Hand manifestations of neurological disease: some alternatives to consider.

Abstract

Patients with a systemic neurological disease can often first present with symptoms and signs affecting the hand. With limited time to review patients in clinic, the symptoms can often be attributed to common hand disorders, such as carpal tunnel syndrome (Figure 1). The aim of this article is to review a few of the common systemic neurological disorders that may first present with manifestations in the hand. A secondary goal would be to prevent the surgical treatment of hand conditions that are more amenable to systemic treatment if appropriately managed. Figure 1. An anteroposterior and lateral clinical photograph of the right hand of a patient with Charcot-Marie Tooth disease. Note the thenar flattening with preservation of hypothenar muscle bulk. Sensory deficit was most notable in the radial three digits. The changes were unilateral. An initial diagnosis of carpal tunnel syndrome had been made. Motor neurone disease (MND) can present with both upper and lower motor neurone signs. The terminology attributed to the disorder is subdivided between upper (primary lateral sclerosis) and lower motor neurone (progressive and spinal musclular atrophies) or both (amyotrophic lateral sclerosis). Onset of the disease is usually in the mid-50s with an incidence of 1–2:100 000. In the hand, …