Useless hand syndrome: Diagnostic role of electromyography and nerve conduction studies.

BACKGROUND

Useless hand syndrome (UHS) refers to clumsiness of complex finger movements and loss of manual dexterity due to cervical cord lesions, often associated with multiple sclerosis (MS). This condition may represent the first demyelinating event in MS or may occur in a patient with pre-existing MS.

METHODS

We report 3 patients with UHS, 2 of whom had not been previously diagnosed with MS. The history and physical examinations, EMG/NCV studies of the arms, and radiological findings are presented.

RESULTS

Presenting symptoms in all 3 cases included paresthesia and difficulty with manual dexterity which led the family physician to refer these patients to a hand surgeon. Pre-EMG neurological examination detected myriad abnormalities such as loss of position sense, two-point discrimination, stereognosis, graphesthesia, and difficulty performing rapid alternating movements. EMG/NCV findings were normal in 2 cases and, in the third case, showed abnormalities which did not explain the clinical picture and pointed to involvement of the central somatosensory pathways. Cervical MRIs revealed demyelinating lesions in all patients.

CONCLUSION

Patients with acute onset of sensory disturbance and clumsy hands are often first referred for EMG/NCV studies. Absence of significant abnormalities may suggest central somatosensory pathway dysfunction and should alert to the possibility of UHS and underlying MS.