A friend of mine went in for an EMG today; she was looking for an explanation for why, over the last few weeks, she's been feeling some weakness in her left hand, particularly the third and fourth fingers. It hasn't been dramatic, but she noticed around Christmas that she was having some trouble gripping things with that hand, that it feels somewhat numb and weak, and that when exposed to cold the symptoms seemed to get worse, so that she had trouble unbuckling her seatbelt. She's about 50, by the way.

The EMG evidently wasn't promising; I don't know details but my friend said her neurologist immediately ruled out the thing we'd thought it might be via Google search, which was ulnar nerve entrapment, and said that, basically, two nerves in my friend's hand are dead and that it must have been coming on for a while and my friend just didn't notice. She also said the neurologist ruled out diabetic neuropathy because it usually presents on both sides simultaneously.

The neurologist, evidently, was frankly puzzled and said so. My friend felt she was leaning towards its being some sort of disease but she wasn't sure what. She's getting more tests on Friday to see what is happening in her feet, and then after that there will probably be more to try to nail down what's causing this.

So far my friend seems to be taking this calmly (though I know she's worried). I on the other hand am freaking out, because I was really hoping that it was the ulnar nerve thing because Google seems to think that the other likely option is ALS. It also says, however, that ALS mimics a whole bunch of other things (but is really quiet about what those might be) and that it often presents with other symptoms like twitching, speech impairment, difficulty swallowing, etc. So I'm sort of hopeful that it could be something less serious but I'm having trouble figuring out what we might be looking at here.

Anyone have any places I can look for resources on someone suffering from two inexplicably dead nerves in the left hand?

Sometimes we can be the most help if all symptoms are listed, maybe the most bothersome to the least..

I don't know if she has described all /most of those to you?

Are her hands the main problem, and then her feet , are they presenting symptoms in a similar way?

Did the neuro say the names of the 2 affected nerves?
Has any MRI/x ray of her c spine been done to rule in/out issues there?

Any other injuries or conditions to consider - now or in the past?

Could it be possible for the hand problems could be some sort of repetitive strain injury? Any neck or shoulder pain or stiffness?

There are so many things it could be from, that those web searches don't even consider, they really only come up with the more well known by name conditions.

Sorry I asked so many questions , but it helps to pin things down a bit more for us.

::hangs head:: The truth is I don't know all the answers here (and I'm hesitant to bug my friend too much because I know she's getting more tests and is trying not to think too much about it in the interim. This is basically me trying to get more info/not freak out, without having to climb all over her about it and make it worse... :/ )

But to do my best...

As near as I can tell, she's only having this symptom in one hand, her left. I think she would have mentioned it if it had cropped up in the other hand. She mentioned a while back that she's dealt with diabetic neuropathy in her feet, but again, the neurologist seems to have ruled that out as a cause. Either way I doubt that they're manifesting anywhere nearly as noticeably, because when I posed diabetic neuropathy as a possibility, she was like "You know, I didn't even think of that..."

I'm sure the neuro did mention the specific nerves but my friend didn't tell me what they were. It's possible that the tests you mention are in the future.

As far as the repetitive strain injury -- I suppose that's possible. She works regularly at a computer, day to day, though it seems to me that would do more straining on the right hand than the left. I know carpal tunnel was also ruled out, along with the ulnar entrapment.

On the contrary, thanks for asking the questions (and putting up with my lack of info). If nothing else, it helps me realize there's a lot I don't know about the situation yet. I'm a worrier by nature, in a big way; I'm just trying to learn as much as I can so I can be reassuring rather than expend my worry at her.

No problem, you can work it into conversations now to help her figure out things, sometimes it's hard to be the one going thru it, you can help her to clarify what she describes to the doctors - it will save time hopefully , so they can best help her.

I had RSIs , it's more of a mild/moderate chronic thing now, but my symptoms were worse in my left hand/arm even though right handed. But I did assembly work so both hands were used one way or another.

::nod:: I guess I will wait and see what her further tests start showing next week; may be back here with further questions then.

The thing that I'm finding most perplexing in trying to do any search about this is that she's not noticing any pain, just numbness, weakness, etc. Almost every sort of nerve damage I've researched seems to have pain in the affected area listed as one of the symptoms...

I would start on some B12 ASAP... did the neurologist TEST for this? It is the most likely cause of nerve problems.

When I was pregnant I lost 80% of my nerve functions in my hands from carpal tunnel. This was a hormone thing, which combined with my growing hypothyroidism which was NOT diagnosed then, it was a painful 4 months for me! Hypothyroidism is one cause of nerve damage. I had EMG and then one steroid shot in the right wrist so at least one hand would work. (I declined the left hand shot offered because I thought that would affect my baby--I was 5mos pregnant).

Many people have low B12 and don't know it. Levels below 400 are even still passed as "normal" by many doctors today!

http://www.aafp.org/afp/2003/0301/p979.html
There are doctors who keep up on new information, as this medical site shows. It is from 2003, and still we see here patients being told levels of 250 are normal! (US reporting concentrations differ from other countries).

I'd start here, and rule out B12 issues. It is important to begin with the common things first and then move on to less common.

Diabetic issues also cause nerve damage. There are supplements shown to help with diabetic neuropathy in medical studies.
Benfotiamine (a special form of thiamine B1)

acetyl carnitine (which helps the mitochondria make energy when glucose is not getting into cells)

R-lipoic acid stablized (a new better form of alpha lipoic acid)

There are drugs that cause nerve damage:
statins for lowering cholesterol are common, and so are fluoroquinolone antibiotics--Cipro, Levaquin and Avelox, and another antibiotic, Flagyl.

All of these issues are far more likely than ALS.
Here is my drug thread... please take a look.
http://neurotalk.psychcentral.com/thread122889.html

supplements for neuropathy:
http://neurotalk.psychcentral.com/thread121683.html

Diabetic neuropathy:
http://neurotalk.psychcentral.com/thread158275.html

B12 thread:
http://neurotalk.psychcentral.com/thread85103.html

With specialists today, one does really not get "special" treatment. Their mindset can be very narrow, and not take into consideration other medical aspects of each patient.
Places like this exist so that patients can know what questions to ask, what tests to ask for, and sadly, once the tests come back, what treatments work best (because doctors at times cannot even treat things adequately!--when nutrients are involved)

--of diabetic neuropathy before, that is certainly a possibility; diabetic neuropathy does not HAVE to present as a distal symmetric set of symptoms. There are even some presentations that are acute or sub-acute in onset and involve particular nerve tracts:

http://neuromuscular.wustl.edu/nother/diabetes.htm

Often, these presentations are the result of the "double crush" effect. A nerve pathway that is already weakened through diabetic ischemic compromise is then compressed by some other force--such as a bulging disc in the spine pressing on a nerve root--and the combined effect symptomologically is more than the "sum of the parts".

Given the area, I think she needs some imaging of the cervical spine, and possibly the shoulder. Compressive neuropathies are very common in those areas anyway (as they are at the wrist and at the elbow, as you've mentioned), and people with impaired glucose tolerance tend to be more sensitive to them.

Thank all of you for the help, very much; you've helped ease my mind a bit, and given me some more stuff to look at and pass along to her when she next goes to the doctor.

This is very, very useful, thank you. I'd done a little bit of research after Jo*mar mentioned a c-spine MRI (which I hadn't heard of before), and am now thinking that a C-7/T-1 herniation or something like that seems like a likely explanation, since it seems like it would also explain why the ulnar entrapment seemed so likely before, and it's less common which explains why her neurologist may not have thought of it...what you say about its possibly combining with the effects of the diabetes supports that and makes a lot of sense.

Anyway, thanks all for letting me ramble/answering my questions. You guys seem to have a really good, supportive community here. I'm impressed.