Progressive Wasting of Hand Muscles

Abstract

The differential diagnosis of progressive wasting of distal hand muscles is facilitated by three preliminary considerations:

• Are signs and symptoms confined to the upper extremities, or is there indication by neurologic findings or electromyography or nerve conduction studies that the legs are also affected? If they are, the patient has polyneuropathy, motor neuron disease, or myopathy, in that order of frequency (see Chap. 25). If they are not, the following questions are suggested:

• Are signs and symptoms unilateral or bilateral? Unilateral affections, as a rule, are suggestive of treatable conditions. Bilateralism is strongly suggestive of systemic disease of the spinal cord or of the musculature.

• Are signs and symptoms strictly motor or sensorimotor? Absence of sensory disturbances has an ominous prognostic meaning. Presence of sensory signs and symptoms helps to pinpoint the locus of lesion.