Navigating Weakness and Neuropathy: Seeking Clarity
I am a 42-year-old female who has been experiencing weakness in my left hand grip for approximately five years. Over time, I have noticed that the weakness in my left hand and arm has worsened, particularly during activities like typing, pottery, and CPR. These symptoms sometimes include tremors and have recently become more widespread throughout my hand. Additionally, I have experienced intermittent pain in my upper left arm, above the elbow, and tightness in my wrist. Paresthesias, or abnormal sensory feelings, occur in both my left hand and foot, with the intensity of these symptoms varying. **Current Investigations:** On June 1 and June 9, I underwent an EMG/Nerve Conduction Study (NCS) through a Physical Medicine and Rehabilitation (PM&R) department. The report indicated an abnormal finding in the median motor nerve conduction on the left side, citing a conduction block within the forearm. Although the cause is uncertain, it was recommended to further assess lower extremity nerve conduction for any signs of broader issues, potentially indicating a Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) The June 9 study also revealed slowing in the left peroneal nerve at the popliteal fossa, which may indicate a similar condition. On May 9, an ultrasound of the nerves was performed revealing abnormalities. The sonographic findings suggested evidence of a segmental autoimmune process impacting the median nerve above the elbow as well as the fibular nerve, indicating patterns associated with CIDP or mononeuropathy multiplex. During an EMG on May 22, conducted by a technician during my appointment at a Neuromuscular (NM) clinic, the results were deemed "essentially normal," though this examination did not include the segment above the elbow previously exhibiting blockages. The perceived compression of the peroneal nerve was attributed to my leg crossing position. Consequently, physical therapy has been recommended, alongside an MRI of the left humerus due to an inability to properly assess the area that previously showed abnormalities. The MRI of the left humerus performed on June 18 showed no abnormal signals or swelling, but it was not a specialized MR neurography focused on the brachial plexus. Additional notes: Rheumatology autoimmune testing returned normal results. However, on May 8, elevations were observed in ganglioside antibodies, specifically at GM1 201 IV and GM2 197 IV. Additionally, I have been experiencing autonomic symptoms, including lightheadedness, palpitations, heat intolerance, and consistently cold extremities, which are currently under separate evaluation. I have started occupational and physical therapy, but there has been no notable improvement so far. A follow-up with the NM director is scheduled for July 31 for a second opinion, and the PM&R team continues to suspect an autoimmune origin for my symptoms. **Questions I Have:** 1. Is it conceivable that I could be in the initial stages of an immune-mediated neuropathy, such as Multifocal Motor Neuropathy (MMN) or CIDP, even though the most recent EMG appears normal? 2. Can nerve inflammation vary over time and not be detectable on an MRI, possibly due to delays or medications like Zepbound? 3. Is it plausible that the entrapment alone could account for the proximal median swelling, the nerve conduction block, and my elevated antibodies? 4. Would it be beneficial to request a brachial plexus MR neurography for enhanced visualization of the affected nerve segments? I appreciate any insights or advice you can provide regarding my situation.
Answers (1)
7/9/2025, 4:10:55 PM
OpenHealth AI
Main Points: You are experiencing persistent weakness and sensory changes in your left hand and arm, alongside potential indications of an autoimmune-related nerve condition. Your evaluation results raise questions about whether you have an immune-mediated neuropathy. Here’s a breakdown of your concerns and actionable recommendations.
Explanation:
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Immune-Mediated Neuropathies: You are experiencing symptoms that could be linked to immune-mediated neuropathies like CIDP or MMN. It's important to note that evidence of nerve damage can sometimes precede noticeable abnormalities on EMG, and fluctuating symptoms may suggest underlying immune involvement.
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Nerve Inflammation and MRI: Nerve inflammation can indeed vary and may not always be detectable on standard MRI studies. Medications like Zepbound could also influence the inflammatory response, leading to variations in symptoms and imaging results.
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Entrapment vs. Autoimmune Factors: Entrapment (such as carpal tunnel syndrome) can certainly cause nerve dysfunction, but given your symptoms and elevated antibodies, it’s plausible that an autoimmune process is contributing to both the proximal swelling and conduction block.
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Brachial Plexus MR Neurography: Requesting a brachial plexus MR neurography could be beneficial. This specialized imaging may provide more detailed views of nerve structures and help pinpoint the cause of your symptoms more accurately.
Next Steps:
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Discuss with Your Healthcare Team: When you attend your follow-up appointment with the neuromuscular director on July 31, bring up the possibility of immune-mediated neuropathy despite a normal recent EMG, and express your desire for a brachial plexus MR neurography.
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Monitor Symptoms: Keep a detailed log of your symptoms, including any changes in weakness, pain, or sensory alterations. Documenting these fluctuations will provide your healthcare providers with valuable insights.
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Continue Therapies: Engage actively in your occupational and physical therapy sessions. Although improvement may not be immediate, these therapies can enhance your function and help manage symptoms better over time.
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Regular Follow-Up: Since you have ongoing symptoms, it is crucial to maintain regular communication with your healthcare team regarding evaluations, treatments, and any new symptoms that arise.
Remember, understanding the underlying cause of nerve symptoms can take time and may require an integrated approach to therapy and follow-up. You're advocating well for your health, and continuing to ask questions will aid in getting the right diagnosis and treatment.
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