.
These symptoms suddenly began at the end of September.
I've undergone many tests, including gastroscopy, colonoscopy, and abdominal ultrasound, all of which showed no significant issues.
Last year, due to frequent scalp numbness, I had a CT scan and EEG, both of which were normal.

I consulted a neurologist who reviewed my previous brain CT and EEG results, and after observing my hand tremors, he diagnosed me with autonomic dysfunction.
I have also been experiencing several symptoms recently, including palpitations, chest tightness, irritable bowel syndrome, and I had a gastric ulcer two months ago.
Lately, I've sometimes experienced frequent urination.

I would like to ask the doctor if autonomic dysfunction can cause my weakness or neurological symptoms.
Do I need to undergo more neurological examinations, or should I be concerned about other conditions?

Yang Xiansheng, 20~29 year old female. Ask Date: 2011/10/21

Dr. Lan Shengxing reply Neurology

The symptoms mentioned, including tremors and decreased coordination, are characteristic of movement disorders, and most of the necessary examinations have already been conducted.
If a more obvious condition were present, it should have been detected.
Therefore, if the symptoms persist, you may consider visiting a movement disorders clinic at a medical center, where other less common movement disorders might be identified.
Additionally, symptoms such as palpitations and chest tightness are more indicative of autonomic nervous system dysfunction and may have a lower correlation with the initial movement disorder symptoms.

Reply Date: 2011/10/21

More Info

Your symptoms of involuntary finger tremors, weakness, and the sensation of your body shaking can indeed be concerning, especially at a young age. It's understandable to feel anxious about these experiences, particularly when they interfere with your daily activities and overall quality of life.
From a neurological perspective, tremors and weakness can arise from various causes, including neurological disorders, metabolic issues, or even psychological factors. In your case, the fact that you have experienced these symptoms for an extended period, along with the recent onset of generalized weakness and muscle soreness, warrants a thorough evaluation.

1. Understanding Tremors and Weakness:
Tremors are involuntary, rhythmic muscle contractions that can result in shaking movements in one or more parts of the body. They can be classified into different types based on their characteristics and underlying causes. For instance, essential tremor is a common condition that typically affects the hands and can worsen with movement or stress. On the other hand, Parkinsonian tremors are often associated with other symptoms like rigidity and bradykinesia (slowness of movement).

Weakness, particularly if it is fluctuating, can be indicative of several conditions, including myasthenia gravis, peripheral neuropathy, or even anxiety-related disorders. The fact that your weakness improves after a few hours or by nighttime may suggest a non-organic cause, but it is essential to rule out any underlying neurological issues.

2. Autonomic Nervous System Dysfunction:
Your neurologist's diagnosis of autonomic nervous system dysfunction (often referred to as dysautonomia) could explain some of your symptoms. The autonomic nervous system controls involuntary bodily functions, including heart rate, digestion, and respiratory rate. Dysautonomia can lead to symptoms such as heart palpitations, gastrointestinal issues, and even muscle weakness or tremors due to the body's inability to regulate these functions effectively.

3. Psychological Factors:
Anxiety and stress can significantly impact physical health, leading to symptoms that mimic neurological disorders. The sensations of tremors and weakness can be exacerbated by anxiety, which can create a feedback loop of worry and physical symptoms. It’s crucial to address any psychological factors that may be contributing to your condition.

4. Further Evaluation:
Given your symptoms and the fact that you have undergone several tests (including CT scans and blood tests) that returned normal results, it may be beneficial to pursue further neurological evaluations. This could include:
- Electromyography (EMG) and Nerve Conduction Studies: These tests can help assess the electrical activity of your muscles and the speed of nerve conduction, which can identify peripheral nerve issues.

- MRI of the Brain and Spine: This imaging can help rule out structural abnormalities that may be affecting your neurological function.

- Referral to a Neurologist Specializing in Movement Disorders: If tremors are a significant concern, a specialist can provide a more focused evaluation.

5. Lifestyle Modifications:
In the meantime, consider lifestyle changes that may help alleviate some of your symptoms. Regular physical activity, stress management techniques (such as mindfulness or yoga), and a balanced diet can support overall health and potentially improve your symptoms.
In conclusion, while your symptoms may be related to autonomic dysfunction or anxiety, it is essential to continue working with your healthcare providers to explore all potential causes. Keeping a symptom diary can also be helpful for your doctors to identify patterns and triggers. Remember, you are not alone in this journey, and seeking support from friends, family, or mental health professionals can also be beneficial.

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