Misdiagnosis in Amyotrophic Lateral Sclerosis

Area of Science:

• Neurology
• Neurosurgery
• Orthopedic Surgery

Background:

• Amyotrophic lateral sclerosis (ALS) symptoms can initially resemble compressive neuropathies like carpal tunnel syndrome.
• Hand surgeons are often the first specialists to encounter patients with undiagnosed ALS.
• Nerve decompression surgery for ALS patients leads to poor outcomes.

Purpose of the Study:

• To assess the frequency of nerve decompression surgeries performed on patients later diagnosed with ALS.
• To highlight the importance of recognizing ALS red flags in hand surgery patients.
• To guide hand surgeons in differentiating ALS from compressive neuropathies.

Main Methods:

• A survey was distributed to members of the American Society for Surgery of the Hand.
• The survey inquired about nerve decompression surgeries performed on patients subsequently diagnosed with ALS.

Main Results:

• 11% of surveyed hand surgeons reported performing nerve decompression on patients later diagnosed with ALS.
• Key "red flag" symptoms include non-sensory weakness, widespread atrophy, progressive bilateral symptoms, and bulbar signs.
• Failure to improve after surgery is a critical indicator.

Conclusions:

• Hand surgeons must be aware of ALS presentation to avoid misdiagnosis and unnecessary procedures.
• Prompt neurodiagnostic testing and neurology referral are recommended for suspected ALS cases.
• Early identification of ALS prevents surgical morbidity and ensures timely treatment.