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Muscle weakness and atrophy

Bassam Bassam12/13/19 2:23 PM (CST)

I saw a 64 year old male for suspected ALS. Among others, his neurological examination and needle EMG were noted for more atrophy and denervation of the abductor pollicis brevis (APB) and first dorsal interosseous (FDI) muscle more than the rest of the hand muscles. I know this has been named split-hand syndrome by the late Asa Wilborun, MD. I wonder if this is specific to ALS, and if so what is the mechanism or explanation for this phenomenon?. Is it that we use these two muscles more often than other hand muscles, more metabolic demand or is it something related to innervation ratio or type?

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