Misdiagnosis in Amyotrophic Lateral Sclerosis

Misdiagnosis in Amyotrophic Lateral Sclerosis

The symptoms of amyotrophic lateral sclerosis (ALS) can mimic those of compressive neuropathies, such as carpal and cubital tunnel syndromes, especially early in a patient’s clinical course. We surveyed members of the American Society for Surgery of the Hand and found that 11% of active and retired...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of hand surgery (American ed.) Vol. 48; no. 8; pp. 822 - 826
Main Authors: Thomson, Cameron G., Hutchinson, Paul R., Stern, Peter J.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-08-2023
Subjects:
ALS
amyotrophic lateral sclerosis
carpal tunnel syndrome
compressive neuropathy
misdiagnosis
ALS
carpal tunnel syndrome
compressive neuropathy
amyotrophic lateral sclerosis
misdiagnosis
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The symptoms of amyotrophic lateral sclerosis (ALS) can mimic those of compressive neuropathies, such as carpal and cubital tunnel syndromes, especially early in a patient’s clinical course. We surveyed members of the American Society for Surgery of the Hand and found that 11% of active and retired members have performed nerve decompression surgeries on patients later diagnosed with ALS. Hand surgeons are commonly the first providers to evaluate patients with undiagnosed ALS. As such, it is important to be aware of the history, signs, and symptoms of ALS to provide an accurate diagnosis and prevent unnecessary morbidities, such as nerve decompression surgery, which invariably results in poor outcomes. The major “red flag” symptoms warranting further work-up include weakness without sensory symptoms, profound weakness and atrophy in multiple nerve distributions, progressively bilateral and global symptoms, presence of bulbar symptoms (such as tongue fasciculations and speech/swallowing difficulties), and, if surgery is performed, failure to improve. If any of these red flags are present, we recommend neurodiagnostic testing and prompt referral to a neurologist for further work-up and treatment.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
content type line 23
ObjectType-Review-1
ISSN:0363-5023
1531-6564
DOI:10.1016/j.jhsa.2023.03.023