I have started the process of figuring out what’s what with my left hand and its loss of grip strength. The good news is that so far it hasn’t done much to impact my day-to-day life. I can ride my motorcycle all day (though I do wear anti-vibration gloves, which do help a bit). I can do all the gardening I have ever done (though lifting cactus pots by carefully gripping the plastic pot between my left thumb and forefinger is not happening). I can type on my iPad all day long (though my left hand shift functionality with my pinky is pretty lame). So, there’s very little beyond some minor annoyance in gripping things in my left hand that is plaguing me. But loss of any physical capability is always worthy of some investigation, so I booked an appointment with a neurologist for a nerve conduction study (NCS) combined with electromyography (EMG), the two done together as one appointment.
The nerve conduction study is about placing small electrodes taped to your skin and delivering brief, mild electrical pulses across a specific nerve. It measures how fast and how strongly signals travel along the nerve. It feels like a quick static-shock or muscle twitch. It’s only mildly uncomfortable and brief, so not painful in any lasting way. The EMG is done with a thin needle electrode, inserted directly into specific muscles along your arms and hand. You’re asked to relax, then gently contract the muscle to get the readings. It records electrical activity to see if muscle and nerve communication is normal. There is a brief pinch on insertion of the needle and then some mild soreness possible after, especially because they’re testing forearm/hand muscles, which are pretty sensitive (one hopes). Together the NCS and EMG distinguish between nerve compression (like at the elbow/wrist or cervical spine), peripheral neuropathy (at the fingertips), and general muscle-level problems. It’s exactly the kind of workup that is necessary for sorting out whether my thumb weakness and hand symptoms are coming from the cervical spine, a specific nerve entrapment, or something more diffuse. The whole procedure took 60 minutes. They say that results are often available same-day from the neurologist doing the test, but my guy wanted more time to study the output.
During the exam, the neurologist asked me to take off my left shoe and sock so he could run a few test extensions. There are a few clinical reasons a neurologist extends EMG/NCS testing to a foot when your main complaints are in the hand. He’s usually trying to rule out generalized peripheral neuropathy. Many neuropathies (diabetic, toxic, idiopathic, vitamin-deficiency related) are length-dependent, they hit the longest nerves first, so the feet show changes before or alongside the hands. Testing a lower extremity helps distinguish a focal problem (cervical radiculopathy, single nerve entrapment) from a broader systemic process. It also establishes a baseline. Foot/leg nerves are commonly unaffected by carpal tunnel, ulnar entrapment, or cervical issues, so they serve as a built-in “normal” reference to compare against the abnormal findings in the hand. He only checked the left foot, so it seems it was a standard screening protocol. If the foot comes back completely normal, that strengthens the case that your symptoms are localized like a cervical spine, thoracic outlet, or a specific compression point rather than a body-wide nerve issue. If the foot also shows abnormalities, that points more toward something systemic. I’ve known for ten years (I had some of these tests done at NYU years ago) that I have some foot neuropathy, so I felt like telling the guy not to bother and that he would find some lower leg nerve damage.
When the test ended I asked the neurologist about the results. He said he needed to consider all the data and would talk to me about it on my return in a few weeks. I pressed him for a preliminary diagnosis and he told me that he suspected a genetic neuropathy. Genetic neuropathy (hereditary neuropathy) is nerve damage caused by inherited gene mutations rather than injury, disease, or toxins. It affects the peripheral nerves — the ones running from your spine out to your hands, feet, and skin. The common symptoms are numbness, tingling, weakness, foot deformities (high arches, hammertoes), muscle wasting in lower legs/hands. Unfortunately that sounds too familiar. Genetic neuropathies usually affect sensory and/or motor nerves, sometimes both. They are often symmetric (both feet, or both hands) and slowly progressive (the key will be HOW slowly)…it is very rare that they present only as late as age 72. I know I had very mild signs from the NYU work in my early 60’s, but progression since then has been imperceptible until just this recent left hand issue. He has told me that if he concludes it is genetic, the full diagnosis will require perhaps family history and genetic testing. I’ve spoken to my sisters and there seems to be no family history of any sort that we can see. Perhaps a genetic test can tell me more.
The prognosis varies hugely depending on the type and genetics, but here’s the general picture: CMT is the most common form and it usually has slow progression over decades. There is no impact on life expectancy and the severity ranges from mild (barely noticeable) to severe (though that’s usually when it starts in middle age). Progressive weakness and sensory loss are the main concerns. Gene therapies and antisense oligonucleotides are emerging for some types of CMT, which could significantly change outcomes going forward. If it’s truly genetic and just appearing now it could be a late-onset form or a mutation with reduced penetrance that’s finally expressing. My mother lived to 100 and had no nerve damage, even later in life. If its not genetic, then it could be something like a B12 deficiency (I take B-12 daily). The bottom line is that at age 72, whether it’s genetic or acquired, the focus shifts to symptom management like good foot care, fall prevention, and maintaining functionality in my hand fine motor skills.
I will pay attention to this this time, unlike ten years ago when I ignored it. I guess I figure that since I’m healthier than I’ve been in fifty years, it’s worthwhile to keep that going. They can poke and prod me all they need to because I’m not letting any of it rattle me…only my nerves…in my hands.