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Updated: Jun 24, 2025

Utility of Dissociated Intrinsic Hand Muscle Atrophy in the Diagnosis of Amyotrophic Lateral Sclerosis
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Clinical Reasoning: A 55-Year-Old Woman With Painless Hand Weakness and Atrophy

Hemani Ticku1, Bashar Katirji1

  • 1From the Neurological Institute (H.T., B.K.), University Hospitals, Cleveland Medical Center; and Department of Neurology (H.T., B.K.), Case Western Reserve University School of Medicine, Cleveland, OH.

Neurology
|June 4, 2024
PubMed

Hand weakness is a frequent chief concern in neurology practice. We report a case of a 55-year-old woman presenting with a chronic, gradually worsening right hand weakness and atrophy, selectively affecting the thenar muscles, without any sensory symptoms. She had a history of carpal tunnel syndrome and previously underwent surgical carpal tunnel release. This case delves into the differential diagnosis of hand weakness and atrophy, emphasizing the significance of myotomal innervation in intrinsic hand muscles. Furthermore, it outlines a systematic approach to diagnosing an uncommon cause for a common clinical presentation, offering a comprehensive differential diagnosis, and exploring various possible causes.

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